Adjuvant and neoadjuvant chemotherapy for invasive bladder cancer

Despite technical advances in the surgical or radiotherapeutic treatment of localized invasive bladder cancer, at least 50% of patients ultimately succumb from the growth and progression of microscopic disease beyond the reach of these local treatment modalities. Systemic chemotherapy prior to or immediately following surgery or radiotherapy or concurrently with radiotherapy has been explored in numerous uncontrolled phase II trials and in several randomized phase III trials in an attempt to eradicate this micrometastatic disease burden. Many of these studies have significant flaws in design, implementation, and analysis. All suffer from the lack of highly effective or well-tolerated chemotherapy. These failed attempts and lessons from successful adjuvant chemotherapy trials in other tumor types indicate directions to be pursued in this highly lethal disease.