New treatment approaches in muscle-invasive bladder cancer Book Section
| Authors: | Gupta, A.; Rosenberg, J. E. |
| Editors: | Knowles, M. A.; Dyrskjøt, L. |
| Article/Chapter Title: | New treatment approaches in muscle-invasive bladder cancer |
| Abstract: | Muscle-invasive bladder cancer (MIBC) constitutes 25% of newly diagnosed cases of bladder cancer per year. Muscle invasive disease remains a poor prognostic factor due to the presence of occult metastases and about 50% of patients have disease recurrence within 2 years of definitive local therapy. The treatment of MIBC has not changed significantly in over 20 years. Radical cystectomy with pelvic lymph node dissection remains the gold standard as definitive therapy for muscle-invasive bladder cancer and cisplatin-based neoadjuvant chemotherapy is the standard of care. Trimodality therapy, consisting of maximal surgical resection followed by concurrent chemoradiation, is an alternative curative approach for select patients who are poor surgical candidates. Adjuvant treatment is recommended for patients with high-risk disease or lymph node involvement. Although the current standard of care is with cisplatin-based regimens, numerous studies are underway evaluating perioperative combinations that may challenge this treatment paradigm. Building from the metastatic disease setting, immune checkpoint inhibitors and novel targeted therapies are being evaluated alone and in combination with chemotherapy for neoadjuvant management of MIBC. Furthermore, identification of biomarkers based on somatic alterations in DNA damage repair genes may predict response to cisplatin-based neoadjuvant chemotherapy and are being validated in prospective studies. In this chapter, we review data in support of the current recommendations for neoadjuvant, definitive local and adjuvant treatment, and discuss ongoing studies in each of these areas and their impact on clinical practice. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2024. |
| Keywords: | radical cystectomy; neoadjuvant chemotherapy; trimodality therapy; immune checkpoint inhibitors; antibody–drug conjugates |
| Book Title: | Biology of Bladder Cancer: From Molecular Insights to Clinical Strategies |
| ISBN: | 978-3-031-68504-0 |
| Publisher: | Springer Nature |
| Publication Place: | Cham, Switzerland |
| Date Published: | 2024-01-01 |
| Start Page: | 457 |
| End Page: | 478 |
| Language: | English |
| DOI: | 10.1007/978-3-031-68505-7_22 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Book Chapter: 22 -- Located in "Part VII: Therapeutic Application Based on Molecular Insights" -- Source: Scopus |
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