Advances in chemotherapy of invasive bladder cancer.

A survey of the literature published during 1999 identified the following advances in the chemotherapy of advanced bladder cancer. At present there are no new chemotherapy regimens superior to MTX + VBL + ADR + CDDP (M-VAC), but improvements in multidrug therapies and the development of new drugs suggest that a new first-line chemotherapy will be established. The efficacy of neoadjuvant chemotherapy could not be validated by meta-analysis, but neoadjuvant chemotherapy can be expected to be a useful tool for individualizing therapy. If it was possible to select accurately those patients who show complete response to a certain chemotherapy regimen, then this selected group would show a 100% complete response rate on that regimen, regardless of the complete response rate of this regimen in an unselected population. Such individualization of therapy would aid in future establishment of bladder-preserving treatment methods for invasive bladder cancers.