Systemic therapy for bladder cancer - a medical oncologist's perspective

Area of Science:

• Medical Oncology
• Urologic Oncology
• Cancer Treatment

Background:

• Advanced bladder cancer, including muscle-invasive and metastatic disease, requires systemic chemotherapy.
• Cisplatin-based multi-agent chemotherapy is the established standard of care.

Purpose of the Study:

• To review current systemic therapies for advanced bladder cancer.
• To discuss evidence-based treatments and future directions in systemic therapy.

Main Methods:

• Review of existing clinical trial data and literature on chemotherapy for bladder cancer.
• Analysis of treatment efficacy, tolerability, and survival outcomes.

Main Results:

• MVAC (methotrexate-vinblastine-doxorubicin-cisplatin) is well-studied, but gemcitabine-cisplatin (GC) offers similar efficacy with improved tolerability for metastatic disease.
• Neoadjuvant chemotherapy improves survival for muscle-invasive bladder cancer patients eligible for cisplatin.
• Adjuvant chemotherapy shows mixed results, and non-cisplatin regimens are experimental.

Conclusions:

• Gemcitabine-cisplatin (GC) is the current standard for metastatic bladder cancer.
• No FDA-approved second-line therapies exist post-metastatic progression on cisplatin.
• Anti-VEGF therapy and immunotherapy are promising future directions.