Systemic therapy in bladder preservation Review
| Authors: | Girardi, D. M.; Ghatalia, P.; Singh, P.; Iyer, G.; Sridhar, S. S.; Apolo, A. B. |
| Review Title: | Systemic therapy in bladder preservation |
| Abstract: | Bladder cancer is an aggressive and lethal disease. Even when presenting as localized muscle-invasive disease, the 5-year survival rate is about 70%, and the recurrence rate after radical cystectomy is approximately 50%. Neoadjuvant chemotherapy (NAC) has the potential to downstage the primary tumor and treat micrometastases, leading to a decrease in recurrence rates and an increase in cure rates. There is level 1 evidence in favor of neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy. However, data from clinical trials evaluating NAC for patients undergoing bladder-sparing treatments are less robust, so this strategy remains controversial. The response to NAC is prognostic and patients with favorable pathological response have better overall survival. Strategies to select patients based on molecular biomarkers have the potential to guide treatment decisions and even de-intensify treatment, avoiding local treatment for those with complete responses to systemic therapy. This review outlines the current literature on the use of NAC in the context of bladder preservation for muscle-invasive bladder cancer, highlights neoadjuvant studies in patients ineligible for cisplatin-based NAC, and discusses novel bladder-preservation strategies, including multimodality combinations and biomarker-driven studies of definitive chemotherapy. © 2020 |
| Keywords: | treatment response; gene mutation; overall survival; review; cisplatin; doxorubicin; interferon; systemic therapy; gemcitabine; neoadjuvant therapy; methotrexate; cancer staging; antineoplastic agent; cd8 antigen; ipilimumab; ticilimumab; cancer immunotherapy; antineoplastic combined chemotherapy protocols; pathology; bladder tumor; urinary bladder neoplasms; vinblastine; immunotherapy; biomarker; cytotoxic t lymphocyte; cystectomy; urinary bladder; urothelial carcinoma; surgery; dna damage response; organ preservation; transcription factor t bet; neoadjuvant chemotherapy; gamma interferon inducible protein 10; transurethral resection; risk reduction; bladder; programmed death 1 ligand 1; cxcl9 chemokine; phase 2 clinical trial (topic); phase 3 clinical trial (topic); phase 1 clinical trial (topic); multicenter study (topic); muscle invasive bladder cancer; bladder preservation; cd8alpha antigen; nivolumab; humans; human; pembrolizumab; abemaciclib; durvalumab; atezolizumab; bladder sparing; tumor mutational burden; enfortumab vedotin; epacadostat; oleclumab |
| Journal Title: | Urologic Oncology: Seminars and Original Investigations |
| Volume: | 41 |
| Issue: | 1 |
| ISSN: | 1078-1439 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2023-01-01 |
| Start Page: | 39 |
| End Page: | 47 |
| Language: | English |
| DOI: | 10.1016/j.urolonc.2020.10.006 |
| PUBMED: | 33223367 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Review -- Export Date: 3 January 2023 -- Source: Scopus |
