Contemporary management of muscle-invasive bladder cancer

Abstract

The current standard treatment for muscle-invasive nonmetastatic bladder cancer is neoadjuvant platinum-based chemotherapy followed by radical cystectomy. However, neoadjuvant chemotherapy is not widely accepted even with level 1 evidence. Adjuvant chemotherapy should be discussed if patients have not received neoadjuvant chemotherapy before surgery and have high-risk pathologic features. Although not considered standard of care, bladder-sparing therapy can be considered for highly selected patients and for those medically unfit for surgery. Even though there are no level 1 data, the treatment outcomes for highly select patients given bladder-sparing therapy appear promising, with many patients retaining a functional bladder. Personalized chemotherapy is currently being actively pursued to target the underlying molecular changes and tailor to individual needs.

Keywords::

• bladder urothelial carcinoma
• chemotherapy
• cisplatin
• personalized chemotherapy
• targeted therapy

Disclaimer

The contents reported/presented within do not represent the views of the Department of Veterans Affairs or the United States Government.

Financial & competing interests disclosure

This work is supported by the VA Career Development Award-2 (principal investigator: C-X Pan) and NCI Cancer Clinical Investigator Team Leadership Award (principal investigator: C-X Pan). C-X Pan is a co-founder of the Accelerated Medical Diagnostics that develops diagnostic tools using accelerator mass spectrometry. The authors have no other 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 apart from those disclosed.

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