Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Neoadjuvant chemotherapy for the treatment of muscle-invasive bladder cancer: argument in favor

Nature Clinical Practice Urology volume 5, pages 484–485 (2008)Cite this article

Remarkable improvements in surgical management of muscle-invasive bladder cancer have occurred in the past 20 years, with advances in continent urinary diversion, lymphadenectomy and perioperative care among the most noteworthy. Prognosis is inversely related to T-stage, with 20–30% of patients with T2 disease, but 70–90% with T4 disease, developing metastatic disease after surgery alone. Node-positive patients have the worst survival. Thus, multidisciplinary efforts are necessary to improve patient survival.1

Perioperative chemotherapy is routine in other epithelial malignancies, including cancers of the breast and colon. A meta-analysis of 14 randomized controlled trials has demonstrated that neoadjuvant chemotherapy in operable breast cancer is as effective as adjuvant treatment, with fewer adverse effects.2 Despite seemingly modest benefits, perioperative chemotherapy for breast and colon cancers has been widely utilized and is thought to be largely responsible for the improvement in cancer-specific mortality seen over the past decade. Of note, overall chemotherapy response rates in advanced bladder, breast and colon cancers are very similar, and bladder cancer actually has the highest complete-response rate of the three.1,2 Thus, we might ask how, and to what extent, multidisciplinary therapy can improve outcomes in muscle-invasive bladder cancer.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Grossman HB et al. (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349: 859–866

    Article  CAS  Google Scholar 

  2. Mieog JS et al. (2007) Neoadjuvant chemotherapy for operable breast cancer. Br J Surg 94: 1189–1200

    Article  CAS  Google Scholar 

  3. Hall RR (2002) Updated results of a randomized controlled trial of neoadjuvant cisplatin (C), methotrexate (M) and vinblastine (V) chemotherapy for muscle invasive bladder cancer [abstract #710]. Proc Am Soc Clin Oncol 21: a710

    Google Scholar 

  4. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration (2005) Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data. Eur Urol 48: 202–205

  5. David KA et al. (2007) Low incidence of perioperative chemotherapy for stage III bladder cancer 1998 to 2003: a report from the National Cancer Data Base. J Urol 178: 451–454

    Article  Google Scholar 

  6. Miles BJ and Eigl BJ (2008) Do Clinical Practice Guidelines (CPG) change clinical practice? An analysis of CPG impact on referral and treatment patterns for neoadjuvant chemotherapy in bladder cancer [abstract #295]. Presented at the ASCO 2008 Genitourinary Cancers Symposium: 2008 February 14–16, San Francisco, CA, USA

  7. von der Maase H et al. (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 18: 3068–3077

    Article  CAS  Google Scholar 

  8. Dash A et al. (2007) Efficacy of neo-adjuvant gemcitabine plus cisplatin (GC) in muscle-invasive urothelial cancer (UC) [abstract #5077]. J Clin Oncol 25 (Suppl 18S): a5077

    Google Scholar 

  9. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration (2005) Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data. Eur Urol 48: 189–199

  10. Dotan ZA et al. (2005) Optimal combined modality treatment improves outcome of locally advanced bladder cancer: analysis of SWOG 8710 [abstract #4531]. J Clin Oncol 23 (Suppl 16S): a4531

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, DJ Gallagher is a Medical Oncology Fellow and DF Bajorin is an Attending Physician in Medical Oncology on the Genitourinary Oncology Service, Memorial–Sloan Kettering Cancer Center, New York, NY, USA.,

    David J Gallagher & Dean F Bajorin

Authors
  1. David J Gallagher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dean F Bajorin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dean F Bajorin.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gallagher, D., Bajorin, D. Neoadjuvant chemotherapy for the treatment of muscle-invasive bladder cancer: argument in favor. Nat Rev Urol 5, 484–485 (2008). https://doi.org/10.1038/ncpuro1147

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro1147

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing