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

  • Gautam JhaEmail author
  • Guru Sonpavde
  • Zeeshan Ahmad
Chapter

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.

Keywords

Urothelial cancer Muscle invasive bladder cancer Neoadjuvant chemotherapy Adjuvant chemotherapy Perioperative chemotherapy Pathologic complete response 

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Hematology, Oncology and Transplantation, Department of MedicineUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of Hematology/OncologyUniversity of Birmingham AlabamaBirminghamUSA
  3. 3.Division of Hematology and OncologyUniversity of AlabamaBirminghamUSA
  4. 4.Department of Internal MedicineUnity HospitalFridleyUSA

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