Management of patients with advanced bladder cancer following major response to systemic chemotherapy

Abstract

Chemotherapy continues to be the treatment of choice for advanced/metastatic bladder cancer. Although response rates as high as 70% have been achieved, there continue to be high progression rates and poor long-term survival. Surgical consolidation offers improved outcomes compared with chemotherapy alone, especially in patients who achieve complete clinical response to chemotherapy. The role of radiation and/or surveillance following major response to chemotherapy in patients with advanced disease remains unclear. Gross regional nodal involvement identified at the time of surgery does not preclude radical cystectomy with lymphadenectomy. Retroperitoneal lymph node dissection may be beneficial to select patients with nonregional retroperitoneal nodal metastasis who achieve good clinical response to chemotherapy. Visceral or lung metastasectomy may be offered to patients with solitary metastasis who achieve a good and durable response to chemotherapy. Nonresponders should be either offered a clinical trial (if available), second-line chemotherapy or best supportive care.

Keywords::

• chemotherapy
• metastasectomy
• metastatic bladder cancer
• radiation
• surgical consolidation
• unresectable bladder cancer

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.