Micro-papillary bladder cancer is a very aggressive subtype of transitional cell carcinoma of the bladder that typically presents with very advanced disease and progresses fast.
Due to fast progression of the disease a question of whether neoadjuvant chemotherapy is beneficial has been raised as delaying surgical treatment may predispose to disease progression.
A new small study suggests that muscle invasive micropapillary bladder cancer responds to neoadjuvant therapy and those patients who respond to the neoadjuvant therapy show improved outcomes.
At this point given our knowledge of the benefit of neoadjuvant chemotherapy in classical muscle invasive transitional cell carcinoma of the bladder and the new data, it appears that it is probably advantageous whenever possible to administer neoadjuvant chemotherapy before definitive surgical treatment for muscle invasive micropapillary bladder cancer with early radical cystectomy.
The question remains whether noninvasive micropapillary bladder cancer which is also typically treated by early cystectomy would benefit from neoadjuvant therapy. Based on disease aggressiveness and our knowledge of tumor biology my guess would be that it would be advantageous for patients to receive new adjuvant therapy in this setting as well.