Hundreds of patients with advanced bladder cancer will now receive just three cycles of chemotherapy instead of six, after major research involving Sheffield changed NHS treatment guidelines.
The update follows results from the international DISCUS trial, published in Annals of Oncology, which found that fewer cycles of chemotherapy can deliver the same survival outcomes while significantly improving patients’ quality of life. For many, it means less time enduring the toxic side effects that often accompany intensive treatment – and more time feeling like themselves.
Rethinking the standard of care
Until now, standard NHS treatment for advanced bladder cancer involved four to six cycles of platinum-based chemotherapy. While effective at controlling the disease, the treatment can be gruelling. Patients frequently experience extreme fatigue, nausea, infections and longer-term impacts on daily life.
The phase II DISCUS trial, led by Queen Mary University of London, asked a simple but important question: could patients safely receive less chemotherapy without compromising survival?
The study enrolled 267 patients across the UK, Spain and France. Participants were randomly assigned to receive either:
- Three cycles of chemotherapy followed by maintenance immunotherapy (avelumab), or
- The previous standard of six chemotherapy cycles.
The findings were clear:
- Overall survival was the same in both groups.
- Patients receiving three cycles maintained their quality of life, while those receiving six reported a decline.
- Severe side effects were less common in the shorter treatment group.
As a result, NHS England has updated its guidelines. Eligible patients can now choose between three or six cycles of chemotherapy before moving to maintenance avelumab.
For many, that choice will mean halving the most difficult part of treatment without reducing its effectiveness.
Sheffield’s leading role
Sheffield Teaching Hospitals NHS Foundation Trust was the top recruiter to the multinational study, playing a central role in delivering the research.
Lead author Professor Thomas Powles, Professor of Genitourinary Oncology at Queen Mary University of London and Director of Barts Cancer Centre, said:
“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.”
Professor Syed A Hussain, Honorary Consultant and Professor of Medical Oncology at Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield, 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.”
Cynthia’s story
For Cynthia Haywood, 79, from Bakewell, the trial has been life changing.
Diagnosed with advanced bladder cancer two years ago, she was told she might only have nine to twelve months to live.
After surgery, she was referred to Weston Park Cancer Centre, where Professor Hussain discussed the DISCUS trial with her.
“I had been diagnosed with quite an advanced bladder cancer so it was a little bit scary so at that stage I felt like I should grab anything to help.”
Cynthia was initially allocated to the six-cycle chemotherapy group. But during her fourth cycle, she developed what she described as a “horrible rash” – a severe allergic reaction that required hospital treatment. Doctors decided it was no longer safe for her to continue chemotherapy and moved her onto maintenance avelumab instead.
“I started on the immunotherapy two years ago in April and I’ve been great on that. I’ve not felt ill and I feel my usual self on it,” Cynthia said.
“When I was on the chemo, I felt quite weary and was wanting to get into bed but now my energy levels are normal and I can lead a normal sort of life and go out and do something every day.”
Now approaching her 80th birthday, Cynthia visits Weston Park every fortnight for treatment. Her scans show the cancer has not progressed.
“I’ve been extremely lucky to be on the trial. It’s certainly improved my standard of life. The cancer’s still there but it’s not got worse over the last few scans so that’s the main thing. I can’t praise the team at Weston Park Cancer Centre enough for their constant care and support. Without the trial I would not be here now. If it has helped others too, that’s a nice feeling as well.”
A shift with national impact
By reducing chemotherapy exposure without compromising survival, the DISCUS findings are expected to benefit hundreds of patients each year across the UK.
For advanced bladder cancer patients, it represents a meaningful shift: fewer cycles, fewer severe side effects – and more life lived between hospital visits.
