Neoadjuvant Chemotherapy Before Radical Cystectomy: Why We Must Adhere?

Area of Science:

• Oncology
• Urology
• Medical Research

Background:

• Muscle-invasive bladder cancer (MIBC) requires effective treatment strategies.
• Neoadjuvant therapy prior to radical cystectomy is a critical component of MIBC management.
• Optimizing neoadjuvant treatment is essential for improving patient survival and outcomes.

Purpose of the Study:

• To conduct a literature review on current and emerging neoadjuvant treatments for MIBC.
• To evaluate the efficacy and potential of various neoadjuvant therapeutic strategies.
• To identify promising novel approaches for MIBC treatment.

Main Methods:

• A nonsystematic literature review was conducted.
• Searches were performed in PubMed, Scopus, and Clinical Trials.gov.
• Included prospective and retrospective studies from the past 15 years.

Main Results:

• Platinum-based chemotherapy (e.g., MVAC, CMV, Gemcitabine-Cisplatin) offers survival benefits for MIBC.
• Neoadjuvant immunotherapy (atezolizumab, pembrolizumab) demonstrates high complete response rates.
• Tyrosine kinase inhibitors are an emerging area for potential survival improvement.

Conclusions:

• Neoadjuvant treatment before radical cystectomy improves oncological outcomes in MIBC.
• MVAC remains a standard for cisplatin-eligible patients.
• Immunotherapy presents a promising novel strategy for cisplatin-ineligible MIBC patients.