Frontline Treatment Approaches for Locally Advanced Urothelial Carcinoma


Preferences for treating patients with locally advanced urothelial carcinoma based on various factors, including disease presentation and patient preference.

Petros Grivas, MD, PhD: Let’s move on to the disease states. Neeraj, we talk about localized bladder cancer, which is amenable to curative intent therapy with surgery or radiation. Then we have the locally advanced but unresectable, which is not amenable to curative intent surgery. We also have distal metastases. Do you have any comments about how you contextualize these disease states of bladder cancer?

Neeraj Agarwal, MD: Absolutely. When patients come to us with localized bladder cancer, curative intent therapy is the top priority. In my experience, surgery—radical cystectomy—is the preferred choice in patients who are surgical candidates. We also offer neoadjuvant chemotherapy with cisplatin to all eligible patients. In a way, not much has aged in how we approach patients with newly diagnosed local muscle-invasive bladder cancer in the last 10 or 15 years. We offer them cisplatin-based neoadjuvant chemotherapy, if they are eligible, followed by radical cystectomy.

If patients are not eligible for surgery, I tend to offer radiation therapy and a consultation with one of my radiation oncology colleagues. As far as adjuvant therapy is concerned, we do not have level 1 evidence supporting approved adjuvant therapy in patients with bladder cancer. But if I see positive lymph nodes in patients who recently had a radical cystectomy, especially if they have not received neoadjuvant chemotherapy, I tend to offer them adjuvant chemotherapy with a cisplatin-based regimen. That’s how I would approach my patients with muscle-invasive local bladder cancer, or urothelial carcinoma.

Transcript edited for clarity.

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