Current Perioperative Therapy for Muscle Invasive Bladder Cancer
1Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada.
Hematology/Oncology Clinics of North America
|May 7, 2021
Summary
Radical cystectomy offers a cure for about half of muscle-invasive bladder cancer patients. Perioperative chemotherapy, especially neoadjuvant cisplatin, is recommended to reduce recurrence risk, while immunotherapy is an emerging option.
Area of Science:
- Oncology
- Urologic Oncology
- Cancer Treatment
Background:
- Radical cystectomy (bladder removal) is the standard treatment for muscle-invasive bladder cancer.
- Current cure rates with radical cystectomy alone are approximately 50%.
- Locoregional control remains a challenge, and systemic recurrence is a major cause of treatment failure.
Purpose of the Study:
- To review the current role and evidence for perioperative therapies in muscle-invasive bladder cancer.
- To discuss the established efficacy of perioperative chemotherapy.
- To highlight emerging strategies like immunotherapy and the need for biomarkers.
Main Methods:
- Review of clinical trial evidence and established treatment guidelines.
- Analysis of data supporting neoadjuvant and adjuvant chemotherapy regimens.
- Discussion of the potential and future directions for perioperative immunotherapy.
Main Results:
- Perioperative radiotherapy has not demonstrated a role in routine care for improving locoregional control.
- Neoadjuvant cisplatin-based chemotherapy is supported by robust trial evidence for reducing systemic recurrence.
- Adjuvant chemotherapy is a viable alternative when neoadjuvant therapy is not feasible.
Conclusions:
- Perioperative chemotherapy, particularly neoadjuvant cisplatin, is a standard of care to improve outcomes in muscle-invasive bladder cancer.
- Perioperative immunotherapy is an emerging frontier requiring further investigation.
- Biomarker development is crucial for personalizing perioperative treatment strategies.
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