Elsevier

Seminars in Oncology

Volume 39, Issue 5, October 2012, Pages 598-607
Seminars in Oncology

Advances in biology and management of bladder cancer
New Therapeutic Challenges in Advanced Bladder Cancer

https://doi.org/10.1053/j.seminoncol.2012.08.007Get rights and content

Treatment of advanced bladder cancer continues to be challenging. Despite initial high response rates with conventional cisplatin-based chemotherapy regimens, 5-year survival is suboptimal at 5% to 20%. Limited advances have been made in chemotherapy, including the design of the triplet regimen and the incorporation of dose intensification (dose-dense) formulations. Novel therapies are desperately needed for first- and second-line therapies and for both fit and unfit patients. Research efforts are now focused on several different areas of therapy, including new chemotherapeutic agents and targeted therapies. Although the use of targeted therapies has failed as of today to demonstrate benefit, a large list of new agents are being studied in properly designed and very promising phase II and III trials. A better understanding of tumor biology and identifying pathways critical for tumorigenesis can provide potential strategies for therapeutic intervention. Understanding the set of changes at the individual patient level hopefully will enable personalized treatment for patients with urothelial cancer.

Section snippets

First-Line Chemotherapy

Even though urothelial carcinoma is an aggressive epithelial tumor compared with other solid tumors, it is rather sensitive to chemotherapy. Therefore, chemotherapy with a regimen to which the patient has been unexposed remains the treatment of choice for patients with advanced bladder cancer. Different cytotoxic drugs with antitumor activity in metastatic urothelial carcinoma have shown responses in a domain of potential clinical utility (Table 1), ranging from single-agent response rates of

Summary/Conclusions

Treatment of advanced bladder cancer continues to be challenging in both the first- and second-line settings and in fit and unfit patients. Limited advances have been made with chemotherapy, including the design of the triplet regimen and the incorporation of dose-intensification (dose-dense) formulations. In second-line, vinflunine has recently been approved as monotherapy based on a superior benefit in overall survival in the population of patients that were fully eligible to be included in

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    Conflicts of interest: J.B.—consultancy and lectures fee from Pierre Fabre; D.P.P.—research support from Lilly Oncology, Sanofi Aventis.

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