gemcitabine hydrochloride and cisplatin before surgery in treating patients with muscle invasive bladder cancer

Conditions: Distal Urethral Cancer; Proximal Urethral Cancer; Squamous Cell Carcinoma of the Bladder; Stage II Bladder Cancer; Stage III Bladder Cancer; Urethral Cancer Associated With Invasive Bladder Cancer

Summary: the purpose of this research study is to find out what effects, good and/or bad, dose-dense (every 14 days) chemotherapy with gemcitabine (gemcitabine hydrochloride) and cisplatin given before surgery have on patients and their muscle invasive bladder cancer.

primary objectives: i. to assess the rate of complete response (pt0) at cystectomy following preoperative dose dense gemcitabine and cisplatin (dd gc) in patients with muscle invasive urothelial carcinoma of the bladder. secondary objectives: i. to assess the toxicity profile of dd gc when given in the neoadjuvant setting: to define the number of patients who complete all three cycles of treatment without dose reduction, and to describe the incidence of toxicity. ii. to assess the 5 year overall and relapse free survival in patients who receive neoadjuvant dd gc. tertiary objectives: i. to evaluate tissue specimens from patients to assess for molecular markers that correlate with clinical outcome. outline: patients receive gemcitabine hydrochloride intravenously (iv) over 30 minutes on day 1 and cisplatin iv on day 1 or divided over days 1 and 2. treatment repeats every 14 days for 3 courses in the absence of disease progression or unacceptable toxicity. beginning 3-8 weeks after chemotherapy, patients undergo radical cystectomy. after completion of study treatment, patients are followed up for 5 years.

Eligibility criteria:
inclusion criteria: * patients must have histologically confirmed urothelial carcinoma of the bladder or urethra; patients with urothelial carcinoma of the prostatic urethra only may be included at primary investigator (pi) discretion; t-stage must be t2 to t4a; patients with radiographic n0 disease or n1 disease are eligible for the study; patients must not have radiographic evidence of metastatic disease; mixed histologies which are predominantly urothelial, such as with squamous or micropapillary differentiation, are allowed so long as there is no component of small cell histology; histology must be confirmed by a pathologist at an institution involved in this study * patients must be candidates for radical cystectomy with the goal of cure * eastern cooperative oncology group (ecog) performance status of 0 or 1 * leukocytes \>= 3,000/mcl * absolute neutrophil count \>= 1,500/mcl * platelets \>= 100,000/mcl * total bilirubin =\< institutional upper limit of normal (uln) * aspartate aminotransferase (ast)(serum glutamic oxaloacetic transaminase \[sgot\])/alanine aminotransferase (alt)(serum glutamic pyruvate transaminase \[sgpt\]) =\< 2.5 x institutional uln * patients must have adequate renal function defined as creatinine clearance \>= 50 ml/min; for eligibility, creatinine clearance may be either calculated using the cockcroft-gault formula or measured with 24 hour urine collection; note that 24 hour urine collection is required at baseline, but does not have to be used for eligibility if calculated clearance by cockcroft-gault is preferred; nephrostomy or ureteral stent placement in order to achieve adequate creatinine clearance is allowed * women of child-bearing potential (wocbp) and men with a female partner who is a wocbp must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) starting prior to beginning treatment and continuing until at least 3 months after last dose of chemotherapy and surgery; should a woman become pregnant or suspect she is pregnant while participating in this study or if a female partner of a man participating in this study becomes pregnant, the treating physician must be notified immediately; wocbp must have a negative serum or urine pregnancy test within 7 days prior to initiating study treatment * no other active malignancy * ability to understand and the willingness to sign written informed consent and health insurance portability and accountability act (hipaa) documents exclusion criteria: * patients who have had intravesicular therapy within 4 weeks of study entry, or those who have not recovered from adverse effects of such agents administered more than 4 weeks earlier * patients may not be receiving any investigational agents within 4 weeks of study entry * history of allergic reactions attributed to compounds of similar chemical or biologic composition to gemcitabine or cisplatin or other agents used in the study * uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * pregnant women are excluded from this study * known human immunodeficiency virus (hiv)-positive patients on combination antiretroviral therapy are ineligible * patients who have undergone prior radiation to greater than or equal to 25% of the bone marrow within the past year are excluded * patients who have received any previous systemic chemotherapy or radiation therapy for urothelial carcinoma within 1 year of study entry are ineligible