Unmet clinical questions in elderly patients with locally advanced and metastatic bladder cancer

Bladder cancer (BC) is a deadly disease with high prevalence in elderly population. Several therapeutic issues are still unsolved in the clinical management of these patients. Radical surgery with or without perioperative chemotherapy represents the best therapeutic strategy in early-stage disease even though recurrence rates are high and few therapy options are available for recurrent patients. Platin-based chemotherapy is currently the standard of care for advanced disease with a poor life expectancy of about 12 months. Novel therapeutic options, including molecular-targeted agents and immunotherapy, are under preclinical and clinical evaluation with promising results.A major issue in BC care is the management of elderly patients, a population with relevant co-morbidities, increased risk of life-threatening toxicities and currently not receiving the best therapy options. This review summarizes literature data about treatment strategies in elderly BC patients and the relevance of geriatric assessment to categorize fit patients who can receive standard therapies from unfit patients who should be treated with extreme caution.