Neoadjuvant gemcitabine and cisplatin: Another step on the path toward improving the outcomes of patients with high-risk, invasive bladder cancer

摘要: I nvasive bladder cancer is a common and dangerous disease that becoming only more prevalent as the population ages. Radical surgical therapy with curative intent has been continues to be mainstay in management of this condition; however, approximately half clinically localized cases go on develop distant metastases postoperatively. Platinum-based combination chemotherapy (methotrexate, vinblastine, doxorubicin, cisplatin [MVAC]) emerged than 20 years ago studies pioneered by Dr. Alan Yagoda associates at Memorial Sloan-Kettering first effective systemic for metastatic urothelial carcinoma. Despite major advance, well concomitant improvements perioperative care, mortality rates have not seen dramatic improvement recent years. A review survival outcomes contemporary versus historical cystectomy series (before after 1985) stratified pathologic stage revealed modest modern era, 5year 60% 67% pT2, 33% 35% pT3, 21% 27% pT4. The casual observer could forgiven less sanguine view state art setting; 2008, there clear room patients high-risk, muscle-invasive cancer. observation responses primary tumor among led evaluation MVAC given before body literature over past 2 decades supporting neoadjuvant platinum-based followed radical particularly promising strategy improve patient outcomes. meta-analysis 3000 patients, representing 98% all relevant randomized controlled trials, demonstrated significant benefit associated cisplatin-based chemotherapy, equivalent 5% See referenced original article pages 2471–7, issue.