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Perioperative chemotherapy for muscle invasive bladder cancer

Rudzinski, Jan K.; Basappa, Naveen S.; North, Scott

Current Opinion in Supportive and Palliative Care: September 2015 - Volume 9 - Issue 3 - p 249–254
doi: 10.1097/SPC.0000000000000148
RENAL AND UROLOGICAL PROBLEMS: Edited by Fred Saad
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Purpose of review Radical cystectomy with or without systemic chemotherapy is considered a standard of care for patients with muscle invasive bladder cancer (MIBC). The purpose of this review is to provide an update on current and recent literature published within the last 12 months reviewing the evidence for use of perioperative chemotherapy for patients with MIBC.

Recent findings In the neoadjuvant chemotherapy (NAC) setting, the evidence demonstrates clinical efficacy and lower rate of toxicity with the use of high-dose methotrexate, vinblastine, doxorubicin, and cyclophosphamide (MVAC) compared with standard MVAC. Higher quality evidence for the use of gemcitabine with cisplatin is not yet available. Meta-analysis of cisplatin-based regimens in the adjuvant setting demonstrates significant benefit in overall survival and disease-free survival specifically in patients with lymph-node-positive disease.

Summary The available evidence suggests that along with radical cystectomy, cisplatin-based perioperative chemotherapy should be the standard of care in patients with MIBC with a higher quality and quantity of literature in support of the NAC approach. Adoption of perioperative chemotherapy for MIBC is on the rise in North America, which is reassuring. Novel therapeutic approaches for cisplatin-ineligible patients are currently being investigated.

aDivision of Urology, Department of Surgery

bDivision of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada

Correspondence to Scott North MD, FRCPC, Division of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, Canada, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada. Tel: +17804328221; e-mail: scott.north@albertahealthservices.ca

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