Bladder cancer is the ninth most common cancer worldwide, with 430 000 diagnosed in 2012. More than 60% of all bladder cancer cases and half of all the 165000 bladder cancer deaths occur in the less developed regions of the world. A strong male predominance is observed with almost 75% of all bladder cancer cases occurring in men.
Major risk factors for bladder cancer include older age, male gender, Caucasian race, personal/family history of bladder cancer, smoking, and exposure to aromatic amines, such as benzidine and beta-naphthylamine used in the dye industry, dietary supplements containing aristolochic acid, and arsenic in drinking water. Prior cyclophosphamide chemotherapy and radiation therapy are well-recognised risk
factors. Mutations in the retinoblastoma gene, phosphatase and tensin homolog (PTEN) gene and Lynch syndrome are also associated with bladder cancer.
Approximately 25% of patients with a bladder cancer have muscle-invasive disease.These patients will either present or develop subsequently metastatic disease. Systemic chemotherapy is the standard initial treatment for patients with inoperable locally advanced mUC. Initial response rates are usually high and the median survival with chemotherapy is approximately 15 months. For patients with advanced unresectable or metastatic disease, treatment with a platinum based regimen has been the cornerstone of treatment. However novel agents have been introduced recently and are
showing promising results