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Landmarks in the treatment of muscle-invasive bladder cancer

Nature Reviews Urology volume 14, pages 565–574 (2017)Cite this article

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Abstract

Muscle-invasive bladder cancer is an aggressive disease associated with high morbidity and mortality. Radical cystectomy is the mainstay of treatment and has evolved since the first reported cystectomy in 1887 to include pelvic lymph node dissection and the creation of increasingly sophisticated urinary diversions, such as neobladders and pouches, which enable patients to maintain continence. Pioneering work in the 1970s established the therapeutic activity of cisplatin in patients with bladder cancer and resulted in the introduction of cisplatin-based neoadjuvant chemotherapy, which led to the first improvement in survival outcomes in decades. Other notable advances include the development of bladder-sparing protocols, which combine surgery, chemotherapy, and radiotherapy. Molecular profiling of bladder cancer has helped to enhance our understanding of tumour biology and identify several therapeutic targets, such as programmed death (PD-1) and its ligand programmed cell death ligand 1 (PD-L1). Over the past 3 years, immune checkpoint inhibitors targeting the PD-1–PD-L1 axis have demonstrated the ability to achieve durable objective responses in trials of patients with metastatic disease. If the current momentum continues, immunotherapy is poised to change the landscape of muscle-invasive bladder cancer treatment, promising improved survival outcomes for patients with this disease.

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Figure 1: Timeline.
Figure 2: Example of a typical enhanced recovery protocol for radical cystectomy.
Figure 3: Template for standard pelvic lymphadenectomy.
Figure 4: Types of urinary diversion.
Figure 5: Types of urinary diversion.

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Authors and Affiliations

  1. Ramesh Thurairaja and Muhammad Shamim Khan are at the Department of Urology, Niyati Lobo, Chloe Mount, Kawa Omar, Rajesh Nair, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.,

    Niyati Lobo, Chloe Mount, Kawa Omar, Rajesh Nair, Ramesh Thurairaja & Muhammad Shamim Khan

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  1. Niyati Lobo
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N.L. researched data for the article, N.L., K.O., R.N., and S.K. made substantial contributions to discussion of content, N.L. and C.M. wrote the article and all authors reviewed and edited the manuscript before submission.

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Correspondence to Muhammad Shamim Khan.

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Lobo, N., Mount, C., Omar, K. et al. Landmarks in the treatment of muscle-invasive bladder cancer. Nat Rev Urol 14, 565–574 (2017). https://doi.org/10.1038/nrurol.2017.82

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