Update on perioperative systemic therapy for urothelial carcinoma

Clin Adv Hematol Oncol. 2019 Mar;17(3):176-183.

Abstract

Level 1 evidence supports cisplatin-based neoadjuvant chemotherapy (NAC) in muscle-invasive urothelial bladder cancer (MIUBC). Recent data from small prospective trials with neoadjuvant immune checkpoint inhibitors are encouraging, but long-term follow-up is required. Randomized trials have failed to accrue a sufficient number of patients and have not demonstrated a survival benefit with adjuvant chemotherapy in MIUBC, but for those with high-risk features at surgery, adjuvant cisplatin-based therapy is appropriate. In upper tract urothelial carcinoma, several retrospective trials and one recent phase 2 prospective trial support the use of NAC, and a randomized trial with adjuvant chemotherapy demonstrated improved disease- and metastasis-free survival and a trend toward improved overall survival.

Publication types

  • Review

MeSH terms

  • Carcinoma / metabolism
  • Carcinoma / pathology
  • Carcinoma / therapy*
  • Cisplatin / therapeutic use*
  • Clinical Trials, Phase II as Topic
  • Humans
  • Neoadjuvant Therapy / methods*
  • Neoplasm Invasiveness
  • Neoplasm Metastasis
  • Perioperative Care / methods*
  • Randomized Controlled Trials as Topic
  • Urinary Bladder Neoplasms / metabolism
  • Urinary Bladder Neoplasms / pathology
  • Urinary Bladder Neoplasms / therapy*
  • Urothelium / metabolism
  • Urothelium / pathology

Substances

  • Cisplatin