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Management of Bladder Cancer, Role of Chemotherapy and Controversies Surrounding Its Application

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Management of Bladder Cancer

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Abstract

Muscle invasive bladder cancer (MIBC) is characterized by a tendency for early metastasis. Urothelial carcinoma (UC) is chemosensitive with significant response rates to cisplatin-based combination chemotherapy regimens. Cisplatin-based chemotherapy regimens have been effective in improving survival in the neoadjuvant setting prior to cystectomy and in patients with metastatic disease and are established standards of care. Definitive trials to support the use of chemotherapy are lacking in the immediate postoperative setting. Utilization of cisplatin is often difficult in these patients because of inadequate renal function, advanced age, poor performance status and other comorbidities such as cardiac dysfunction; however, there are limited data to support the use of non-cisplatin regimens. There are no established therapies for patients who are ineligible for cisplatin, fail to respond to neoadjuvant chemotherapy, recur soon after perioperative chemotherapy or progress on first-line chemotherapy, and as a result, urgent clinical trials are needed to address this gap in information. Although biomarkers of response are lacking, pathologic complete response at cystectomy following neoadjuvant chemotherapy appears to be a surrogate for improved survival.

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Authors and Affiliations

  1. Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, 516 Delaware Street SE, 14-150 PWB, MMC 8480, Minneapolis, MN, 55455, USA

    Gautam Jha M.B.B.S., M.S. & Zeeshan Ahmad M.D.

  2. Department of Hematology/Oncology, University of Birmingham Alabama, 1802 6th Avenue South, NP 2540B, Birmingham, AL, 35294, USA

    Guru Sonpavde M.D.

  3. Division of Hematology and Oncology, University of Alabama, 1720 2nd Avenue South, WTI5, Birmingham, AL, 35294-3300, USA

    Guru Sonpavde M.D.

  4. Department of Internal Medicine, Unity Hospital, Fridley, MN, USA

    Zeeshan Ahmad M.D.

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  1. Gautam Jha M.B.B.S., M.S.
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  2. Guru Sonpavde M.D.
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Correspondence to Gautam Jha M.B.B.S., M.S. .

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  1. Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA

    Badrinath R. Konety

  2. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Sam S. Chang

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Jha, G., Sonpavde, G., Ahmad, Z. (2015). Management of Bladder Cancer, Role of Chemotherapy and Controversies Surrounding Its Application. In: Konety, B., Chang, S. (eds) Management of Bladder Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1881-2_30

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