PMID: 8456189Jan 1, 1993Paper

Neoadjuvant versus adjuvant chemotherapy in invasive bladder cancer

Recent Results in Cancer Research. Fortschritte Der Krebsforschung. Progrès Dans Les Recherches Sur Le Cancer
H I Scher

Abstract

In a disease where the majority of deaths occur from metastases, improvement in survival requires the integration of systemic therapies. Research efforts must continue to focus on improving case selection criteria, improving complete response proportions, and overcoming drug resistance. Recommending a single treatment plan such as radical surgery, chemotherapy, or radiation therapy for all patients with an invasive bladder cancer is rapidly becoming outdated. Case selection is being refined by focusing on both clinical and pathologic features of the tumor. The latter include evaluation of NM23 RNA levels, or DNA ploidy and T138 surface antigen expression, which have been shown to correlate with metastatic potential. The use of hematopoietic growth factors has the potential to improve both the tolerance of chemotherapy and complete response proportions, a prerequisite for cure. However, the dose response curves for most of the known active agents are not well defined, and ultimately, new agents and strategies will be required. Drug resistance is a major barrier, but as the mechanisms are unravelled, more selective therapies can be designed. For example, resistance to adriamycin and vinblastine, two of the agents in the M-VAC reg...Continue Reading

Citations

Oct 31, 1998·International Urogynecology Journal and Pelvic Floor Dysfunction·M M KirollosR A Bradbrook

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