Patients with early stage non muscle invasive bladder cancer usually undergoing transurethral tumor resection followed by local therapy with BCG or chemotherapy and are being followed closely by their urologists. Patients with more advanced disease but still local, should undergo chemotherapy prior to surgery.
This treatment is called neoadjuvant chemotherapy and is consistent of platinum based therapy and ideally should be dose dense MVAC (treatment every 2 weeks for 4-6 cycles with cisplatin, vinblastine, adriamycin, methotrexate) while there is evidence that cisplatin with gemcitabine could also be used in the neoadjuvant setting. For patients who did not receive neoadjuvant chemotherapy, the standard approach will be to give adjuvant chemotherapy with cisplatin/gemcitabine post operatively. For patients with metastatic disease the only approved first line therapy is platinum based treatment while there are a few second line options with some modest response rates. For patients with small cell features in their initial histology the treatment should be directed to the small cell component and so managed with platinum doublet and etoposide chemotherapy regimen. Given the overall poor prognosis and aggressiveness of urothelial cancer, we are encouraging our patients to participate into clinical trials so we can offer them more treatment options that they could not receive otherwise and that will help the scientific community to better understand this disease entity.