Accelerating neoadjuvant chemotherapy for muscle-invasive bladder cancer

The efficacy of neoadjuvant chemotherapy before radical cystectomy for individuals with muscle-invasive bladder cancer has been evidenced since the 1990s. Although the clinical benefit of cisplatin-containing regimens is indisputable, establishing the optimal scheme has been a challenge, requiring the evaluation of efficacy, toxicity, and effect on surgical resection. In current clinical practice, the chemotherapeutic regimens most commonly used have not been tested in phase 3 trials in the neoadjuvant setting. Instead, superior efficacy has been inferred from randomised trials in advanced urothelial cancer. 1 von der Maase H Hansen SW Roberts JT et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol. 2000; 18: 3068-3077 Crossref PubMed Scopus (1968) Google Scholar Perioperative dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin in muscle-invasive bladder cancer (VESPER): survival endpoints at 5 years in an open-label, randomised, phase 3 studyOur results on overall survival at 5 years were in accordance with the primary endpoint analysis (3-year progression-free survival). We found no evidence of improved overall survival with dd-MVAC over GC in the perioperative setting, but the data support the use of six cycles of dd-MVAC over four cycles of GC in the neoadjuvant setting. These results should impact practice and future trials of immunotherapy in bladder cancer. Full-Text PDF