Review of metastatic bladder cancer.

Bladder cancer is a major cause of new cancer diagnosis throughout the world. The standard therapy for muscle-invasive bladder cancer is radical cystectomy, while superficial bladder cancer can often be managed with serial resections or intravesical therapy. The 5-year overall survival for patients undergoing radical cystectomy is only about 50%, with the majority of deaths due to metastatic bladder cancer. For these patients and for those who have metastases at diagnosis, chemotherapy with the combination of methotrexate, vinblastine, doxorubicin, and cisplatin is still the standard treatment. Gemcitabine, taxanes, ifosfamide, and pemetrexed have also demonstrated activity in bladder cancer, allowing the development of less toxic chemotherapy regimens that are the subject of ongoing clinical research. Recent insights into the biology of bladder cancer, the introduction of new chemotherapy regimens, and randomized trials of perioperative chemo-therapy have significantly improved the outlook for patients with metastatic bladder cancer. Molecular markers appear to correlate with prognosis after cystectomy, but require further clinical validation and have not replaced pathologic staging for the purpose of making adjuvant treatment decisions. Recent advances in the fields of tumor genetics, angiogenesis, and tumor immunology have been applied in the ongoing development of novel treatment strategies for this challenging disease.