The role of chemotherapy in the management of bladder cancer

Bladder cancer represents for man the second genitourinary cancer after prostate cancer. Urothelial carcinoma is the most predominant histological type. In up to 70% of the cases, the diagnosis of bladder cancer is performed at early stages (Ta-T1). In this situation, the treatment of the disease is the transurethral resection with or without intravesical treatment (BCG, Amiticyne). In advanced disease, treatment is essentially palliative with chemotherapy based on cisplatin type MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) or gemcitabine-cisplatin. In invasive stages (T2-T3-T4), the radical cystoprostatectomy combined with urinary diversion for man, and the pelvectomy for woman are the gold standard. However, over 50% of these patients experienced metastatic recurrence during their evolution, which prompted investigators last 10 years to assess the value of neoadjuvant chemotherapy in their management. Indeed, neoadjuvant chemotherapy is now recognized as a standard by numerous American and European institutions. However, adjuvant chemotherapy remains controversial even for patients with lymph node involvement. The purpose of this literature review is to highlight the role of chemotherapy in the management of urothelial carcinoma of bladder with locally advanced and metastatic disease. The role of targeted therapies alone, in combination with chemotherapy, and in maintenance, is being evaluated. (C) 2011 Elsevier Masson SAS. All rights reserved.