Neoadjuvant Chemotherapy in Invasive Bladder Cancer: Update of a Systematic Review and Meta-Analysis of Individual Patient Data

To update a systematic review and meta-analysis that assesses the effect of neoadjuvant chemotherapy in the treatment of patients with invasive bladder cancer.Following a prespecified protocol, we analysed updated individual patient data from all eligible randomised controlled trials that compared neoadjuvant chemotherapy plus local treatment with the same local treatment alone.Updated results are based on 11 trials, 3005 patients; comprising 98% of all patients from known eligible randomised controlled trials. We found a significant survival benefit associated with platinum-based combination chemotherapy (HR = 0.86, 95% CI 0.77-0.95, p = 0.003). This is equivalent to a 5% absolute improvement in survival at 5 years. There was also a significant disease-free survival benefit associated with platinum-based combination chemotherapy (HR = 0.78 95% CI 0.71-0.86, p < 0.0001), equivalent to a 9% absolute improvement at 5 years.These results provide the best available evidence in support of the use of neoadjuvant platinum-based combination chemotherapy.