Neoadjuvant chemotherapy in patients with muscle invasive bladder cancer. From literature review to clinical practice: it's a long way to go...

In general oncology, neoadjuvant chemotherapy is given in patients at operable stages before local treatment for two principal reasons: to improve survival by eliminating micrometastases and to select patients for organ preservation strategies. In patients with muscle-invasive bladder cancer, data from clinical trials and meta-analyses have shown a significant benefit in overall survival, with a 5% absolute benefit at 5 years, provided neoadjuvant cisplatin-based combination chemotherapy is used. However, these results have not convinced the medical community since adjuvant chemotherapy after primary cystectomy is frequently used in daily practice. Additionally, bladder sparing in selected patients on the basis of response to neoadjuvant chemotherapy has been described as a feasible approach in some selected centres. These results have to be confirmed by large prospective cooperative studies. The identification of individual or multiple molecular markers, which may identify these patients who are more likely to benefit from neoadjuvant chemotherapy is a major endpoint for the next decade.