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Clinical Scenario: The Role of Perioperative Chemotherapy

A 61-year-old man received neoadjuvant chemotherapy and radical cystectomy, with final pathology showing pT3aN0M0 disease
  • Eila C. SkinnerEmail author
Chapter

Abstract

Neoadjuvant chemotherapy plus radical cystectomy is the primary recommended therapy for muscle-invasive bladder cancer. Final surgical pathology is the strongest predictor of subsequent recurrence risk. There is no proven adjuvant treatment that can impact the risk of recurrence for those with adverse pathologic features such as persistent extravesical disease. These patients should be considered for clinical trials when available.

Keywords

Neoadjuvant chemotherapy Predictors of recurrence Pathology Adjuvant therapy 

Abbreviations

CMV

Cisplatin, methotrexate, vinblastine

GC

Gemcitabine, cisplatin

MVAC

Methotrexate, vinblastine, adriamycin (doxorubicin), cisplatin

References

  1. 1.
    Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP, Raghavan D, Crawford ED. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003;349:859–66.PubMedCrossRefGoogle Scholar
  2. 2.
    International Collaboration of Trialists, Medical Research Council Advanced Bladder Cancer Working Party, European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol. 2011;29:2171–7.PubMedCentralCrossRefGoogle Scholar
  3. 3.
    Herr HW, Faulkner JR, Grossman HB, et al. Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clini Oncol. 2004;22:2781–9.CrossRefGoogle Scholar
  4. 4.
    Vale CL, Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data. Eur Urol. 2005;48:202–6.CrossRefGoogle Scholar
  5. 5.
    Wynquist E, Kirchner TS, Segal R, Chin J, Lukka H. Neoadjuvant chemotherapy for transitional cell carcinoma of the bladder: a systematic review and meta-analysis. J Urol. 2004;171:561–9.CrossRefGoogle Scholar
  6. 6.
    Porter MP, Kerrigan C, Donato BM, Ramsey SD. Patterns of use of systemic chemotherapy for Medicare beneficiaries with urothelial bladder cancer. Urol Oncol. 2011;29:252–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Petrelli F, Coinu A, Cabiddu M, Ghilardi M, Vavassori I, Barni S. Correlation of pathologic complete response with survival after neoadjuvant chemotherapy in bladder cancer treated with cystectomy: a meta-analysis. Eur Urol. 2013;65:350–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Rosenblatt R, Sherif A, Rintala E, Wahlqvist R, Ullen A, Nilsson S, Malstrom P-U, The Nordic Urothelial Cancer Group. Pathologic downstaging is a surrogate marker for efficacy and increased survival following neoadjuvant chemotherapy and radical cystectomy for muscle-invasive urothelial bladder cancer. Eur Urol. 2012;61:1229–38.PubMedCrossRefGoogle Scholar
  9. 9.
    Sonpavde G, Goldman BH, Speights VO, Lerner SP, David P. Wood MD, Vogelzang NJ, Trump DL, Natale RB, Grossman HB, Crawford ED. Quality of pathologic response and surgery correlate with survival for patients with completely resected bladder cancer after neoadjuvant chemotherapy. Cancer. 2009;115:4104–9.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Shariat SF, Chromecki TF, Cha EK, Karakiewicz PI, Sun M, Fradet Y, Isbarn H, Scherr DS, Bastian PJ, Plummer K, Fajkovic H, Sagalowsky AI, Ashfaq R, Doblinger M, Cote RJ, Lotan Y. Risk stratification of organ confined bladder cancer after radical cystectomy using cell cycle related biomarkers. J Urol. 2012;187:457–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Raghavan D, Burgess E, Gaston KE, Haake MR, Riggs B. Neoadjuvant and adjuvant chemotherapy approaches for invasive bladder cancer. Sem Oncol. 2012;39:588–97.CrossRefGoogle Scholar
  12. 12.
    Takata R, Katagiri T, Kanehir M, Tsunoda T, Suin T, Miki T, Namiki M, Kohri K, Atsushita Y, Fujioka T, Nakamura Y. Predicting response to methotrexate, vinblastine, doxorubicin and cisplatin neoadjuvant chemotherapy for bladder cancers through genome-wide gene expression profiling. Clin Cancer Res. 2005;11:2625.PubMedCrossRefGoogle Scholar
  13. 13.
    Bellmut J, Pons F, Orsola A. Molecular determinants of response to cisplatin-based neoadjuvant chemotherapy. Curr Opin Urol. 2013;23(5):466–71.CrossRefGoogle Scholar
  14. 14.
    Smith SC, Baras AS, Lee JK, Theodorescu D. The COXEN principle: translating signatures of in vivo chemosensitivity into tools for clinical outcome prediction and drug discovery in cancer. Cancer Res. 2010;70:1753–8.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Vale CL, Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data. Eur Urol. 2005;48:189–201.CrossRefGoogle Scholar
  16. 16.
    Sternberg CN, Bellmunt J, Sonpavde G, Siefer-Radtke AO, Stadler WM, Bajorin DF, Dreicer R, George DJ, Milowsky MI, Thodorescu D, Vaughn DJ, Galsky MD, Soloway MS, Quinn DA. ICUD-EAU International Consultation on Bladder Cancer 2012: Chemotherapy for urothelial carcinoma—neoadjuvant and adjuvant settings. Eur Urol. 2013;63:58–66.PubMedCrossRefGoogle Scholar
  17. 17.
    Fairey AS, Daneshmand S, Quinn D, Dorff T, Dorin R, Lieskovsky G, Schuckman A, Cai J, Miranda G, Skinner EC. Neoadjuvant chemotherapy with gemcitabine/cisplatin vs methotrexate/vinblastine/doxorubicin/cisplatin for muscle-invasive urothelial carcinoma of the bladder: a retrospective analysis from the University of Southern California. Urol Oncol. 2012;31:1737–43.PubMedCrossRefGoogle Scholar
  18. 18.
    Volkmer BG, Kuefer R, Bartsch Jr GC, Gust K, Hautmann RE. Oncological followup after radical cystectomy for bladder cancer: Is there any benefit? J Urol. 2009;181:1587–93.PubMedCrossRefGoogle Scholar
  19. 19.
    Stein JP, Lieskovsky G, Cote R, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19:666.PubMedGoogle Scholar
  20. 20.
    Sanderson KM, Stein JP, Cai J, et al. Upper tract recurrence following radical cystectomy for transitional cell carcinoma. An analysis of 1069 patients with 10-year follow-up. J Urol. 2007;177:2008–94.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of UrologyThomas A. Stamey Research Chair of UrologyStanfordUSA

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