Neoadjuvant chemotherapy preceding cystectomy for bladder cancer.
BACKGROUND
Occult micrometastasis at the time of radical cystectomy leads predominantly to distant failures in patients with locally advanced, muscle-invasive transitional cell carcinoma of the bladder.


OBJECTIVE
Data supporting neoadjuvant chemotherapy for locally advanced bladder cancer are reviewed.


RESULTS
Studies evaluating adjuvant chemotherapy have been limited by inadequate statistical power. However, randomized clinical trials have demonstrated a survival benefit for neoadjvuant cisplatin-based combination chemotherapy. Trials employing neoadjuvant therapy are particularly valuable in the development of novel systemic therapy regimens, since pathological complete remission appears to be a powerful prognostic factor for long-term survival.


CONCLUSIONS
Neoadjuvant chemotherapy is a standard for the therapy of locally advanced bladder cancer, and the neoadjuvant paradigm may assist in accelerating novel agent development.
Sonpavde
Guru
G
Texas Oncology, P.A. and US Oncology Research, 501 Medical Center Blvd, Webster, TX 77598, USA. gurUSonpavde@usoncology.com
Amiel
Gilad E
GE
Mims
Martha P
MP
Hayes
Teresa G
TG
Lerner
Seth P
SP
D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015653:Cystectomy; D006801:Humans; D019042:Muscle Neoplasms / Q000188:drug therapy / Q000556:secondary; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D016032:Randomized Controlled Trials as Topic; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
D000970:Antineoplastic Agents