Neoadjuvant therapy in muscle-invasive bladder cancer: a model for rational accelerated drug development

Urol Clin North Am. 2015 May;42(2):217-24, viii-ix. doi: 10.1016/j.ucl.2015.02.004. Epub 2015 Mar 11.

Abstract

Since the advent of cisplatin-based combination therapy in the management of muscle-invasive and advanced bladder cancer, there has been little progress in improving outcomes for patients. Novel therapies beyond cytotoxic chemotherapy are needed. The neoadjuvant paradigm lends to acquiring ample pretreatment and posttreatment tumor tissue as a standard of care, which enables comprehensive biomarker analyses to better understand mechanisms of both response and resistance, which will aid drug development. This article discusses the evolution of neoadjuvant therapy as standard treatment and the role it may serve toward the development of novel therapies.

Keywords: Bladder cancer; Cisplatin; Immunotherapy; Neoadjuvant chemotherapy; Predictive biomarkers; The Cancer Genome Atlas; Urothelial cancer.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Chemotherapy, Adjuvant
  • Cisplatin / administration & dosage
  • Cystectomy
  • Doxorubicin / administration & dosage
  • Drug Discovery
  • Humans
  • Methotrexate / administration & dosage
  • Neoadjuvant Therapy / methods*
  • Neoplasm Invasiveness
  • Treatment Outcome
  • Urinary Bladder Neoplasms / pathology
  • Urinary Bladder Neoplasms / therapy*
  • Vinblastine / administration & dosage

Substances

  • Vinblastine
  • Doxorubicin
  • Cisplatin
  • Methotrexate

Supplementary concepts

  • M-VAC protocol
  • MEC protocol 1