The role of perioperative chemotherapy for bladder cancer is not clear. The remains doubt about effectiveness of such chemotherapy and whether is should be given preoperatively or postoperatively. The World Health Organization and the Societe Internationale d’Urologie presented consensus recommendations in the management of patients with locally advanced and metastatic TCC. With regard to neoadjuvant chemotherapy, the panel concluded that overall survival for the whole group was not affected. Certain subsets did exhibit improved survival. Notably, patients treated with cisplatin-based combination chemotherapy had a 5% improvement in survival compared with untreated patients—from 45% to 50%. The panel further concluded that patients with clinical stage T2 tumors had at best a modest benefit, whereas patients with more advanced-stage disease potentially had a more substantial benefit.
A major benefit to adjuvant chemotherapy over neoadjuvant chemotherapy is the ability to stratify patients based on pathologic stage, or based on tumor biomarkers. The panel did not think that stage T2 disease benefits from adjuvant chemo.
NCCN recommends consideration of both neopadjuvant and adjuvant chemo as a category 2A on p. BL-5 of its bladder cancer guidelines. In its descriptive section it says that it should be considered based on risk factors and nodal status. It recommends gemcitabine and cisplatin or MVAC and specifically not carboplatin for adjuvant therapy.
In its decriptive section it says that it should be considered based on risk factors and nodal status. It recommends gemcitabine and cisplatin but specifically not carboplatin; even for patients with reduced renal function it recommends split dose cisplatin instead of carboplatin.
Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data Advanced Bladder Cancer (ABC) Meta-analysis Collaboration.
Advanced Bladder Cancer (ABC) Meta-analysis Collaboration.Eur Urol. 2005 Aug;48(2):189-199; discussion 199-201.
Sternberg CN, Donat SM, Bellmunt J, Millikan RE, Stadler W, De Mulder P, Sherif A, von der Maase H, Tsukamoto T, Soloway MS Chemotherapy for bladder cancer: treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer.Urology. 2007 Jan;69(1 Suppl):62-79.
Sternberg CN, Donat SM, Bellmunt J, et al: Chemotherapy for bladder cancer: treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer. Urology 69:62-79,2007.