Chemotherapy for bladder cancer in patients with impaired renal function

Carcinoma of the bladder is a common, chemosensitive malignancy. The value of chemotherapy for transitional cell carcinoma (the commonest malignant bladder histology in the developed world) has been demonstrated in both the palliative and the neoadjuvant settings, with survival benefits in both scenarios being achieved with cisplatin-based regimens. Conventional drug treatment is, therefore, dependent on adequate renal function, but renal impairment is a common confounding factor in patients with bladder cancer, due in part to obstruction of the urinary tract and in part to comorbidity in an elderly population. A recent consensus statement deems patients with impaired renal function unsuitable for cisplatin treatment, but the limited available evidence does not support the exclusion of cisplatin in patients with moderate renal impairment. The literature on which to base alternative, non-cisplatin-based chemotherapy is inadequate, but the perception that carboplatin-based combinations are inferior to cisplatin-based combinations is probably incorrect. Trials are needed to specifically examine chemotherapy in patients with bladder cancer and renal impairment.