Neoadjuvant chemotherapy in muscle-invasive bladder cancer

Radical cystectomy is the standard treatment for patients with muscle-invasive bladder cancer. Bladder cancer is a chemoresponsive disease and should be dealt with in a multimodality approach. Neoadjuvant chemotherapy is intended for patients with operable clinical stage T2 to T4a muscle-invasive disease to improve survival. Meta-analysis of cisplatin-containing combination neoadjuvant chemotherapy trials revealed a 5% difference in favor of neoadjuvant chemotherapy. Bladder preservation in selected patients on the basis of response to neoadjuvant chemotherapy is a feasible approach. The goal now must be to find more effective drugs and to better predict the individual response to therapy.