Advertisement

Neoadjuvant vs. Adjuvant Chemotherapy: Which Is Right?

  • Robert J. Jones
Chapter

Abstract

Muscle invasive bladder cancer which has not yet spread outside the bladder presents a very high risk of subsequent death from metastatic disease. It also presents the opportunity to cure by aggressive, multimodal therapy. Whilst a radical treatment approach to the bladder (either by cystectomy or by radical radiotherapy with or without concomitant radiosensitization) is fundamental, as the most lethal risk is from systemic disease, there is a clear role for systemic therapy around the time of radical treatment. The strongest data support the use of chemotherapy before surgery or radiotherapy (neoadjuvant), but this is not always feasible and so adjuvant chemotherapy after cystectomy presents an alternative treatment approach, albeit the data to support adjuvant therapy are less strong. How best to choose patients for neoadjuvant, adjuvant or, indeed, no systemic therapy remains controversial and uncertain.

Keywords

Adjuvant Cisplatin Neoadjuvant Muscle-invasive Variants 

References

  1. 1.
    Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003;349:859–66.CrossRefPubMedGoogle Scholar
  2. 2.
    International Collaboration of Trialists. Neoadjuvant cisplatin, methotrexate and vinblastine chemotherapy for muscle-invasive bladder cancer: a randomised controlled trial. Lancet. 1999;35:533–40.Google Scholar
  3. 3.
    International Collaboration of Trialists; Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group); European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group; Australian Bladder Cancer Study Group; National Cancer Institute of Canada Clinical Trials Group; Finnbladder; Norwegian Bladder Cancer Study Group; Club Urologico Espanol de Tratamiento Oncologico Group, Griffiths G, Hall R, Sylvester R, Raghavan D, Parmar MK. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol. 2011;29:2171–7.CrossRefGoogle Scholar
  4. 4.
    Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data. Eur Urol. 2005;48:202–6.CrossRefGoogle Scholar
  5. 5.
    von der Maase H, Hansen SW, Roberts JT, Dogliotti L, Oliver T, Moore MJ, et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol. 2000;18:3068–77.CrossRefPubMedGoogle Scholar
  6. 6.
    Zargar H, Espiritu PN, Fairey AS, Mertens LS, Dinney CP, Mir MC, et al. Multicenter assessment of neoadjuvant chemotherapy for muscle-invasive bladder cancer. Eur Urol. 2015;67:241–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Bruins HM, Aben KK, Arends TJ, van der Heijden AG, Witjes AJ. The effect of the time interval between diagnosis of muscle-invasive bladder cancer and radical cystectomy on staging and survival: a Netherlands Cancer Registry analysis. Urol Oncol. 2016;34:166.e1–6.CrossRefGoogle Scholar
  8. 8.
    Johnson DC, Nielsen ME, Matthews J, Woods ME, Wallen EM, Pruthi RS, et al. Neoadjuvant chemotherapy for bladder cancer does not increase risk of perioperative morbidity. BJU Int. 2014;114:221–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sonpavde G, Goldman BH, Speights VO, Lerner SP, Wood DP, Vogelzang NJ, et al. Quality of pathologic response and surgery correlate with survival for patients with completely resected bladder cancer after neoadjuvant chemotherapy. Cancer. 2009;115:4104–9.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Seiler R, Ashab HAD, Erho N, van Rhijn BWG, Winters B, J D, et al. Impact of molecular subtypes in muscle-invasive bladder cancer on predicting response and survival after neoadjuvant chemotherapy. Eur Urol. 2017;72:544–54.CrossRefPubMedGoogle Scholar
  11. 11.
    James ND, Hussain SA, Hall E, Jenkins P, Tremlett J, Rawlings C, et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med. 2012;366:1477–88.CrossRefPubMedGoogle Scholar
  12. 12.
    Sternberg CN, Skoneczna I, Kerst JM, Albers P, Fossa SD, Agerbaek M, et al. Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (EORTC 30994): an intergroup, open-label, randomised phase 3 trial. Lancet Oncol. 2015;16:76–86.CrossRefPubMedGoogle Scholar
  13. 13.
    Leow JJ, Martin-Doyle W, Rajagopal PS, Patel CG, Anderson EM, Rothman AT, et al. Adjuvant chemotherapy for invasive bladder cancer: a 2013 updated systematic review and meta-analysis of randomized trials. Eur Urol. 2014;66:42–54.CrossRefPubMedGoogle Scholar
  14. 14.
    Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Adjuvant chemotherapy for invasive bladder cancer (individual patient data). Cochrane Database Syst Rev. 2006;(2):CD006018.Google Scholar
  15. 15.
    Birtle AJ, Lewis R, Johnson M, Hall E, POUT Trial Management Group (TMG). Time to define an international standard of postoperative care for resected upper urinary tract transitional cell carcinoma (TCC)—opening of the peri-operative chemotherapy versus surveillance in upper tract urothelial cancer (POUT) trial. BJU Int. 2012;110:919–21.CrossRefPubMedGoogle Scholar
  16. 16.
    Fischer-Valuck BW, Rao YJ, Henke LE, Rudra S, Hui C, Baumann BC, Gay HA, Michalski JM. Treatment patterns and survival outcomes for patients with small cell carcinoma of the bladder. Eur Urol Focus. 2017. pii: S2405–4569(17)30205–5.Google Scholar
  17. 17.
    JBellmunt J, Orsola A, Leow JJ, Wiegel T, De Santis M, Horwich A, on behalf of the ESMO Guidelines Working Group. Bladder cancer: ESMO practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3):iii40–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Beatson West of Scotland Cancer CentreUniversity of GlasgowGlasgowUK

Personalised recommendations