Muscle-invasive and metastatic bladder cancer: current and emerging therapies

The most common malignance of the urinary tract is urothelial cell carcinoma. The standard of care of non muscle invasive bladder cancer, intravesical chemo- and immunotherapy, while effective, is associated with a considerable side-effect profile and an elevated number of failures: approximately 30% of patients either do not respond to treatment or reveal recurrent disease within 5 years. Muscle invasive bladder cancer is life threatening, showing modest chemosensitivity, and usually requires radical cystectomy with or without neoadjuvant chemotherapy which may improve the overall survival benefit. Although bladder cancer is fairly well-genetically characterized, clinical trials with molecularly targeted agents have, in comparison to other solid tumors, been few in number and largely unsuccessful. Hence, bladder cancer represents a considerable opportunity and challenge for alternative therapies