Perioperative chemotherapy for muscle invasive bladder cancer

Radical cystectomy with or without systemic chemotherapy is considered a standard of care for patients with muscle invasive bladder cancer (MIBC). The purpose of this review is to provide an update on current and recent literature published within the last 12 months reviewing the evidence for use of...

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Bibliographic Details
Published inCurrent opinion in supportive & palliative care Vol. 9; no. 3; p. 249
Main Authors Rudzinski, Jan K, Basappa, Naveen S, North, Scott
Format Journal Article
LanguageEnglish
Published United States 01.09.2015
Subjects
Antineoplastic Combined Chemotherapy Protocols - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Chemotherapy, Adjuvant
Cisplatin
Cystectomy - methods
Doxorubicin
Humans
Methotrexate
Neoplasm Invasiveness
Palliative Care
Perioperative Period
Urinary Bladder Neoplasms - drug therapy
Urinary Bladder Neoplasms - surgery
Vinblastine
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Summary:Radical cystectomy with or without systemic chemotherapy is considered a standard of care for patients with muscle invasive bladder cancer (MIBC). The purpose of this review is to provide an update on current and recent literature published within the last 12 months reviewing the evidence for use of perioperative chemotherapy for patients with MIBC. In the neoadjuvant chemotherapy (NAC) setting, the evidence demonstrates clinical efficacy and lower rate of toxicity with the use of high-dose methotrexate, vinblastine, doxorubicin, and cyclophosphamide (MVAC) compared with standard MVAC. Higher quality evidence for the use of gemcitabine with cisplatin is not yet available. Meta-analysis of cisplatin-based regimens in the adjuvant setting demonstrates significant benefit in overall survival and disease-free survival specifically in patients with lymph-node-positive disease. The available evidence suggests that along with radical cystectomy, cisplatin-based perioperative chemotherapy should be the standard of care in patients with MIBC with a higher quality and quantity of literature in support of the NAC approach. Adoption of perioperative chemotherapy for MIBC is on the rise in North America, which is reassuring. Novel therapeutic approaches for cisplatin-ineligible patients are currently being investigated.
ISSN:1751-4266
DOI:10.1097/spc.0000000000000148