New developments in urothelial cancer

Urothelial cancer is among the most chemotherapy-sensitive neoplasms of all the solid tumors. However, for the majority of patients with advanced disease, response durations with conventional treatment are relatively short. Second-line systemic treatment regimens are associated with modest response rates and poor outcomes. Trials in both the first- and second-line settings have demonstrated that a ceiling in efficacy has likely been reached with cytotoxic drugs, particularly in unselected patient populations. Promising areas of investigation include integrating predictive biomarkers to optimize patient selection for specific therapies, disrupting driving oncogenomic mutations, and associated signaling pathways and cotargeting both tumor and the immune system or tumor stroma. In addition, expanded sources of evidence generation are of interest in an effort to refine treatment for the general population of patients with advanced urothelial cancer, not only those who meet the narrow eligibility criteria used in most clinical trials.

SEOM clinical guidelines for the treatment of invasive bladder cancer

The purpose of this article is to provide updated recommendations for the diagnosis and treatment of muscle- invasive and metastatic bladder cancer. The diagnosis of muscle-invasive bladder cancer is made by transurethral resection and following histopathologic evaluation. Invasive bladder cancer should be staged according to the UICC system. Patients with confirmed muscle-invasive bladder cancer should be staged by computed tomography scans of the chest, abdomen and pelvis. Radical cystectomy is the treatment of choice for both sexes and lymph node dissection should be an integral part of cystectomy. In muscle- invasive bladder cancer (cT2-4aN0M0) patients with good performance status (PS 0-1) and correct renal function, neoadjuvant chemotherapy should be recommended. Adjuvant chemotherapy is widely used in high-risk patients with pathologic stage T3 or T4 and/or positive nodes and within clinical trials. Multimodality bladder-preserving treatment in localised disease is currently regarded only as an alternative in selected, well informed and compliant patients for whom cystectomy is not considered for clinical or personal reasons. In metastatic disease, the first-line treatment for patients is cisplatin-containing combination chemotherapy. Recently, vinflunine has been approved in Europe for second-line treatment and is an option for second-line therapy in patients progressing to first-line platinum-based chemotherapy.