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Published on: February 12, 2017
Perioperative chemotherapy for localized bladder cancer
1University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada.
Introduction:
Survival benefits have been recently reported in meta-analyses of randomized clinical trials (RCTs) studying perioperative chemotherapy for muscle-invasive urothelial cancer. Controversy and lack of awareness of these data have diminished their impact on daily practice, and they deserve further scrutiny.
Materials And Methods:
Recently published meta-analyses of RCTs studying perioperative chemotherapy for bladder cancer were narratively reviewed, along with two reports from the most recently reported RCT of neoadjuvant chemotherapy for bladder cancer.
Results:
Two recently published individual patient data meta-analyses report that cisplatin-based combination neoadjuvant chemotherapy is associated with an absolute survival benefit of 5% at 5 years, and adjuvant chemotherapy with an absolute survival benefit of 9% at 3 years. However, the value of the adjuvant meta-analysis is limited by the available data. Positive surgical margins and fewer than 10 lymph nodes removed are associated with poorer prognosis. Pathological complete response is associated with better survival.
Conclusions:
Patients diagnosed with muscle-invasive urothelial cancer may benefit from perioperative chemotherapy and should be routinely referred to a medical oncologist. Surgical factors potentially have a greater impact on survival than the use of perioperative chemotherapy. RCTs studying all stages of localized muscle-invasive bladder cancer are currently enrolling patients in Canada and are a high priority.
