in muscle invasive bladder cancer,chemotherapy with Mvac regimen is given after radical or partial cystectomy or neoadjuvant chemotherapy is given?
In muscle-invasive bladder cancer (MIBC), chemotherapy with the MVAC regimen (methotrexate, vinblastine, doxorubicin, and cisplatin) can be administered both as neoadjuvant chemotherapy before radical cystectomy or as adjuvant chemotherapy after surgery. The decision regarding whether to administer neoadjuvant or adjuvant chemotherapy depends on several factors, including the stage of the cancer, the patient’s overall health and comorbidities, and the preferences of the patient and healthcare team.
- Neoadjuvant Chemotherapy: Neoadjuvant chemotherapy involves administering chemotherapy before surgery. The goal of neoadjuvant chemotherapy in MIBC is to shrink the tumor, potentially downstage the cancer, and eradicate micrometastases before surgery. This approach aims to improve surgical outcomes and long-term survival. Neoadjuvant chemotherapy with regimens such as MVAC has been shown to improve overall survival and reduce the risk of cancer recurrence compared to surgery alone in patients with MIBC.
- Adjuvant Chemotherapy: Adjuvant chemotherapy is administered after surgery to eliminate any residual cancer cells and reduce the risk of cancer recurrence. Adjuvant chemotherapy may be recommended for patients with MIBC who did not receive neoadjuvant chemotherapy or who have residual disease after surgery. Adjuvant chemotherapy aims to improve disease-free survival and overall survival by targeting any remaining cancer cells that may have spread beyond the bladder.
Both neoadjuvant and adjuvant chemotherapy have been shown to provide survival benefits in patients with MIBC, but the optimal timing of chemotherapy administration may vary depending on individual patient factors and tumor characteristics. The decision to administer neoadjuvant or adjuvant chemotherapy should be made in consultation with a multidisciplinary team of healthcare providers, including medical oncologists, urologists, and radiation oncologists, based on the specific circumstances of each patient’s case.