Systemic Chemotherapy for Urothelial Cancer – How to Select Systemic Therapy in Bladder Cancer

U rothelial cancer (UC) has long been recognised as a chemosensitive disease, and systemic chemotherapy plays a crucial role in the management of localised and advanced disease. Unfortunately, there has been a paucity of progress during the last 15 years in this area. Neoadjuvant use of cisplatin-based combinations has shown survival benefit and together with radical cystectomy should constitute the cornerstone of early disease management. Most importantly, Galsky criteria concerning fitness for cisplatin provide a useful tool for clinicians, in order to select patients with substantial benefit from cisplatin-based chemotherapy. Adjuvant chemotherapy may be useful in selected cases, but its wide implementation has to be proved. Recently, the advent of modern immunotherapy seems to offer new effective choices for patients with advanced UC.