Neoadjuvant induction dose-dense MVAC for muscle invasive bladder cancer: efficacy and safety compared with classic MVAC and gemcitabine/cisplatin
- 929 Downloads
To investigate the efficacy and safety of neoadjuvant induction dose-dense MVAC (dd-MVAC) for muscle invasive bladder cancer (MIBC). Results of the 2-week-per-cycle regimen were compared with classic MVAC (4 weeks per cycle) and gemcitabine/cisplatin (GC, 3 weeks per cycle).
We included 166 patients with non-organ-confined MIBC, who received neoadjuvant induction dd-MVAC (80), classic MVAC (35), or GC (51) between 1990 and 2014. Complete pathological response (pCR) was defined as no evidence of residual tumor in cystectomy and lymphadenectomy specimens (ypT0N0). pCR and toxicity rates were compared among regimens.
pCR was found in 29 % of dd-MVAC-treated patients, which was not significantly different from classic MVAC (20 %, p = 0.366) and GC (32 %, p = 0.845). Grade 3–4 toxicity rates related to dd-MVAC and GC (44 %) were similar (p = 0.202), whereas the toxicity rate for classic MVAC (55 %) was significantly higher than for dd-MVAC (32 %) uncorrected (p = 0.026) and corrected for patient and tumor characteristics (OR 2.84, p = 0.037).
Neoadjuvant induction dd-MVAC resulted in pathological response rates similar to classic MVAC and GC treatment in patients with non-organ-confined MIBC. The shorter cycle duration compared with classic MVAC and GC and the significantly lower toxicity rate compared with classic MVAC indicate that dd-MVAC should be the preferred option for neoadjuvant induction treatment.
KeywordsBladder cancer Neoadjuvant chemotherapy Dose dense MVAC Cisplatin
Compliance with Ethical Standards
For this type of study, formal consent is not required.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.International Collaboration of Trialists on behalf of the Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group), the European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group, the Australian Bladder Cancer Study Group, et al. (2011) International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 Trial. J Clin Oncol 29:2171–7Google Scholar
- 11.Sobin L, Gospodarowicz M, Wittekind C (2009) Urological tumours, urinary bladder. In: Sobin L, Gospodarowicz M, Wittekind C (eds) TNM classification of malignant tumors, 7th edn. Wiley, New York, pp 262–265Google Scholar
- 12.Plimack ER, Hoffman-Censits JH, Viterbo R et al (2014) Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin is safe, effective, and efficient neoadjuvant treatment for muscle-invasive bladder cancer: results of a multicenter phase II study with molecular correlates of response and toxicity. J Clin Oncol 32:1895–1901PubMedCentralCrossRefPubMedGoogle Scholar
- 17.von der Maase H, Hansen SW, Roberts JT et al (2000) 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 18:3068–3077PubMedGoogle Scholar