Hundreds of patients with advanced bladder cancer in the UK will now have the option to receive three cycles of chemotherapy instead of six, following new research from Queen Mary University of London. The findings have prompted the NHS to update its treatment guidelines, potentially reducing side effects and improving quality of life for those undergoing care.
Previously, standard NHS treatment involved four to six cycles of intensive chemotherapy followed by avelumab immunotherapy. While this approach has been effective, it often leads to severe side effects such as fatigue, nausea, infections, and long-term impacts on daily living.
The DISCUS trial—a randomized phase II study led by international investigators—was published in Annals of Oncology. It examined whether reducing the number of chemotherapy cycles would allow patients to live just as long as those receiving the current standard while experiencing fewer side effects.
The trial included 267 participants with advanced bladder cancer. They were assigned either three or six cycles of chemotherapy before starting avelumab maintenance therapy. Results showed that halving the number of chemotherapy cycles did not significantly compromise disease control but did reduce unnecessary side effects.
As a result, NHS guidelines now offer eligible patients a choice between three and six cycles of chemotherapy followed by maintenance avelumab. This change is expected to benefit hundreds each year by making treatment more tolerable without sacrificing effectiveness.
Lead author Thomas Powles, Professor of Genitourinary Oncology at Queen Mary University of London and Director at Barts Cancer Centre, Barts Health NHS Trust stated: "Fewer cycles of chemotherapy appear to improve quality of life without significantly compromising activity. This is particularly attractive for those patients who struggle with side effects."
Syed A Hussain, Professor of Medical Oncology and Honorary Consultant at University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust added: "This update to NHS England guidance has the potential to benefit a significant proportion of patients, particularly those who discontinue chemotherapy after three cycles because of treatment-related toxicity."
"It is exciting to see that the DISCUS results have helped to change NHS England guidelines and patients can now be offered maintenance Avelumab treatment after three cycles of platinum-based chemotherapy."
