A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer.
BACKGROUND
Muscle-invasive bladder cancer (MIBC) is a disease with a pattern of predominantly distant and early recurrences. Neoadjuvant cisplatin-based combination chemotherapy has demonstrated improved outcomes for MIBC.


OBJECTIVE
To review the data supporting perioperative chemotherapy and emerging regimens for MIBC.


METHODS
Medline databases were searched for original articles published before April 1, 2012, with the search terms bladder cancer, urothelial cancer, radical cystectomy, neoadjuvant chemotherapy, and adjuvant chemotherapy. Proceedings from the last 5 yr of major conferences were also searched. Novel and promising drugs that have reached clinical trial evaluation were included.


RESULTS
The major findings are addressed in an evidence-based fashion. Prospective trials and important preclinical data were analyzed.


CONCLUSIONS
Cisplatin-based neoadjuvant combination chemotherapy is an established standard, improving overall survival in MIBC. Pathologic complete response appears to be an intermediate surrogate for survival, but this finding requires further validation. Definitive data to support adjuvant chemotherapy do not exist, and there are no data to support perioperative therapy in cisplatin-ineligible patients. Utilization of neoadjuvant cisplatin is low, attributable in part to patient/physician choice and the advanced age of patients, who often have multiple comorbidities including renal and/or cardiac dysfunction. Trials are using the neoadjuvant paradigm to detect incremental pathologic response to chemobiologic regimens and brief neoadjuvant single-agent therapy to screen for the biologic activity of agents.
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Joshua J
JJ
Meeks
Joaquim
J
Bellmunt
Bernard H
BH
Bochner
Noel W
NW
Clarke
Siamak
S
Daneshmand
Matthew D
MD
Galsky
Noah M
NM
Hahn
Seth P
SP
Lerner
Malcolm
M
Mason
Thomas
T
Powles
Cora N
CN
Sternberg
Guru
G
Sonpavde
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy; D019317:Evidence-Based Medicine; D006801:Humans; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*
D002945:Cisplatin