Chemotherapy practices and perspectives in invasive bladder cancer

Centre Léon Bérard, Department of Medical Oncology, 28 rue Laënnec, 69008 Lyon, France.
Expert Review of Anti-infective Therapy (Impact Factor: 3.46). 11/2006; 6(10):1473-82. DOI: 10.1586/14737140.6.10.1473
Source: PubMed


Bladder cancer is the fifth most common cancer in adult patients. Two-thirds of patients have superficial tumors and their treatment is conservative. Nevertheless, 30% of superficial tumors become infiltrative and represent a third of tumors at initial diagnosis. Overall mortality from bladder cancer is 30%. Important molecular events may explain the carcinogenesis and evolution of these tumors. Infiltrating bladder cancers are currently treated by radical cystectomy. Neoadjuvant chemotherapy has demonstrated a positive impact on patients' outcomes before cystectomy. Adjuvant chemotherapy after cystectomy is currently being studied in an international randomized trial. Patients with advanced disease are treated by chemotherapy with palliative intentions. Two regimens are standard: the combination of methotrexate, vinblastine, adriamycin and cisplatin, and the combination of gemcitabine and cisplatin. The addition of paclitaxel to the latter regimen is the subject of ongoing study. Only a few patients have long-term nonevolutive disease. Research must be focused on the combination of chemotherapy and targeted drugs directed through gene methylation, cytokine-receptor activation and signaling pathways.

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    • "Until now, even after successful radical cystectomy and lymph node dissection, about 50% of bladder cancer patients eventually show recurrence and have poor survival [1]. For more than 30 years, there have been many efforts to reduce the recurrence of high-risk bladder cancer after curative surgery, however, numerous clinical trials failed to show conclusive evidence on the impact of adjuvant chemotherapy even by using the most toxic combination regimens [37]. Considering these facts, blocking VEGF-C/D pathway and lymphangiogenesis could be another attractive alternative to reduce the recurrence of bladder tumor after curative radical cystectomy. "
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    ABSTRACT: Most bladder cancer patients experience lymphatic metastasis in the course of disease progression, yet the relationship between lymphangiogenesis and lymphatic metastasis is not well known. The aim of this study is to elucidate underlying mechanisms of how expanded lymphatic vessels and tumor microenvironment interacts each other and to find effective therapeutic options to inhibit lymphatic metastasis. The orthotopic urinary bladder cancer (OUBC) model was generated by intravesical injection of MBT-2 cell lines. We investigated the angiogenesis, lymphangiogenesis, and CD11b+/CD68+ tumor-associated macrophages (TAM) by using immunofluorescence staining. OUBC displayed a profound lymphangiogenesis and massive infiltration of TAM in primary tumor and lymphatic metastasis in lymph nodes. TAM flocked near lymphatic vessels and express higher levels of VEGF-C/D than CD11b- cells. Because VEGFR-3 was highly expressed in lymphatic vascular endothelial cells, TAM could assist lymphangiogenesis by paracrine manner in bladder tumor. VEGFR-3 expressing adenovirus was administered to block VEGF-C/D signaling pathway and clodronate liposome was used to deplete TAM. The blockade of VEGF-C/D with soluble VEGF receptor-3 markedly inhibited lymphangiogenesis and lymphatic metastasis in OUBC. In addition, the depletion of TAM with clodronate liposome exerted similar effects on OUBC. VEGF-C/D are the main factors of lymphangiogenesis and lymphatic metastasis in bladder cancer. Moreover, TAM plays an important role in these processes by producing VEGF-C/D. The inhibition of lymphangiogenesis could provide another therapeutic target to inhibit lymphatic metastasis and recurrence in patients with invasive bladder cancer.
    Full-text · Article · Apr 2011 · Molecular Cancer
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    ABSTRACT: Among genito-urinary tumors, gemcitabine is indicated only for the treatment of locally advanced and metastatic urothelial cancer. The combination of gemcitabine and cisplatin is a new standard in this disease. Gemcitabine shows activity in refractory germ cell tumors. In salvage treatment its role is ongoing evaluation. The combination of gemcitabine and 5-fuoruracile has modest activity in renal cell carcinoma. Pemetrexed is not indicating in genitor-urinary tumors, further evaluation in urothelial cancer is warranted.
    No preview · Article · Feb 2007 · Bulletin du cancer
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    ABSTRACT: to identify the place and role of modern chemotherapy in invasive bladder cancer. overview of the important data of papers presented in the last three years. Cisplatin-based chemotherapy with methotrexate-vinblastine-doxorubicin-cisplatin (M-VAC) or gemcitabine-cisplatin (GC) is the standard treatment and prolongs survival in metastatic disease. The paclitaxel-gemcitabine-cisplatin (TGC) protocol did not change standard therapy. Neoadjuvant chemotherapy before cystectomy for T2-3 disease provides a survival benefit compared with surgery alone. Adjuvant chemotherapy is less compelling, however, it is used in case of locally advanced, extravesical and/or lymph node-positive disease. The identification of patient's risk factors helps the decision of individual treatment strategy. Better understanding of molecular mechanisms and carcinogenetic pathways of bladder cancer and combination of old and new drugs with targeted therapy may increase the effectiveness of treatment in bladder cancer.
    No preview · Article · Feb 2007 · Magyar Onkológia
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