Targeting chemotherapy to advanced bladder cancer patients most likely to benefit.

Evaluation of: Vickers AJ, Cronin AM, Kattan MW et al.; The International Bladder Cancer Nomogram Consortium: Clinical benefits of a multivariate prediction model for bladder cancer: a decision analytic approach. Cancer 115(23), 5460-5469 (2009). The prognosis from muscle-invasive bladder cancer is poor. Improvements in survival can be made with the use of chemotherapy. The best results are obtained using multiagent regimens, which increase cure rates by approximately 5%. Thus, few patients benefit when compared with treatment morbidity. This low complete response rate makes powering of clinical trials difficult and may prevent them determining which patients benefit most from chemotherapy. Here, we discuss work by Vickers et al. reporting a decision-based analysis using a nomogram to determine the benefit for individual patients from chemotherapy. This decision aid can reduce the number of patients treated by 0.006, without compromising recurrence. The authors conclude that a nomogram-derived 25% risk threshold produced better targeting of chemotherapy than the current standard criteria (mostly using pathological stage).