[Why use chemotherapy in cancer of the bladder? What are the initial limitations]

Four chemical agents are active, in isolation, against metastatic bladder cancer: cisplatin (nephrotoxicity) (C or Cis), doxorubicin (cardiac toxicity) or adriamycin (A), vinblastine (V) and methotrexate (M). Combinations of these drugs are more effective, with complete response rates of up to 30 to 40%. The current combinations are: CM; Cis cyclophosphamide, A; CMV; MVAC. This last combination appears to be the most effective. Chemotherapy is essentially prescribed for palliative purposes (improvement of symptoms) in metastatic cancers. It may also constitute adjuvant treatment following total cystectomy, in order to decrease the local or distant recurrence rate. Neoadjuvant chemotherapy, before surgery, can reduce the tumour bulk allowing preservation of the bladder. Haematopoietic growth factors are used to reduce the toxicity of chemotherapy and the action of these drugs can also be potentiated by radiotherapy.