Dr. Bajorin on Chemotherapy Approaches in Bladder Cancer

Dean F. Bajorin, MD, professor of Medicine, Memorial Sloan Kettering Cancer Center, discusses the standard chemotherapy approaches for patients with metastatic and muscle-invasive bladder cancer.

Historically, bladder cancer has been treated with chemotherapy in metastatic and muscle-invasive disease, Bajorin says. In the metastatic setting, there are 2 standard chemotherapy regimens. For patients who are fit, in good physical condition, and have good renal function, cisplatin-based therapy is the standard approach. One regimen is MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) and the other is a combination of gemcitabine and cisplatin. Both treatments are considered interchangeable with regard to first-line therapy, he adds.

However, in a frailer and older patient population, kidney function can be compromised. Therefore, cisplatin is not possible in many of those patients, he explains. Because of this, carboplatin-based therapy has been the mainstay treatment. There have been randomized trials of carboplatin plus gemcitabine showing it as the best tolerated therapy and, in some patients, it can have a substantial benefit.