Abstract
Systemic treatment of bladder cancer is indicated in patients with invasive disease. In the absence of metastatic lymph node involvement or distant metastases, radical cystectomy (RACE) is indicated, which can be preceded by neoadjuvant chemotherapy (in some patients, adjuvant chemotherapy may be appropriate).
In patients who are unable to undergo RACE, transurethral resection followed by radiotherapy or chemoradiotherapy can be performed. In case of lymph node involvement or distant metastases, palliative cancer treatment is indicated with chemotherapy being still its standard (cisplatin + gemcitabine or carboplatin + gemcitabine regimens, intensified MVAC regimen).
A more recent approach includes immunotherapy: in patients receiving cisplatin-based chemotherapy, atezo- lizumab, nivolumab and pembrolizumab have been approved, in patients for whom cisplatin is not recommended, atezolizumab and pembrolizumab have been registered. Another therapeutic use of immunotherapy is the concept of maintenance therapy with avelumab.
