Adjuvant and neoadjuvant approaches for urothelial cancer: Updated indications and controversies

Urothelial carcinoma (UC) of the bladder and upper urinary tract still results an open challenge for clinical oncologists. Excluding selected patients who will particularly benefit from chemo-radiotherapy combined to endoscopic tumour removal, surgery represents the only curative approach for localized stages. Unfortunately, over 50% of operated patients do experience local or distant recurrence of the disease. Several pre and/or postoperative treatments are under evaluation in patients with UC in order to effectively reduce the difficulty and morbidity of more extensive procedures and to increase the Disease-Free Survival (DFS). The number of trials has been rapidly increased by the development of immunocheckpoint inhibitors, used alone or in combined strategies with chemotherapy, radiotherapy or other immunotherapies. The aim of this review is to illustrate the current status of neoadjuvant and adjuvant treatments in UC focusing our attention to the major ongoing trials in these settings.