Hundreds of people with advanced bladder cancer across the UK can now receive three rather than six chemotherapy cycles following research by Queen Mary University of London which has led to a change to NHS treatment guidelines. For people with the condition, this means fewer toxic side effects and a better quality of life during treatment.
Until recently, people with advanced bladder cancer routinely received between four to six cycles of intensive chemotherapy, followed by avelumab, a type of immunotherapy, as standard NHS care. While effective, this treatment can often cause severe side effects, including extreme fatigue, nausea, infections and long-term impacts on daily life.
The international, investigator -led, randomised phase II DISCUS trial, published today in Annals of Oncology, sought to find out if giving patients fewer rounds of chemotherapy could help them survive just as long as current standard care, while causing fewer side effects and making treatment easier to cope with.
The study included 267 people with advanced bladder cancer. Participants were allocated to receive either three cycles of chemotherapy, or the previous standard of six chemotherapy cycles, followed by avelumab. The study found that:
those who received three-cycles of chemotherapy reported their quality of life remained the same, while those in the six-cycle group reported a poorer quality of life.
the median overall survival was the same for those undergoing three cycles and those undergoing six cycles.
severe side effects were less common in those who received fewer cycles of chemotherapy.
As a result of this research, NHS guidelines have been updated, offering eligible patients a choice between three and six cycles of chemotherapy followed by maintenance avelumab. By halving the number of chemotherapy cycles, treatment and quality of life is expected to improve for hundreds of patients each year, reducing unnecessary side effects while maintaining the chance of controlling the disease.
Lead author Thomas Powles, Professor of Genitourinary Oncology at Queen Mary University of London and Director of the Barts Cancer Centre at Barts Health NHS Trust, 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.”
Second author, Syed A Hussain, Professor of Medical Oncology and Honorary consultant, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust said: “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.”
Annals of Oncology
Randomized controlled/clinical trial
People
Three versus six cycles of platinum-based chemotherapy followed by avelumab maintenance as first-line treatment for advanced urothelial cancer: the phase II DISCUS trial.
12-Feb-2026
TP reports grants or contracts from AstraZeneca, Roche, Bristol-Myers Squibb, Exelixis, Ipsen, MSD, Novartis, Pfizer, Seattle Genetics, Merck Serono, Astellas, Johnson & Johnson, and Eisai; consulting fees and honoraria from AstraZeneca, Bristol-Myers Squibb, Exelixis, Incyte, Ipsen, MSD, Novartis, Pfizer, Seattle Genetics, Merck Serono, Astellas, Johnson & Johnson, Eisai, Roche, Mashup, and Gilead Sciences; support for attending meetings and/or travel from Roche, Pfizer, MSD, AstraZeneca, Ipsen, Gilead Sciences, Astellas, and MSD; participation on a data safety monitoring board or advisory board for AstraZeneca, Roche, Bristol-Myers Squibb, Exelixis, Ipsen, MSD, Novartis, Pfizer, Seattle Genetics, Merck Serono, Astellas, Johnson & Johnson, and Eisai; and other financial interests from Novartis, Pfizer, AstraZeneca, Roche/Genentech, Eisai, and Merck. SAH has received research funding from CR UK, MRC/NIHR, UHB charities, CCC charities, North West Cancer Research, Yorkshire Cancer Research, Weston Park Cancer Charity, Bayer, Janssen, Boehringer Ingelheim, Eli Lilly, Roche; participated on advisory board or consultancy for Roche, MSD, AstraZeneca, BMS, Janssen, GSK, Astellas, Pfizer, Merck, Gilead, Boehringer Ingelheim. MAC has received speaker fees from AstraZeneca and BMS; has attended advisory boards for Astellas and MSD; has received speaker fees and attended an advisory board for Merck; and has received a grant from Janssen. IGC received honoraria as a speaker from Ipsen, and honoraria for travel and accommodation expenses from Ipsen. JMC declares consultant, advisory, or speaker roles for Ipsen, Roche, Pfizer, Sanofi, Janssen, and BMS, and has received research grants from Pfizer, Ipsen, and Roche. JP has received speaker fees and attended advisory boards for Astellas, MSD, Janssen, Roche, Eisai, Bayer, AstraZeneca, and Ipsen; has received grants and attended an advisory board for Merck; has received speaker fees from BMS; and has received speaker fees and grants and attended advisory boards for Gilead and Novartis. JM has participated in advisory boards for AstraZeneca, Bristol-Myers Squibb, Eisai, Merck-Pfizer, Ipsen, Astellas, Bayer, and received honoraria for meeting chair or conferences from Astellas, Bristol-Myers Squibb, Eisai, Pfizer, Ipsen, Merck, EUSA Pharma, and MSD. LMD has received honoraria from Janssen, Ipsen, Bayer, and Pfizer. RJ reports research support from Clovis, Astellas, Exelixis, AstraZeneca, and Roche, and honoraria from Clovis, Astellas, AstraZeneca, Roche, Ipsen, Bristol-Myers Squibb, Pfizer, Merck Serono, Merck Sharp Dohme, Janssen, Bayer, and Novartis. DC has received consulting or advisory role for Janssen Oncology, Roche/Genentech, Astellas Pharma, AstraZeneca, Pfizer, Novartis, Ipsen, Bristol-Myers Squibb, MSD Oncology, Bayer, Lilly, Sanofi, Pierre Fabre, Boehringer Ingelheim; research funding from Janssen Oncology; and travel, accommodations, expenses from Pfizer, Roche, Bristol-Myers Squibb, AstraZeneca Spain. ID has received research grant to institution from Roche, AstraZeneca; honoraria from Bristol-Myers Squibb, MSD, Ipsen, Roche-Genentech, Janssen, Astellas Pharma, EUSA Pharma, Bayer, Novartis, Gilead, Bayer; support for attending meetings and/or travel from Merck-Pfizer, Ipsen, Janssen, Bayer, AstraZeneca; serves on the advisory board for Bristol-Myers Squibb, MSD, Ipsen, Roche-Genentech, Astellas Pharma, EUSA Pharma, Bayer, Novartis, Eisai, Debio Pharma, Pharmacyclycs, Gilead. YL reports honoraria from AstraZeneca, Astellas Pharma, BMS, Gilead Sciences, Janssen, Roche, Merck KGaA, Merck Sharp & Dohme LLC, Pfizer, Sanofi Pasteur, Seagen, and Taiho Oncology; and travel accommodations/expenses from Astellas Pharma, AstraZeneca, BMS, Janssen, Merck KGaA, Merck Sharp & Dohme LLC, Pfizer, Roche, and Seagen. BS has received reimbursement for travel expenses from Genentech, Merck Sharp & Dohme (MSD), Pfizer, and Bristol-Myers Squibb (BMS); has received research funding from Roche, Genentech, Merck Sharp & Dohme, Pfizer, and Bristol-Myers Squibb; and has received honoraria from Merck, Roche, Pfizer, Ellipses, Ipsen, and Janssen. FJS has received travel expenses from Merck and Eusa Pharma, and honoraria from Merck Sharp & Dohme. EG has received honoraria for speaker engagements, advisory roles, or funding of continuous medical education from Adacap, AMGEN, Angelini, Astellas, AstraZeneca, Bayer, Blueprint, Bristol-Myers Squibb, Caris Life Sciences, Celgene, Clovis-Oncology, Eisai, Eusa Pharma, Genetracer, Guardant Health, HRA-Pharma, Ipsen, ITM-Radiopharma, Janssen, Lexicon, Lilly, Merck KGaA, MSD, Nanostring Technologies, Natera, Novartis, ONCODNA (Biosequence), Palex, Pharmamar, Pierre Fabre, Pfizer, Roche, Sanofi-Genzyme, Servier, Taiho, and Thermo Fisher Scientific. EG has received research grants from Pfizer, AstraZeneca, Astellas, and Lexicon Pharmaceuticals. All other authors have declared no conflicts of interest.