Adjuvant chemotherapy in bladder cancer patients with histological variants: time to change the approach?

Bladder cancer (BCa) is a common malignancy, with about 81,190 estimated new cases and 17,240 estimated deaths in the United States in 2018 (1). Neoadjuvant cisplatin-based combination chemotherapy (NAC) followed by radical cystectomy (RC) with bilateral pelvic lymph node dissection is currently considered the standard of care in muscle-invasive bladder cancer (MIBC) patients (2). However, 5 years survival after surgery is approximately 50% (3). In this regard, adjuvant cisplatin based-chemotherapy (AC) improves survival outcomes and should be administered in medically fit, NAC naïve patients with pT3/4 and/or positive nodes diseases at RC (2).