title: Chemotherapy for Muscle-Invasive Bladder Cancer.
abstract: In the last 25 years, there has been an improved understanding of the pathogenesis of muscle-invasive bladder cancer (BC). Development of new treatment strategies has followed. We have progressed from the awareness of the efficacy of platinum compounds, especially cisplatin, as single agents to the development of effective drug combinations with greater attention in improving safety profiles while impacting on survival. Peri-operative chemotherapy (CHT) is the standard of care for non-metastatic disease. The most evidence in terms of a survival advantage is derived from neoadjuvant chemotherapy (NC) trials, but adjuvant medical treatment should be strongly considered when NC has not been utilized. Patient selection and a multidisciplinary approach are essential. Platinum-based CHT is still the standard of care for both early and advanced disease. A deeper knowledge of the pathogenesis of BC will derive from gene expression profiling (GEP), and this will give us new prognostic and predictive tools to develop more targeted treatments. A high mutational rate has been observed in BC, which can generate neoantigens that initiate cancer immunity. Immunotherapy will become a pivotal treatment for BC, in the very near future. Emerging data are encouraging, and these treatments may well revolutionize the medical approach to this disease while CHT will play a less important role.
authors.affiliation: Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglione Flajani, Circonvallazione Gianicolense 87, Rome, 00152, Italy. trentapatrizia@libero.it.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Trenta
authors.affiliation: Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglione Flajani, Circonvallazione Gianicolense 87, Rome, 00152, Italy. fabiocalabro1@alice.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Calabrò
authors.affiliation: Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglione Flajani, Circonvallazione Gianicolense 87, Rome, 00152, Italy. cerbone.linda@gmail.com.
authors.forename: Linda
authors.initials: L
authors.lastname: Cerbone
authors.affiliation: Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglione Flajani, Circonvallazione Gianicolense 87, Rome, 00152, Italy. cnsternberg@corasternberg.com.
authors.forename: Cora N
authors.initials: CN
authors.lastname: Sternberg
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D019317:Evidence-Based Medicine; D020869:Gene Expression Profiling; D006801:Humans; D007167:Immunotherapy / Q000639:trends; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D011379:Prognosis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*
keywords: Bladder cancer; Chemotherapy; Surgery; Survival
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