An overlooked benefit of neoadjuvant chemotherapy in the treatment of muscle-invasive cancer of the urinary bladder

Abstract

Urinary bladder cancer is the third most frequent malignancy of the genitourinary tract, and its incidence and mortality have been increasing in Slovenia. Loco-regional treatment is key in radical treatment of the muscle-invasive cancer of the urinary bladder, and systemic chemotherapy treatment may provide additional benefits to the patients. Phase III clinical trials have demonstrated a significant prolongation of the overall survival of patients treated with neoadjuvant cisplatin-based combination chemotherapy. However, neoadjuvant chemotherapy has not yet been established sufficiently in everyday clinical practice, despite its clearly demonstrated effectiveness. Every patient with muscle-invasive cancer of the urinary bladder, who is receiving treatment with a curative intent and is a candidate for systemic treatment, should be informed of the possibility of receiving neoadjuvant chemotherapy treatment.

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Povzetek

Rak sečnega mehurja predstavlja tretji najpogostejši malignom genitourinarnega trakta, incidenca in umrljivost za rakom sečnega mehurja pa sta v Sloveniji v porastu. V radikalnem zdravljenju mišično invazivnega raka sečnega mehurja je ključnega pomena lokoregionalno zdravljenje, bolniki pa so lahko deležni tudi dodatnih koristi od sistemskega zdravljenja s kemoterapijo. Klinične raziskave faze III so pokazale pomembno podaljšanje skupnega preživetja bolnikov, ki so bili zdravljeni s kombinirano neoadjuvantno kemoterapijo na osnovi cisplatina. Kljub njeni jasno dokazani učinkovitosti se neoadjuvantna kemoterapija v vsakodnevni klinični praksi širom po svetu ni uveljavila v zadostni meri. Vsak bolnik z mišično invazivnim rakom sečnega mehurja, ki je zdravljen z namenom ozdravitve in je kandidat za sistemsko zdravljenje, bi moral biti seznanjen z možnostjo zdravljenja z neoadjuvantno kemoterapijo.