Contemporary update on neoadjuvant therapy for bladder cancer

Area of Science:

• Urology
• Oncology
• Medical Oncology

Background:

• Neoadjuvant chemotherapy (NAC) before radical cystectomy for bladder cancer is debated.
• Prospective studies show a 5% absolute survival benefit at 5 years with cisplatin-based NAC.
• Underuse stems from perceived modest benefit, patient ineligibility, and fear of surgical delay.

Purpose of the Study:

• To review the current evidence and challenges surrounding neoadjuvant chemotherapy for bladder cancer.
• To discuss the potential of novel therapies and genomic data in optimizing NAC.
• To emphasize the importance of surgical quality in radical cystectomy.

Main Methods:

• Review of prospective, randomized studies on neoadjuvant chemotherapy for bladder cancer.
• Analysis of factors influencing NAC adoption and underuse.
• Discussion of emerging therapeutic strategies and surgical considerations.

Main Results:

• Cisplatin-based NAC provides a modest but significant survival benefit in select bladder cancer patients.
• Individualized, risk-adapted approaches are used to guide NAC decisions.
• New cytotoxic, targeted therapies, and immune checkpoint inhibitors require further study in the neoadjuvant setting.

Conclusions:

• Neoadjuvant chemotherapy for bladder cancer remains underutilized despite proven survival benefits.
• Genomic characterization and novel therapies may refine patient selection for NAC.
• Optimal surgical outcomes, including radical cystectomy with extended lymph node dissection by expert surgeons, are critical post-NAC.