Dr. Wright on Frontline Considerations in Locally Advanced Bladder Cancer

Jonathan L. Wright, MD, MS, FACS, medical director of the University of Washington Medical Center Urology Clinic, associate professor of urology at University of Washington, and affiliate investigator at the Fred Hutchinson Cancer Research Center, discusses frontline considerations in patients with locally advanced, muscle-invasive bladder cancer.

The first decision that has to be made is whether or not the patient should receive neoadjuvant chemotherapy and if they are a candidate for chemotherapy, says Wright. Patients who undergo radical cystectomy must be carefully monitored following the procedure to determine the role of adjuvant chemotherapy. Determining whether or not a patient qualifies for bladder preservation is another component of care in this setting.

In terms of selection criteria for neoadjuvant chemotherapy, patients should be eligible for cisplatin with muscle-invasive or locally advanced T3, T4, and/or node-positive disease; that includes those who have adequate renal function and no significant hearing loss, peripheral neuropathy, says Wright. The main factor is to identify patients who are primarily eligible for cisplatin based on renal function, as that is the best treatment available in the neoadjuvant setting, Wright concludes.