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Update on chemotherapy for advanced bladder cancer
Jonathan E Rosenberg1, Peter R Carroll, Eric J Small
1Department of Medicine, University of California-San Francisco, San Francisco, California, USA. jrosenbe@medicine.ucsf.edu
The Journal of Urology
|June 11, 2005
Summary
Neoadjuvant chemotherapy improves survival for advanced bladder cancer. Gemcitabine/cisplatin is now standard first-line treatment, but optimal second-line and targeted therapies are still needed.
Area of Science:
- Oncology
- Urologic Oncology
- Cancer Treatment
Background:
- Bladder cancer treatment has advanced, particularly for advanced and metastatic stages.
- Current strategies focus on improving survival and quality of life for patients.
Purpose of the Study:
- To summarize the current state-of-the-art treatments for advanced bladder cancer.
- To review recent clinical trial data and retrospective analyses.
Main Methods:
- Comprehensive review of published prospective phase II/III clinical trials.
- Analysis of retrospective patient data for advanced bladder cancer.
Main Results:
- Neoadjuvant chemotherapy shows a modest survival benefit (5-6%) for locally advanced bladder cancer.
- Gemcitabine/cisplatin is the preferred first-line chemotherapy for metastatic disease due to efficacy and lower toxicity compared to MVAC.
- Chemoradiation offers bladder preservation with acceptable progression risk for select patients.
Conclusions:
- Cisplatin-based neoadjuvant chemotherapy benefits locally advanced bladder cancer.
- Gemcitabine/cisplatin is the current standard first-line regimen for patients with adequate renal function.
- Further research is needed for optimal second-line treatments, therapies for medically unfit patients, and development of targeted agents.