Introduction: Neoadjuvant Chemotherapy in Bladder Cancer

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Muscle-invasive bladder cancer presents as a systemic disease in a substantial number of patients, with neoadjuvant chemotherapy representing an optimal standard of care. However, despite this, many community practices do not commonly administer neoadjuvant chemotherapy, Dean F. Bajorin, MD, notes.

Neoadjuvant chemotherapy should be administered followed by consolidation surgery, such as cystectomy and bilateral pelvic lymph node dissection, for patients with muscle-invasive bladder cancer, believes Bajorin. Two of the leading neoadjuvant chemotherapy regimens are cisplatin, methotrexate, and vinblastine (CMV) and methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC). Adverse events associated with these therapies include renal toxicity, myelosuppression, mucositis, and infection.

At this time, neoadjuvant chemotherapy should be utilized for all patients with muscle-invasive bladder cancer. Evidence has suggested that ERCC2 mutations could correlate with sensitivity to cisplatin-based regimens; however, Bajorin comments that clinical trials exploring both ERCC1 and ERCC2 as predictive markers of chemotherapy in bladder cancer have not shown conclusive results.