Peri-operative Chemotherapy for Muscle-Invasive Bladder Cancer View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2018

AUTHORS

Thomas Seisen , Benjamin Pradère , Morgan Rouprêt

ABSTRACT

The role of perioperative chemotherapy as an adjunct to radical cystectomy for muscle-invasive bladder cancer has been explored by several landmark randomized controlled trials over the past decades. On the one hand, a meta-analysis of level-I evidence and long-term results from the largest trials support the use of neoadjuvant chemotherapy, which is now advocated as the standard of care by most of the clinical guidelines worldwide. On the other hand, evidence supporting the use of adjuvant chemotherapy is more contentious. Specifically, several meta-analyses identified a survival benefit with the immediate postoperative delivery of cisplatin-based regimen, but the investigators identified multiple methodological limitations in the vast majority of included randomized controlled trials. Nonetheless, the use of adjuvant chemotherapy is currently considered for patients with adverse pathological features at radical cystectomy. The toxicity of both neoadjuvant and adjuvant chemotherapy is acceptable and well-aligned with what expected with cisplatin-based regimens. Given its greater response rate, the methotrexate, vinblastine, doxorubicine, and cisplatin combination is preferentially used in the neoadjuvant setting, while the gemcitabine plus cisplatin combination is more commonly delivered in the adjuvant setting because of its better toxicity profile. However, there is no prospective evidence suggesting a survival superiority of one regimen over the other. Finally, the comparative effectiveness of neoadjuvant vs. adjuvant chemotherapy has been poorly assessed in the current literature. Nonetheless, the only randomized controlled trial indirectly comparing both suggested no survival difference between the pre- and postoperative delivery of cisplatin-based chemotherapy. More... »

PAGES

1-19

Book

TITLE

Urologic Oncology

ISBN

978-3-319-42603-7
978-3-319-42603-7

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-319-42603-7_25-1

DOI

http://dx.doi.org/10.1007/978-3-319-42603-7_25-1

DIMENSIONS

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