Neoadjuvant chemotherapy for bladder cancer: current status

Muscle-invasive bladder cancer is typically an aggressive solid tumour with the propensity for early systemic dissemination. Although curative-intent local therapy with either radical cystectomy or radiotherapy remains the gold standard intervention, the high rate of systemic failure has prompted investigators to evaluate various strategies in an attempt to improve survival, including the early administration of systemic chemotherapy. Recently completed, Phase III studies of neoadjuvant chemotherapy trials demonstrated a modest, but real survival advantage for a small subset of patients. Other strategies include, attempts to both preserve the bladder using combinations of limited surgical resection, systemic chemotherapy and radiotherapy. This review focuses on the potential of neoadjuvantly-administered therapies to impact the management of muscle invasive bladder cancer.