Abstract
Neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy is a recommended standard of care for muscle-invasive bladder cancer based on an increased rate of survival with this approach. Multiple regimens exist, with the most commonly used being gemcitabine plus cisplatin (GC) and dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC). Eligible patients with preserved renal function, hearing, and without neuropathy are candidates for cisplatin; carboplatin is not an acceptable substitute and should not be used in this neoadjuvant setting. There are currently no prospective data comparing the efficacy of GC versus ddMVAC; however, the utility of predictive biomarkers is being explored. Improved supportive care allows many patients to complete neoadjuvant chemotherapy; however, radical cystectomy remains the definitive curative treatment. Patients that are ineligible for cisplatin, develop intolerable toxicity, or experience progressive disease should proceed directly to surgery.
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Bernard, B., Flaig, T.W. (2021). Neoadjuvant Chemotherapy. In: Kamat, A.M., Black, P.C. (eds) Bladder Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-70646-3_20
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