30 research outputs found
Systemic chemotherapy in inoperable or metastatic bladder cancer
Urothelial cancer is a common malignancy. The management of patients
with recurrent disease after cystectomy or initially metastatic or
unresectable disease represents a therapeutic challenge. Systemic
chemotherapy prolongs survival but long-term survival remains
infrequent. During recent years there has been improvement due to the
use of novel chemotherapeutic agents, mainly gemcitabine and the
taxanes. The long-considered-standard MVAC has been challenged by
combinations showing more favourable toxicity profiles and equal
(gemcitabine-cisplatin) or even improved (dose-dense, G-CSF-supported
MVAC) efficacy. Specific interest has also been generated in specific
groups of patients (elderly patients, patients with renal function
impairment or comorbidities), who are not fit for the standard
cisplatin-based chemotherapy but can derive significant benefit from
carboplatin- or taxane-based treatment. Retrospective analyses have
enabled the identification of groups of patients with different
prognoses, who possibly require different therapeutic approaches. Modern
chemotherapy offers a chance of long-term survival in patients without
visceral metastases, possibly in combination with definitive local
treatment. Finally, the progress of targeted therapies in other
neoplasms seems to be reflected in advanced bladder cancer by recent
studies indicating that biological agents can be combined with modern
chemotherapy. The true role of such therapies is currently being
evaluated
Systemic chemotherapy in inoperable or metastatic bladder cancer
Urothelial cancer is a common malignancy. The management of patients
with recurrent disease after cystectomy or initially metastatic or
unresectable disease represents a therapeutic challenge. Systemic
chemotherapy prolongs survival but long-term survival remains
infrequent. During recent years there has been improvement due to the
use of novel chemotherapeutic agents, mainly gemcitabine and the
taxanes. The long-considered-standard MVAC has been challenged by
combinations showing more favourable toxicity profiles and equal
(gemcitabine-cisplatin) or even improved (dose-dense, G-CSF-supported
MVAC) efficacy. Specific interest has also been generated in specific
groups of patients (elderly patients, patients with renal function
impairment or comorbidities), who are not fit for the standard
cisplatin-based chemotherapy but can derive significant benefit from
carboplatin- or taxane-based treatment. Retrospective analyses have
enabled the identification of groups of patients with different
prognoses, who possibly require different therapeutic approaches. Modern
chemotherapy offers a chance of long-term survival in patients without
visceral metastases, possibly in combination with definitive local
treatment. Finally, the progress of targeted therapies in other
neoplasms seems to be reflected in advanced bladder cancer by recent
studies indicating that biological agents can be combined with modern
chemotherapy. The true role of such therapies is currently being
evaluated