Second-line therapy in bladder cancer.
OBJECTIVE
To review new developments in second-line treatment for transitional cell carcinoma of the urinary bladder focusing on advances and findings within the last year.


RESULTS
So far no standard therapy has been established for pretreated patients with transitional cell carcinoma. Prognostic and predictive factors for response and outcome in pretreated patients have been studied retrospectively and will help to identify those who might benefit from intensive therapy and those who would rather improve their quality of life with best supportive care. Single-agent chemotherapy in this setting provided low response rates, short progression-free and overall survival. Vinflunine, a novel vinca-alkaloid, and best supportive care had a modest, but still significant benefit at a very moderate toxicity rate in a randomized phase III trial. As for second-line combination chemotherapy, response rates as well as potential toxicities are higher and the progression-free survival and overall survival benefits are still poorly understood. New chemotherapeutics and approaches like metronomic chemotherapy and novel agents are under investigation.


CONCLUSIONS
With vinflunine there is reasonable hope for a new standard chemotherapy in second-line management of transitional cell carcinoma. However, due to the reported results with single agents and combination chemotherapy, treatment within clinical trials is still the best choice in patients progressing after first-line chemotherapy.
Bachner
Mark
M
3rd Medical Department - Center for Oncology and Hematology, Kaiser Franz Josef-Spital der Stadt Wien, Ludwig Boltzmann Institute for Applied Cancer Research Vienna (LBI-ACR VIEnna), Vienna, Austria.
De Santis
Maria
M
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005493:Folic Acid Antagonists / Q000627:therapeutic use; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D016879:Salvage Therapy; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D014747:Vinblastine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000970:Antineoplastic Agents; D005493:Folic Acid Antagonists; C111217:vinflunine; D014747:Vinblastine