[Chemotherapy of bladder cancer. Systemic therapy with reduced toxicity]

For many years, MVAC chemotherapy has been the standard treatment for patients with advanced bladder cancer. Since only a small proportion of patients with advanced disease may be cured by chemotherapy, the expected toxicity profile has to be balanced against the clinical benefit. It is of importance to select patients who may probably respond to chemotherapy. The treatment-associated toxicity needs to be considered especially in unfit and elderly patients. The introduction of innovative new compounds and combinations for the treatment of advanced bladder cancer has opened new avenues. In particular, the good activity of the synthetic nucleoside analogue gemcitabine has improved chemotherapeutic approaches for older patients. For this group of patients, monotherapy with gemcitabine or paclitaxel as well as combinations with cisplatin, carboplatin, or methotrexate is feasible with acceptable side effects.