Bladder cancer patients over 80 have lower cancer-free survival rate.
Advanced age is associated with a diminished response to intravesical therapy for superficial bladder cancer, a study found.
Fadi N. Joudi, MD, assistant professor of urology at the University of Iowa in Iowa City, and his colleagues studied 1,008 patients involved in a national multicenter phase II trial of bacillus Calmette-Guérin (BCG) plus interferon alpha-2b intravesical therapy for superficial bladder cancer.
For patients previously treated with BCG, response rates were 47% for those younger than 50 years, 50% for those aged 51-60 years, 55% for those aged 61-70, 42% for those aged 71-80, and 32% for patients older than 80. Among BCG-naïve patients, those younger than 50 had
a 45% response rate. Patients in the age groups 51-60, 61-70, 71-80, and those older than 80 had response rates of 66%, 65%, 56%, and 47%, respectively. The largest difference in cancer-free survival for all patients (BCG naïve and BCG treated) at 24 months was between those aged 61-70 and those older than 80 years: 61% vs. 39%, respectively. Those over 80 were 74% less likely to respond than patients 61-70 years of age.
“If elderly patients with bladder cancer do not respond to intravesical immunotherapy perhaps other treatment modalities like intravesical chemotherapy should be explored,” Dr. Joudi said at the American Urological Association annual meeting in Atlanta. “We recommended that further studies are needed to confirm these findings.”
The investigators do not know why patients younger than 50 had a relatively poor response, but noted that the number of patients was small. “The only explanation is that there must be some other factor that we did not account for,” Dr. Joudi said, adding that it could be related to the individual’s cancer biology.
Very elderly patients may have a decreased response to intravesical immunotherapy, perhaps due to depressed baseline immune status. This would cause an inability to mount an immune reaction to BCG or interferon.