Onkológia 3/2016

Systemic treatment of bladder cancer – neoadjuvant, adjuvant and palliative chemotherapy

Bladder malignancies are the most common malignancies of urogenital system. Urothelial carcinoma covers 90% of all bladder cancers. Transurethral resection of bladder tumor (TURBT) and subsequent histological examination are crucial in establishing the diagnosis. Urothelial carcinoma can be divided into two histological subtypes: non- muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). Radical cystectomy and pelvic lymphadenectomy are standard of care in MIBC excluding metastatic MIBC. Several randomized trials confirmed benefit of neoadjuvant chemotherapy in MIBC. Adjuvant chemotherapy is indicated in high- risk patients with MIBC, if no neoadjuvant chemotherapy has been administered. In stage IV patients, palliative chemotherapy is a standard of care. Unsatisfactory outcomes of chemotherapy led to development of targeted- therapy and immunotherapy. Introduction of those drugs into standard treatment of advanced MIBC is a question of long -term research.

Keywords: urothelial bladder cancer, neoadjuvant chemotherapy, targeted therapy, immunotherapy, angiogenesis inhibitors