TY - JOUR
T1 - Chemoradiation for muscle-invasive bladder cancer using 5-fluorouracil versus capecitabine
T2 - A nationwide cohort study
AU - de Haar-Holleman, Amy
AU - van Hoogstraten, Lisa M. C.
AU - Hulshof, Maarten C. C. M.
AU - Tascilar, Metin
AU - Brück, Katharina
AU - Meijer, Richard P.
AU - Alfred Witjes, J.
AU - BlaZIB Study Group
AU - Kiemeney, Lambertus A.
AU - Aben, Katja K. H.
N1 - Funding Information: The BlaZIB study is funded by the Dutch Cancer Society (KWF; IKNL 2015–7914). The funding agency had no further role in this study. Funding Information: The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry. The members of the BlaZIB study group are: Katja K.H. Aben, PhD (PI, Netherlands Comprehensive Cancer Organisation). Lambertus A. Kiemeney, PhD, Prof (PI, Radboud University Medical Centre). J. Alfred Witjes, MD, PhD, Prof (PI, Radboud University Medical Centre). Lisa M.C. van Hoogstraten, MSc (project coordinator, Netherlands Comprehensive Cancer Organisation). Theodora M. Ripping, PhD (researcher, Netherlands Comprehensive Cancer Organisation). Joost Boormans, MD, PhD (Erasmus Medical Centre). Catharina A. Goossens-Laan, MD, PhD (Alrijne Hospital). Antoine G. van der Heijden, MD, PhD (Radboud University Medical Centre). Michiel S. van der Heijden, MD, PhD (Netherlands Cancer Institute). Sipke Helder (Patient association ‘Leven met blaas- of nierkanker’). Tom J.N. Hermans, MD, PhD (VieCuri Medical Centre). Maarten C.C.M. Hulshof, MD, PhD (Amsterdam University Medical Centres, location AMC). Anna M. Leliveld, MD, PhD (University Medical Centre Groningen). Geert J.L.H. van Leenders, MD, PhD (Erasmus Medical Centre). Richard P. Meijer, MD, PhD, FEBU (University Medical Centre Utrecht). Reindert J.A. van Moorselaar, MD, PhD, Prof (Amsterdam University Medical Centres, location VUmc). Sasja F. Mulder, MD, PhD (Radboud University Medical Centre). Juus L. Noteboom, MD, PhD (University Medical Centre Utrecht). Jorg R. Oddens, MD, PhD (Amsterdam University Medical Centres, location AMC). Theo M. de Reijke, MD, PhD (Amsterdam University Medical Centres, location University of Amsterdam, department of Urology). Bas W.G. van Rhijn, MD, PhD, FEBU (Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital). Joep G.H. van Roermund, MD, PhD (Maastricht University Medical Centre). Tineke J. Smilde, MD, PhD (Jeroen Bosch Hospital). Guus W.J. Venderbosch (Patient association ‘Leven met blaas- of nierkanker’). Bart P. Wijsman, MD, PhD (Elisabeth-TweeSteden Ziekenhuis). Publisher Copyright: © 2023 The Authors
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Background and purpose: Oral capecitabine and intravenous 5-fluorouracil (5-FU) are both used as a radiosensitizer in chemoradiotherapy (CRT). A capecitabine-based regimen is more convenient for both patients and healthcare professionals. Since large comparative studies are lacking, we compared toxicity, overall survival (OS) and disease-free survival (DFS) between both CRT-regimens in patients with muscle-invasive bladder cancer (MIBC). Materials and methods: All patients diagnosed with non-metastatic MIBC between November 2017-November 2019 were consecutively included in the BlaZIB study. Data on patient, tumor, treatment characteristics and toxicity were prospectively collected from the medical files. From this cohort, all patients with cT2-4aN0-2/xM0/x, treated with capecitabine or 5-FU-based CRT were included in the current study. Toxicity in both groups was compared using Fisher-exact tests. Propensity score-based inverse probability treatment weighting (IPTW) was applied to correct for baseline differences between groups. IPTW-adjusted Kaplan-Meier OS and DFS curves were compared using log-rank tests. Results: Of the 222 included patients, 111 (50%) were treated with 5-FU and 111 (50%) with capecitabine. Curative CRT was completed according to treatment plan in 77% of patients in the capecitabine-based group and 62% of the 5-FU group (p = 0.06). Adverse events (14 vs 21%, p = 0.29), 2-year OS (73% vs 61%, p = 0.07) and 2-year DFS (56% vs 50%, p = 0.50) did not differ significantly between groups. Conclusions: Chemoradiotherapy with capecitabine and MMC is associated with a similar toxicity profile compared to 5-FU plus MMC and no difference in survival was found. Capecitabine-based CRT, as a more patient-friendly schedule, may be considered as an alternative to a 5-FU-based regimen.
AB - Background and purpose: Oral capecitabine and intravenous 5-fluorouracil (5-FU) are both used as a radiosensitizer in chemoradiotherapy (CRT). A capecitabine-based regimen is more convenient for both patients and healthcare professionals. Since large comparative studies are lacking, we compared toxicity, overall survival (OS) and disease-free survival (DFS) between both CRT-regimens in patients with muscle-invasive bladder cancer (MIBC). Materials and methods: All patients diagnosed with non-metastatic MIBC between November 2017-November 2019 were consecutively included in the BlaZIB study. Data on patient, tumor, treatment characteristics and toxicity were prospectively collected from the medical files. From this cohort, all patients with cT2-4aN0-2/xM0/x, treated with capecitabine or 5-FU-based CRT were included in the current study. Toxicity in both groups was compared using Fisher-exact tests. Propensity score-based inverse probability treatment weighting (IPTW) was applied to correct for baseline differences between groups. IPTW-adjusted Kaplan-Meier OS and DFS curves were compared using log-rank tests. Results: Of the 222 included patients, 111 (50%) were treated with 5-FU and 111 (50%) with capecitabine. Curative CRT was completed according to treatment plan in 77% of patients in the capecitabine-based group and 62% of the 5-FU group (p = 0.06). Adverse events (14 vs 21%, p = 0.29), 2-year OS (73% vs 61%, p = 0.07) and 2-year DFS (56% vs 50%, p = 0.50) did not differ significantly between groups. Conclusions: Chemoradiotherapy with capecitabine and MMC is associated with a similar toxicity profile compared to 5-FU plus MMC and no difference in survival was found. Capecitabine-based CRT, as a more patient-friendly schedule, may be considered as an alternative to a 5-FU-based regimen.
KW - 5-Fluorouracil
KW - Bladder cancer
KW - Capecitabine
KW - Chemoradiotherapy
KW - Drug toxicity
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85152058185&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.radonc.2023.109584
DO - https://doi.org/10.1016/j.radonc.2023.109584
M3 - Article
C2 - 36863459
SN - 0167-8140
VL - 183
JO - Radiotherapy and oncology
JF - Radiotherapy and oncology
M1 - 109584
ER -