Neoadjuvant and Adjuvant Therapy in Bladder Cancer

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Neoadjuvant or adjuvant chemotherapy is commonly administered for patients with muscle-invasive bladder cancer, since the disease is commonly diagnosed with distant metastases. In many circumstances, neoadjuvant therapy is preferred, since individuals often tolerate chemotherapy better when it is administered before a major surgery, Evan Y. Yu, MD, notes.

If administering adjuvant chemotherapy, it should be utilized as soon after surgery as possible, Yu adds. Adjuvant chemotherapy should be administered within 12 weeks of a surgical procedure, notes Dean F. Bajorin, MD. There is a need for nontoxic adjuvant therapy, such as immunotherapy, for patients with bladder cancer, adds Daniel P. Petrylak, MD.

A phase II study is examining the HER2-directed autologous cellular immunotherapy DN2402 as an adjuvant treatment for patients with high-risk bladder cancer, Yu notes. This treatment involves the ex vivo activation of autologous peripheral blood mononuclear cells, including antigen presenting cells, using a recombinant fusion protein. Early data have shown upregulation of the immune system with this therapy, but mature survival data have not been established, says Yu.