The influence of retinoic acid receptor (RAR) status of bladder tumours on the course of the disease.

Retinoids influence bladder tumour development in animals and tumour recurrence in man. Some human tumours contain intracellular receptor proteins for retinoids. The effect of the presence of such retinoic acid receptors (RAR) on tumour response to conventional therapy has been studied in 59 patients. Thirty-two of 36 RAR+ve and 11 of 23 RAR-ve tumour patients were alive after a mean follow-up period of 2.6 years. Higher stage and grade were more commonly associated with RAR-ve tumours. Independent of stage, recurrence was more common in RAR-ve tumours. These studies suggest that RAR-ve tumours are more likely to recur and more likely to become invasive. However, further studies are required to determine the clinical value of RAR receptor status as a prognostic indicator.

Cis-diamminedichloroplatinum (DDP) as initial treatment of invasive bladder cancer.

Cis-diamminedichloroplatinum (DDP) was used as the initial treatment in a pilot study of 17 patients with biopsy-proven transitional cell carcinoma of the bladder. No patient had received any previous radiotherapy or chemotherapy. The clinical stages of the tumours were T2 (2 patients), T3 (13) and T4 (2). Before treatment the tumours were assessed by cystoscopy, biopsy, examination under anaesthesia (EUA), computed axial tomography (CT scan) and ultrasound. DDP was given at a dose of 100 mg/m2 intravenously with hydration using mannitol and saline. Each patient received three treatments at 3-weekly intervals. Twelve days after the third treatment, response was assessed by cystoscopy, biopsy, EUA, CT scan and ultrasound. Eleven of the 17 patients had a partial response. Survival was significantly increased in responders compared with non-responders. Seven patients had a low creatine clearance following treatment, 5 had audiograms showing evidence of ototoxicity and 2 developed leucopenia during treatment. This study confirmed the activity of DDP in bladder cancer and showed that it was active in producing a response in the primary tumour in 11 of 17 patients.