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Cisplatin-Based Therapy in Muscle-Invasive Bladder Cancer

Insights From: Dean F. Bajorin, MD, MSKCC; Daniel P. Petrylak, MD, Yale;Evan Y. Yu, MD, Seattle Cancer Care
Published: Saturday, May 16, 2015

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A team-based approach that includes input from a surgeon and medical oncologist is essential for patients with muscle-invasive bladder cancer, Dean F. Bajorin, MD, notes. A multidisciplinary approach in the treatment of muscle-invasive bladder cancer appears to increase the percentage of patients receiving neoadjuvant cisplatin-based chemotherapy, according to study. 
Cisplatin-based chemotherapy can be curative in a subset of patients with muscle-invasive bladder cancer, comments Dean F. Bajorin, MD, noting that the specific regimen is not as important as utilizing a cisplatin-based regimen. Specific regimens include gemcitabine and cisplatin or MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin). Patients’ eligibility for cisplatin-based therapy will be dependent on their renal function, cardiac function, and auditory acuity.

Patients who are ineligible for cisplatin-based therapy may be given carboplatin and gemcitabine, which has less favorable median and long-term survival data compared with cisplatin-based therapy, says Bajorin. Nodal-only metastatic disease and better performance status appear to be prognostic of improved 5-year survival rates with cisplatin-based therapy. Bajorin and Evan Y. Yu, MD, concur that single-agent therapy, such as gemcitabine or a taxane, may be used in an older patient population with multiple comorbidities
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For High-Definition, Click
A team-based approach that includes input from a surgeon and medical oncologist is essential for patients with muscle-invasive bladder cancer, Dean F. Bajorin, MD, notes. A multidisciplinary approach in the treatment of muscle-invasive bladder cancer appears to increase the percentage of patients receiving neoadjuvant cisplatin-based chemotherapy, according to study. 
Cisplatin-based chemotherapy can be curative in a subset of patients with muscle-invasive bladder cancer, comments Dean F. Bajorin, MD, noting that the specific regimen is not as important as utilizing a cisplatin-based regimen. Specific regimens include gemcitabine and cisplatin or MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin). Patients’ eligibility for cisplatin-based therapy will be dependent on their renal function, cardiac function, and auditory acuity.

Patients who are ineligible for cisplatin-based therapy may be given carboplatin and gemcitabine, which has less favorable median and long-term survival data compared with cisplatin-based therapy, says Bajorin. Nodal-only metastatic disease and better performance status appear to be prognostic of improved 5-year survival rates with cisplatin-based therapy. Bajorin and Evan Y. Yu, MD, concur that single-agent therapy, such as gemcitabine or a taxane, may be used in an older patient population with multiple comorbidities
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