Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer
Background: We aimed to provide a comprehensive literature review on the best practice management of patients with nonmetastatic muscle-invasive bladder cancer (MIBC) using neoadjuvant chemotherapy (NAC). Method: Between July and September 2018, we conducted a systematic review using MEDLINE and EMB...
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Series: | Therapeutic Advances in Urology |
Online Access: | https://doi.org/10.1177/1756287218823678 |
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doaj-795be4a5f2274e979d7e3fc96ea4b11c2020-11-25T03:17:43ZengSAGE PublishingTherapeutic Advances in Urology1756-28802019-01-011110.1177/1756287218823678Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancerGautier MarcqEdouard JarryIdir OuzaidJean-François HermieuFrançois HenonJean-Christophe FantoniEvanguelos XylinasBackground: We aimed to provide a comprehensive literature review on the best practice management of patients with nonmetastatic muscle-invasive bladder cancer (MIBC) using neoadjuvant chemotherapy (NAC). Method: Between July and September 2018, we conducted a systematic review using MEDLINE and EMBASE electronic bibliographic databases. The search strategy included the following terms: Neoadjuvant Therapy and Urinary Bladder Neoplasms. Results: There is no benefit of a single-agent platinum-based chemotherapy. Platinum-based NAC is the gold standard therapy and mainly consists of a combination of cisplatin, vinblastine, methotrexate, doxorubicin, gemcitabine or even epirubicin (MVAC). At 5 years, the absolute overall survival benefit of MVAC was 5% and the absolute disease-free survival was improved by 9%. This effect was observed independently of the type of local treatment and did not vary between subgroups of patients. Moreover, a ypT0 stage (complete pathological response) after radical cystectomy was a surrogate marker for improved oncological outcomes. High-density MVAC has been shown to decrease toxicity (with a grade 3–4 toxicity ranging from 0% to 26%) without impacting oncological outcomes. To date, there is no role for carboplatin administration in the neoadjuvant setting in patients that are unfit for cisplatin-based NAC administration. So far, there is no published trial evaluating the role of immunotherapy in a neoadjuvant setting, but many promising studies are ongoing. Conclusion: There is a strong level of evidence supporting the clinical use of a high-dose-intensity combination of methotrexate, vinblastine, doxorubicin and cisplatin in a neoadjuvant setting. The landscape of MIBC therapies should evolve in the near future with emerging immunotherapies.https://doi.org/10.1177/1756287218823678 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gautier Marcq Edouard Jarry Idir Ouzaid Jean-François Hermieu François Henon Jean-Christophe Fantoni Evanguelos Xylinas |
spellingShingle |
Gautier Marcq Edouard Jarry Idir Ouzaid Jean-François Hermieu François Henon Jean-Christophe Fantoni Evanguelos Xylinas Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer Therapeutic Advances in Urology |
author_facet |
Gautier Marcq Edouard Jarry Idir Ouzaid Jean-François Hermieu François Henon Jean-Christophe Fantoni Evanguelos Xylinas |
author_sort |
Gautier Marcq |
title |
Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer |
title_short |
Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer |
title_full |
Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer |
title_fullStr |
Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer |
title_full_unstemmed |
Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer |
title_sort |
contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer |
publisher |
SAGE Publishing |
series |
Therapeutic Advances in Urology |
issn |
1756-2880 |
publishDate |
2019-01-01 |
description |
Background: We aimed to provide a comprehensive literature review on the best practice management of patients with nonmetastatic muscle-invasive bladder cancer (MIBC) using neoadjuvant chemotherapy (NAC). Method: Between July and September 2018, we conducted a systematic review using MEDLINE and EMBASE electronic bibliographic databases. The search strategy included the following terms: Neoadjuvant Therapy and Urinary Bladder Neoplasms. Results: There is no benefit of a single-agent platinum-based chemotherapy. Platinum-based NAC is the gold standard therapy and mainly consists of a combination of cisplatin, vinblastine, methotrexate, doxorubicin, gemcitabine or even epirubicin (MVAC). At 5 years, the absolute overall survival benefit of MVAC was 5% and the absolute disease-free survival was improved by 9%. This effect was observed independently of the type of local treatment and did not vary between subgroups of patients. Moreover, a ypT0 stage (complete pathological response) after radical cystectomy was a surrogate marker for improved oncological outcomes. High-density MVAC has been shown to decrease toxicity (with a grade 3–4 toxicity ranging from 0% to 26%) without impacting oncological outcomes. To date, there is no role for carboplatin administration in the neoadjuvant setting in patients that are unfit for cisplatin-based NAC administration. So far, there is no published trial evaluating the role of immunotherapy in a neoadjuvant setting, but many promising studies are ongoing. Conclusion: There is a strong level of evidence supporting the clinical use of a high-dose-intensity combination of methotrexate, vinblastine, doxorubicin and cisplatin in a neoadjuvant setting. The landscape of MIBC therapies should evolve in the near future with emerging immunotherapies. |
url |
https://doi.org/10.1177/1756287218823678 |
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