Advances in Chemotherapy and Targeted Systemic Therapies for Urothelial Cancer

Systemic chemotherapy for cancer of the urothelial tract is used according to two main strategies. Neoadjuvant or adjuvant treatment combined with surgery and/or radiotherapy is aimed at cure of localised disease whilst treatment for advanced incurable disease allows for improved survival and palliation of symptoms. Cisplatin based combination regimens represent the standard of care in both of these settings and incorporation of gemcitabine has allowed for improvements in tolerability over older drugs. However, despite high objective response rates, impact on survival is modest. Targeted agents are now being incorporated into early phase clinical trials. These exciting new strategies hold promise for improved efficacy but with new challenges regarding toxicity profiles. This review will describe current evidence for the use of systemic chemotherapy for urothelial cancer and the state of the research evidence for use of the newer targeted agents.