Bladder cancer
ICD-10 C67 · ICD-11 2C94

Treatment of Muscle-Invasive Bladder Cancer (T2–T4a, cN0-1, M0) in Patients Eligible for Cisplatin

This protocol applies to patients with muscle-invasive bladder cancer staged T2 through T4a, with nodal status cN0 or cN1 and no distant metastasis (M0), who are candidates for cisplatin-based chemotherapy.

Clinical Scenario

A key determinant of eligibility is adequate renal function: a glomerular filtration rate (eGFR) above 40 mL/min is required to qualify for cisplatin-based perioperative therapy. Regional nodal involvement up to cN1 is included within this pathway.

Treatment Approach

The strategy involves cisplatin-based perioperative chemotherapy, which in select regimens is combined with immunotherapy, integrated around radical cystectomy. The complete regimen options, selection criteria, and surgical requirements are detailed in the full protocol.

Treatment Goals

The primary endpoint at surgery is pathologic complete response (ypT0N0) or significant pathologic downstaging (≤ ypT2N0) at radical cystectomy — outcomes associated with improved prognosis.

Instant Access to Structured Evidence-Based Regimens

References

  1. Offer perioperative chemoimmunotherapy with cisplatin/gemcitabine and durvalumab to patients with muscle-invasive bladder cancer (MIBC) (T2-T4a, cN0-1 M0) who are eligible for cisplatin-based chemotherapy (glomerular filtration rate > 40mL/min. allowed) and immunotherapy.
  2. Offer neoadjuvant cisplatin-based combination chemotherapy to patients with MIBC (T2-T4a, cN0 M0) who are eligible for cisplatin-based chemotherapy.
  3. 1,063 patients underwent randomisation and received either four cycles of GC or the same chemotherapy plus durvalumab for four cycles every three weeks in the neoadjuvant part and durvalumab alone for eight cycles every four weeks in the adjuvant part.
  4. Perform a lymph node dissection (LND) as an integral part of radical cystectomy.
  5. Perform a standard LND, because an extended LND does not improve survival and increases the risk of morbidity.
  6. Neoadjuvant treatment may have a major impact on OS in patients who achieve ypT0N0 or ≤ ypT2N0.
  7. ypT0N0 after NAC and cystectomy is associated with better prognosis.
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