Category: Survival

Bladder cancer: Are 3 cycles of chemotherapy as good as 6 cycles – when combined with immunotherapy maintenance?

Yes; 3 is as good as 6.

The annual congress of European Society for Medical Oncology is currently underway at Berlin. Lot of exciting studies are being presented.

One of the interesting studies relate to bladder cancer. The bladder study looked at the optimum number of chemotherapy cycles that needs to be given.

Chemotherapy do cause significantly more side effects the immunotherapy. If fewer cycles are given, treatment might be more tolerable.

This bladder trial looked at giving only 3 cycles of chemotherapy compared to the standard 6 cycles.

The study found that fewer cycles improved quality of life without compromising overall benefits from the treatment

Reference

Grande E, et al. DISCUS: A phase II study comparing 3 vs 6 cycles of platinum-based chemotherapy prior to maintenance avelumab in advanced urothelial cancer. ESMO Congress 2025 – LBA 109

ESMO daily reporter. Is less more for patients with genitourinary cancers? 17 Oct 2025 Christoph Oing

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information research only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options, which are relevant and specific to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Is it useful to monitor for cancer recurrence after treatment for bowel cancer ?

No; unfortunately routine tests not useful to prolong life.

Logic dictates that early detection of bowel cancer recurrence would lead to prompt treatment and prolong life.

But cancer doesn’t do logic !

A large trial looked at usefulness of routine blood tests and scans for early diagnosis of cancer recurrence in bowel cancer patients.

The trial found that blood tests and scans were useful to diagnose recurrence early; but this early detection of recurrence ultimately did NOT improve life expectancy.

The study used tumour markers in blood [carcinoembryonic antigen CEA ] and Scans [computed tomography CT-scans] during the 5 years after surgery for bowel cancer.

Extra scans and bloods are NOT always useful.

References

  1. ESMO CEA and/or CT-scan Surveillance After Curative Surgery for Patients with Stage II or III CRC Does Not Provide Any Benefit in 5-year OS.
  2. Lepage C, Phelip J-M, Cany L, et al. for PRODIGE 13 investigators/Collaborators. Effect of 5 years of CT-scan and CEA follow-up on survival endpoints in patients with colorectal cancer . Annals of Oncology; Published online 17 September 2025. DOI: https://doi.org/10.1016/j.annonc.2025.09.004

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information research only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options, which are relevant and specific to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Is radiotherapy to prostate useful even after the cancer has escaped from prostate?

Yes, it can be helpful but only in certain circumstances.

Former US President Biden is in the news this week and multiple media outlets reports that Biden is having  radiation therapy to prostate along with hormone therapy.

The news outlets also indicate that Biden has aggressive prostate cancer which has spread to the bones.

Any spread of prostate cancer to bones is classified as stage 4 prostate cancer.

If cancer has NOT spread outside the prostate, the combination of radiation and hormones could be curative .

But, with stage 4 prostate cancer, radiation is generally not curative. This is because once the cancer cells have spread, it is extremely difficult to eradicate those cancer cells permanently. 

A large UK trial ( STAMPEDE trials) found that “Radiotherapy to the prostate did NOT improve overall survival for unselected patients with newly diagnosed metastatic prostate cancer”

So if radiation does not improve survival, why did the oncologists offer radiation therapy to Biden?

Full medical details are not available and so it is difficult to give a definitive answer in Biden’s case.

There are few possibilities.

In the above mentioned STAMPEDE trial , in a smaller select group of patients, Radiation therapy did improve overall survival in men with a low metastatic burden. ( ie fewer cells have spread).

One can only speculate whether that’s been the case with regards to Mr Biden.

References

  1. CNN. Biden starts radiation therapy for aggressive form of prostate cancer. By Kevin Liptak, Fadel Allassa. UPDATED OCT 11, 2025, 11:28 AM PUBLISHED OCT 11, 2025, 10:01 AM
  2. BBC news. Biden receiving radiation therapy for prostate cancer. By Jaroslav Lukiv. Published 11 October 2025.
  3. Lancet. Stampede trial. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial.

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information research only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options, which are relevant and specific to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Is radiotherapy needed for all lymphoma patients after completing a course of chemotherapy?

In previous decades, radiotherapy was routinely used to consolidate remission after completion of chemotherapy in Lymphoma patients.

Chemotherapy alone can cure a lot of these patients. Radiotherapy can be associated with long term side effects even 10 years after completion of treatment.

So increasingly there is a tendency to omit radiotherapy in those lymphoma patients who had responded extremely well to chemotherapy alone.

Long term trial results, in a group of lymphoma patients who had mediastinal (chest) lymphoma, confirms that radiotherapy can be safely omitted in those patients who had excellent response to chemotherapy alone.

Reference

Omission of Radiotherapy in Primary Mediastinal B-Cell Lymphoma: IELSG37 Trial Results | Journal of Clinical Oncology

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

A new blood test for cancer

Cancer cells can float in a person’s blood. But finding them, in the past, used to be like “looking for a needle in a haystack”.

But new smart technology promises to detect these cancer cells easily and much early before a person develops symptoms. Detection of cancer cells at an early stage may be helpful for some patients.

A recently published study in the journal “Annals of Oncology” reports exciting results.

A Californian company called Grail has developed a blood test which seems to have a high degree of accuracy for detection of multiple cancers.

Times newspaper reports that “The NHS will begin a pilot scheme of the test with 140,000 people this year. If that is successful it will be used for millions of patients by 2025”

A word of caution though.

Just because something could be diagnosed early does not always mean that it is a good thing.

The most important thing is whether the early diagnosis can lead to better cure rates and a better quality of life.

If a test detects a cancer early but has no meaningful effect on quantity or quality of life, then it is not a good thing.

For example. Up to 80% of men have prostate cancer which can now be detected by a simple blood test called PSA. There is a good reason why we are NOT using the simple PSA test in every 80 year old.

Most 80 year old men die WITH prostate cancer rather than DUE to prostate cancer.

So why diagnose a cancer that is not causing symptoms if it is not going to make person live longer !

REFERENCES

Times. New blood test, created by Californian company Grail, detects cancers among over-50s. Kat Lay, Health Editor. Friday June 25 2021, 12.01am, The Times.

Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. E A Klein et al. Ann Oncol. 2021.

Guardian. Blood test that finds 50 types of cancer is accurate enough to be rolled out.
Diagnostic tool being piloted by NHS England shows ‘impressive results’ in spotting tumours in early stages
Blood tests’ development could help the NHS further.
Nadeem Badshah and agency
Fri 25 Jun 2021 06.00 BST

Daily Mail. NHS trials ‘holy grail’ blood test that can spot 50 kinds of cancer: Ground-breaking check that can accurately detect two thirds of deadly cancers early in healthy people could save thousands of lives a year. By Victoria Allen Science Correspondent For The Daily Mail
00:00, 25 Jun 2021 , updated 10:04, 25 Jun 2021

NHS. Should I have a PSA test?

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Should chemotherapy be used before radiotherpy for bladder cancer?

Yes, chemotherapy given before surgery or radiotherapy for invasive bladder cancer improves cure rates and survival rates.

But there is also strong U.K. data to show that Chemotherapy given along with Radiotherapy is useful because it makes radiotherapy work better .

Should chemotherapy be given before radiotherapy and then followed by more chemotherapy along with radiotherapy ?

There is lot of scientific debate on this question and well known U.K. experts are favouring this “double chemo” approach in-spite of inconclusive new data published in the European Urology journal.

The NICE guidelines on bladder cancer also favours this approach of “double” chemotherapy ( before as well as along radiotherapy).

It is a question that ideally needs to addressed in clinical trials .

Read my views expressed in a letter published in the Journal European Urology

Reference: Re: Syed A. Hussain,
Nuria Porta, Emma Hall, et al. Outcomes in Patients with Muscle-invasive Bladder Cancer Treated with Neoadjuvant Chemotherapy
Followed by (Chemo)radiotherapy in the BC2001 Trial. Eur Urol 2021;79:307–15

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.