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September 2015

Benefits of Adjuvant Chemotherapy for Bladder Cancer

Author Affiliations
  • 1Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Ontario, Canada
  • 2Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
JAMA Oncol. 2015;1(6):727-728. doi:10.1001/jamaoncol.2015.1210

Despite radical surgery or radiotherapy, approximately 50% of patients with muscle-invasive bladder cancer (MIBC) will relapse and die. To improve on these outcomes, a series of randomized controlled trials (RCTs) evaluating neoadjuvant (NACT) and adjuvant chemotherapy (ACT) were launched in the 1980s.

By the early 2000s there was level 1 evidence in support of NACT. Accruing to clinical trials of ACT has been more difficult, and there is a lack of high-quality data to inform oncologists about the role of ACT. If clinicians and patients had widely adopted NACT, lack of evidence in support of ACT would be moot; however, the reality is that very few patients in North America are treated with NACT.1,2 In the past few years, a series of studies have shown benefit for ACT in patients with muscle-invasive bladder cancer (MIBC).2-5 In this Viewpoint, we review the convergence of evidence in support of ACT for bladder cancer and propose that despite the lack of level 1 evidence it is time for perioperative chemotherapy for bladder cancer (neoadjuvant or adjuvant) to become standard of care.

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1 Comment for this article
Prakash Thapaliya | Peacehealth
If patients were treated after prospective discussion in a multidisciplinary team,more people would be getting NACT.But I have found out that many times they get surgery, before seeing medical oncologists, in the community setting.