ICUD-EAU International Consultation on Bladder Cancer 2012: Chemotherapy for urothelial carcinoma-neoadjuvant and adjuvant settings.
BACKGROUND
We present a summary of the Second International Consultation on Bladder Cancer recommendations on chemotherapy for the treatment of bladder cancer using an evidence-based strategy.


OBJECTIVE
To review the data regarding chemotherapy in patients with clinically localized and metastatic bladder cancer with a focus on its use for patients in the neoadjuvant and adjuvant settings.


METHODS
Medline databases were searched for original articles published prior to April 1, 2012, using the following search terms: bladder cancer, urothelial cancer, metastatic, advanced, neoadjuvant, and adjuvant therapy. Proceedings of major conferences from the last 5 yr also were searched. Novel and promising drugs currently in clinical trials were included.


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


CONCLUSIONS
Cisplatin-based combination chemotherapy for advanced and metastatic bladder cancer is an established standard, improving overall survival. In the advanced setting, cisplatin-ineligible patients may benefit from gemcitabine and carboplatin. Meta-analyses undertaken for neoadjuvant cisplatin-based combination chemotherapy show a 5% benefit in overall survival. Pathologic complete remission may be an intermediate surrogate for survival, but requires further validation. Use of neoadjuvant chemotherapy is low, and is attributable to patient and physician choice because of limited benefit, advanced age, and comorbidities including renal and/or cardiac dysfunction. Sufficient data to support adjuvant chemotherapy are lacking.
Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy. cstern@mclink.it
Cora N
CN
Sternberg
Joaquim
J
Bellmunt
Guru
G
Sonpavde
Arlene O
AO
Siefker-Radtke
Walter M
WM
Stadler
Dean F
DF
Bajorin
Robert
R
Dreicer
Daniel J
DJ
George
Matthew I
MI
Milowsky
Dan
D
Theodorescu
David J
DJ
Vaughn
Matthew D
MD
Galsky
Mark S
MS
Soloway
David I
DI
Quinn
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000592:standards* / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000592:standards; D006801:Humans; D020360:Neoadjuvant Therapy / Q000592:standards*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019459:Urothelium / Q000187:drug effects* / Q000473:pathology