Neoadjuvant chemotherapy for bladder cancer

Abstract

Background: Muscle invasive bladder cancer (MIBC) is an aggressive malignancy, with 5-year survival rates ranging from 36% to 48% for pT3-4/pN+ tumors. Radical cystectomy (RC) remains the gold-standard treatment for the management of MIBC. Perioperative treatment can improve overall survival (OS), with more robust evidence favoring neoadjuvant chemotherapy (NAC). Objective: This review aims to discuss the historical perspectives, recent advances, experimental therapies, and current evidence for the use of various chemotherapeutic drugs in a neo-adjuvant setting for the treatment of MIBC. Data Sources: We searched and analyzed research articles, reviews, clinical trials, and meta-analyses addressing NAC in the management of MIBC. Results: The advantages of NAC in MIBC include the delivery of chemotherapy at the earliest time point when the micrometastatic burden is presumed to be the lowest. It has improved patient compliance and better tolerability in preoperative period with more number of patients completing the therapy. It reflects in vivo chemosensitivity of urothelial cancer along with favorable pathological outcomes in individual showing response. Delay in RC in nonresponders and overtreatment in low-stage disease are the potential disadvantages. Conclusion: NAC in MIBC is associated with improved OS. Cisplatin-based NAC is the current standard of care in eligible patients.