Chemotherapy for bladder cancer

Transitional cell carcinoma (TCC) of the urinary bladder is the second most common genitourinary malignancy. Each year, over 73,000 new cases are reported in Europe and over 56,000 new cases in the United States. A substantial percentage of these patients develop metastases despite initial management for presumed localized disease, whereas others have metastases at the time of presentation. Once metastasis occurs, the median survival for patients with TCC is approximately 1 year. To improve this poor survival rate, intense efforts over the past two decades have focused on the development of active chemotherapeutic regimens for use in this disease, both in the perioperative setting and in the setting of advanced disease. Chemotherapy for advanced disease is discussed here first because of its impact on the management of early-stage disease.