open access

Vol 8, No 1 (2003)
Published online: 2003-01-01
Submitted: 2002-08-20
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Treatment of bladder cancer: the present and the future

Piotr Milecki, Sergiusz Nawrocki, Iwona Skoneczna, Zbigniew Kwias
DOI: 10.1016/S1507-1367(03)70993-6
·
Rep Pract Oncol Radiother 2003;8(1):25-32.

open access

Vol 8, No 1 (2003)
Published online: 2003-01-01
Submitted: 2002-08-20

Abstract

Bladder cancer is one of the most frequent tumours of the urinary tract and the treatment of this malignancy requires close co-operation between urologists and oncologists. The superficial disease is treated with good results with transurethral resections and local immunotherapy or chemotherapy. However, there is a considerable fraction of BCG-refractory tumours (30%) and progression to muscle-invasive cancer. New approaches such as BCG combined with low-dose interferon or recombinant BCG strains are promising but need to be explored in prospective trials. Better understanding of the tumour biology and immunology will probably make it possible select patients with a high risk of progressive disease and to tailor further therapy options.

The cornerstone of muscle invasive tumours treatment is radical cystectomy. The neoadjuvant chemotherapy is a promising option, especially in tumours invading deeply into the bladder wall or infiltrating the surrounding organs, but it require furthers confirmation of the results in phase III trials before introducing it as a standard treatment. However some leading centers have already implemented neoadjuvant chemotherapy in some selected groups of patients (eg. M.D. Anderson). Combined chemotherapy and modern 3-D conformal radiotherapy enable us to preserve the organ and the function of the bladder (bladder conserving therapy) and they are intensively studied in current trials.

In the near future molecular characterisation of individual tumours might help to choose a bladder conserving therapy or cystectomy adopted to a for particular patient. So far, four-drug regimen – MVAC has been widely used in metastatic and locally advanced disease. Recently, it was shown that a combination of gemcitabine and cisplatin (GC) is equally effective but less toxic. New chemotherapies tested in clinical trials include gemcitabine, taxanes and new-class drugs interfering with signal transduction. Individualization of established and experimental treatment options based on molecular tumour characteristics, such as p53 status will probably be the future of bladder cancer pharmacotherapy.

Abstract

Bladder cancer is one of the most frequent tumours of the urinary tract and the treatment of this malignancy requires close co-operation between urologists and oncologists. The superficial disease is treated with good results with transurethral resections and local immunotherapy or chemotherapy. However, there is a considerable fraction of BCG-refractory tumours (30%) and progression to muscle-invasive cancer. New approaches such as BCG combined with low-dose interferon or recombinant BCG strains are promising but need to be explored in prospective trials. Better understanding of the tumour biology and immunology will probably make it possible select patients with a high risk of progressive disease and to tailor further therapy options.

The cornerstone of muscle invasive tumours treatment is radical cystectomy. The neoadjuvant chemotherapy is a promising option, especially in tumours invading deeply into the bladder wall or infiltrating the surrounding organs, but it require furthers confirmation of the results in phase III trials before introducing it as a standard treatment. However some leading centers have already implemented neoadjuvant chemotherapy in some selected groups of patients (eg. M.D. Anderson). Combined chemotherapy and modern 3-D conformal radiotherapy enable us to preserve the organ and the function of the bladder (bladder conserving therapy) and they are intensively studied in current trials.

In the near future molecular characterisation of individual tumours might help to choose a bladder conserving therapy or cystectomy adopted to a for particular patient. So far, four-drug regimen – MVAC has been widely used in metastatic and locally advanced disease. Recently, it was shown that a combination of gemcitabine and cisplatin (GC) is equally effective but less toxic. New chemotherapies tested in clinical trials include gemcitabine, taxanes and new-class drugs interfering with signal transduction. Individualization of established and experimental treatment options based on molecular tumour characteristics, such as p53 status will probably be the future of bladder cancer pharmacotherapy.

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Keywords

Bladder cancer; chemotherapy; immunotherapy; radiotherapy; gene therapy

About this article
Title

Treatment of bladder cancer: the present and the future

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 8, No 1 (2003)

Pages

25-32

Published online

2003-01-01

DOI

10.1016/S1507-1367(03)70993-6

Bibliographic record

Rep Pract Oncol Radiother 2003;8(1):25-32.

Keywords

Bladder cancer
chemotherapy
immunotherapy
radiotherapy
gene therapy

Authors

Piotr Milecki
Sergiusz Nawrocki
Iwona Skoneczna
Zbigniew Kwias

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