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Current Status of Perioperative Therapy in Muscle-Invasive Bladder Cancer and Future Directions

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A Correction to this article was published on 20 April 2023

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Abstract

Purpose of Review

Cisplatin-based combination chemotherapy has been a standard of care in the perioperative management of muscle-invasive bladder cancer for years, but several novel therapies are under active investigation. This review aims to provide an update on recent relevant literature and a forward look at the future landscape of adjuvant and neoadjuvant therapy in muscle-invasive bladder cancer patients who opt for radical cystectomy.

Recent Findings

The recent approval of nivolumab as adjuvant therapy established a new treatment option for high-risk patients with muscle-invasive bladder cancer after radical cystectomy. Several phase II studies of chemo-immunotherapy combinations and immunotherapy alone have reported pathological complete responses in the 26–46% range, including studies in cisplatin-ineligible patients. Randomized studies of perioperative chemo-immunotherapy, immunotherapy alone, and enfortumab vedotin are ongoing.

Summary

Muscle-invasive bladder cancer remains a challenging disease associated with significant morbidity and mortality; however, increasing options in systemic therapy and an increasingly personalized approach to cancer treatment suggest continued future improvements in patient care.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022. https://doi.org/10.3322/caac.21708.

    Article  PubMed  Google Scholar 

  2. Sanchez A, Wszolek MF. Bladder cancer: quality of life in patients with non-muscle-invasive bladder cancer. Nat Rev Urol. 2015. https://doi.org/10.1038/nrurol.2015.12.

    Article  PubMed  Google Scholar 

  3. Flaig TW. NCCN guidelines updates: management of muscle-invasive bladder cancer. J Natl Compr Canc Netw. 2019;17:591–3.

    CAS  PubMed  Google Scholar 

  4. Griffiths G. 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. 2011. https://doi.org/10.1200/JCO.2010.32.3139.

    Article  PubMed  Google Scholar 

  5. Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003;349:859–66.

    Article  CAS  PubMed  Google Scholar 

  6. Powles T, Csőszi T, Özgüroğlu M, et al. Pembrolizumab alone or combined with chemotherapy versus chemotherapy as first-line therapy for advanced urothelial carcinoma (KEYNOTE-361): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021. https://doi.org/10.1016/S1470-2045(21)00152-2.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Vale C. Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. The Lancet. 2003;361:1927–34.

    Article  CAS  Google Scholar 

  8. Meeks JJ, Bellmunt J, Bochner BH, et al. A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer. Eur Urol. 2012;62:523–33.

    Article  CAS  PubMed  Google Scholar 

  9. Grant C, Amdur R, Whalen M. Trends in the use of neoadjuvant chemotherapy for bladder cancer with nonurothelial variant histology: an analysis of the National Cancer Database. Indian J Urol. 2019. https://doi.org/10.4103/iju.iju_142_19.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Choueiri TK, Jacobus S, Bellmunt J, et al. Neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin with pegfilgrastim support in muscle-invasive urothelial cancer: pathologic, radiologic, and biomarker correlates. J Clin Oncol. 2014. https://doi.org/10.1200/JCO.2013.52.4785.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Plimack ER, Hoffman-Censits JH, Viterbo R, et al. 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. 2014. https://doi.org/10.1200/JCO.2013.53.2465.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Iyer G, Balar AV, Milowsky MI, et al. Multicenter prospective phase ii trial of neoadjuvant dose-dense gemcitabine plus cisplatin in patients with muscle-invasive bladder cancer. J Clin Oncol. 2018. https://doi.org/10.1200/JCO.2017.75.0158.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Flaig TW, Tangen CM, Daneshmand S, et al. Clin Cancer Res. 2021. https://doi.org/10.1158/1078-0432.CCR-20-2409.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Flaig TW, Tangen C, Daneshmand S, et al. SWOG S1314: a randomized phase II study of co-expression extrapolation (COXEN) with neoadjuvant chemotherapy for localized, muscle-invasive bladder cancer with overall survival follow up. J Clin Oncol. 2022;40:536–536.

    Article  Google Scholar 

  15. Pfister C, Gravis G, Fléchon A, et al. Randomized phase III trial of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin, or gemcitabine and cisplatin as perioperative chemotherapy for patients with muscle-invasive bladder cancer. Analysis of the GETUG/AFU V05 VESPER trial secondary endpoints: chemotherapy toxicity and pathological responses [Formula presented]. Eur Urol. 2021. https://doi.org/10.1016/j.eururo.2020.08.024.

    Article  PubMed  PubMed Central  Google Scholar 

  16. • Pfister C, Gravis G, Fléchon A, et al. Dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin or gemcitabine and cisplatin as perioperative chemotherapy for patients with nonmetastatic muscle-invasive bladder cancer: results of the GETUG-AFU V05 VESPER Trial. J Clin Oncol. 2022;40:2013–22. This study demonstrated a higher local control rate and significant improvement in 3-year PFS for dd-MVAC compared to GC for neoadjuvant chemotherapy for MIBC, although with 6 cycles of dd-MVAC compared to 4 cycles of GC.

    Article  CAS  PubMed  Google Scholar 

  17. Galsky MD, Arija JÁA, Bamias A, et al. Atezolizumab with or without chemotherapy in metastatic urothelial cancer (IMvigor130): a multicentre, randomised, placebo-controlled phase 3 trial. The Lancet. 2020. https://doi.org/10.1016/S0140-6736(20)30230-0.

    Article  PubMed  Google Scholar 

  18. Rose TL, Harrison MR, Deal AM, et al. Phase II study of gemcitabine and split-dose cisplatin plus pembrolizumab as neoadjuvant therapy before radical cystectomy in patients with muscle-invasive bladder cancer. J Clin Oncol. 2021. https://doi.org/10.1200/JCO.21.01003.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hoimes CJ, Adra N, Fleming MT, et al. Phase Ib/II neoadjuvant (N-) pembrolizumab (P) and chemotherapy for locally advanced urothelial cancer (laUC): final results from the cisplatin (C)-eligible cohort of HCRN GU14-188. J Clin Oncol. 2020. https://doi.org/10.1200/jco.2020.38.15_suppl.5047.

    Article  PubMed  Google Scholar 

  20. Kaimakliotis HZ, Adra N, Kelly WK, et al. Phase II neoadjuvant (N-) gemcitabine (G) and pembrolizumab (P) for locally advanced urothelial cancer (laUC): interim results from the cisplatin (C)-ineligible cohort of GU14-188. J Clin Oncol. 2020. https://doi.org/10.1200/jco.2020.38.15_suppl.5019.

    Article  Google Scholar 

  21. Gupta S, Sonpavde G, Weight CJ, et al. Results from BLASST-1 (Bladder Cancer Signal Seeking Trial) of nivolumab, gemcitabine, and cisplatin in muscle invasive bladder cancer (MIBC) undergoing cystectomy. J Clin Oncol. 2020. https://doi.org/10.1200/jco.2020.38.6_suppl.439.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gupta S, Gibb E, Sonpavde GP, et al. Biomarker analysis and updated clinical follow-up from BLASST-1 (Bladder Cancer Signal Seeking Trial) of nivolumab, gemcitabine, and cisplatin in patients with muscle-invasive bladder cancer (MIBC) undergoing cystectomy. J Clin Oncol. 2022. https://doi.org/10.1200/jco.2022.40.6_suppl.528.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cathomas R, Petrausch U, Hayoz S, et al. Perioperative chemoimmunotherapy with durvalumab (Durva) in combination with cisplatin/gemcitabine (Cis/Gem) for operable muscle-invasive urothelial carcinoma (MIUC): preplanned interim analysis of a single-arm phase II trial (SAKK 06/17). J Clin Oncol. 2020. https://doi.org/10.1200/jco.2020.38.6_suppl.499.

    Article  Google Scholar 

  24. Cathomas R, Rothschild S, Hayoz S, et al. Safety and efficacy of perioperative cisplatin/gemcitabine (cis/gem) and durvalumab (durva) for operable muscle-invasive urothelial carcinoma (MIUC): SAKK 06/17. J Clin Oncol. 2021. https://doi.org/10.1200/jco.2021.39.6_suppl.430.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Funt SA, Lattanzi M, Whiting K, et al. Neoadjuvant atezolizumab with gemcitabine and cisplatin in patients with muscle-invasive bladder cancer: a multicenter, single-arm, phase II trial. J Clin Oncol. 2022. https://doi.org/10.1200/JCO.21.01485.

    Article  PubMed  Google Scholar 

  26. Bandini M, Gibb EA, Gallina A, et al. Does the administration of preoperative pembrolizumab lead to sustained remission post-cystectomy? First survival outcomes from the PURE-01 study☆. Ann Oncol. 2020. https://doi.org/10.1016/j.annonc.2020.09.011.

    Article  PubMed  Google Scholar 

  27. Powles T, Kockx M, Rodriguez-Vida A, et al. Clinical efficacy and biomarker analysis of neoadjuvant atezolizumab in operable urothelial carcinoma in the ABACUS trial. Nat Med. 2019. https://doi.org/10.1038/s41591-019-0628-7.

    Article  PubMed  Google Scholar 

  28. van Dijk N, Gil-Jimenez A, Silina K, et al. Preoperative ipilimumab plus nivolumab in locoregionally advanced urothelial cancer: the NABUCCO trial. Nat Med. 2020. https://doi.org/10.1038/s41591-020-1085-z.

    Article  PubMed  Google Scholar 

  29. Grivas P, Yin J, Koshkin VS, et al. PrE0807: a phase Ib feasibility trial of neoadjuvant nivolumab (N) without or with lirilumab (L) in cisplatin-ineligible patients (pts) with muscle-invasive bladder cancer (MIBC). J Clin Oncol. 2021;39:4518–4518.

    Article  Google Scholar 

  30. Yin M, Joshi M, Meijer RP, Glantz M, Holder S, Harvey HA, Kaag M, Fransen van de Putte EE, Horenblas S, Drabick JJ. Neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and two-step meta-analysis. Oncologist. 2016;21:708–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Burdett S, Fisher DJ, Vale CL, et al. Adjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and meta-analysis of individual participant data from randomised controlled trials. Eur Urol. 2022. https://doi.org/10.1016/j.eururo.2021.09.028.

    Article  Google Scholar 

  32. Donat SM, Shabsigh A, Savage C, Cronin AM, Bochner BH, Dalbagni G, Herr HW, Milowsky MI. Potential impact of postoperative early complications on the timing of adjuvant chemotherapy in patients undergoing radical cystectomy: a high-volume tertiary cancer center experience. Eur Urol. 2009. https://doi.org/10.1016/j.eururo.2008.07.018.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sternberg CN, Skoneczna I, Kerst JM, et al. Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (EORTC 30994): an intergroup, open-label, randomised phase 3 trial. Lancet Oncol. 2015. https://doi.org/10.1016/S1470-2045(14)71160-X.

    Article  PubMed  Google Scholar 

  34. Bharadwaj M, Kaul S, Fleishman A, et al. Adjuvant chemotherapy versus observation following radical cystectomy for locally advanced urothelial carcinoma of the bladder. Urol Oncol: Semin Orig Investig. 2022. https://doi.org/10.1016/j.urolonc.2022.02.002.

    Article  Google Scholar 

  35. Haque W, Lewis GD, Verma V, Darcourt JG, Butler EB, Teh BS. The role of adjuvant chemotherapy in locally advanced bladder cancer. Acta Oncol (Madr). 2018. https://doi.org/10.1080/0284186X.2017.1415461.

    Article  Google Scholar 

  36. Sharma P, Retz M, Siefker-Radtke A, et al. Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275): a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2017. https://doi.org/10.1016/S1470-2045(17)30065-7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. •• Bajorin DF, Witjes JA, Gschwend JE, et al. Adjuvant nivolumab versus placebo in muscle-invasive urothelial carcinoma. N Engl J Med. 2021. https://doi.org/10.1056/nejmoa2034442. This study established nivolumab as a standard of care option for adjuvant treatment of patients with high-risk MIBC after RC.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Bellmunt J, Hussain M, Gschwend JE, et al. Adjuvant atezolizumab versus observation in muscle-invasive urothelial carcinoma (IMvigor010): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2021. https://doi.org/10.1016/S1470-2045(21)00004-8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. • Powles T, Assaf ZJ, Davarpanah N, et al. ctDNA guiding adjuvant immunotherapy in urothelial carcinoma. Nat. 2021. https://doi.org/10.1038/s41586-021-03642-9. Findings from this study identified ctDNA as a biomarker that may be useful in predicting improved response to adjuvant immunotherapy in high-risk MIBC patients after RC.

    Article  Google Scholar 

  40. Powles T, Meeks JJ, Galsky MD, et al. A phase III, randomized, open-label, multicenter, global study of efficacy and safety of durvalumab in combination with gemcitabine plus cisplatin for neoadjuvant treatment followed by durvalumab alone for adjuvant treatment in muscle-invasive bladder cancer (NIAGARA). J Clin Oncol. 2021. https://doi.org/10.1200/jco.2021.39.6_suppl.tps505.

    Article  PubMed  Google Scholar 

  41. Siefker-Radtke AO, Steinberg GD, Bedke J, Nishiyama H, Fang X, Kataria R, Homet Moreno B, Hoimes CJ. Phase III study of perioperative pembrolizumab (pembro) plus neoadjuvant chemotherapy (chemo) versus placebo plus neoadjuvant chemo in cisplatin-eligible patients (pts) with muscle-invasive bladder cancer (MIBC): KEYNOTE-866. J Clin Oncol. 2020. https://doi.org/10.1200/jco.2020.38.6_suppl.tps599.

    Article  Google Scholar 

  42. Sonpavde G, Necchi A, Gupta S, et al. ENERGIZE: a phase III study of neoadjuvant chemotherapy alone or with nivolumab with/without linrodostat mesylate for muscle-invasive bladder cancer. Future Oncol. 2019. https://doi.org/10.2217/fon-2019-0611.

    Article  PubMed  Google Scholar 

  43. Apolo AB, Rosenberg JE, Kim WY, et al. Alliance A031501: phase III randomized adjuvant study of MK-3475 (pembrolizumab) in muscle-invasive and locally advanced urothelial carcinoma (MIBC) (AMBASSADOR) versus observation. J Clin Oncol. 2019. https://doi.org/10.1200/jco.2019.37.7_suppl.tps504.

    Article  Google Scholar 

  44. • Powles T, Rosenberg JE, Sonpavde GP, et al. Enfortumab vedotin in previously treated advanced urothelial carcinoma. N Engl J Med. 2021. https://doi.org/10.1056/nejmoa2035807. This study identified significantly prolonged survival with EV compared to standard chemotherapy for patients with locally advanced or metastatic urothelial carcinoma who had previously received platinum-based chemotherapy and a PD-1 or PD-L1 inhibitor. These findings have led to several ongoing trials investigating the use of EV in perioperative management of MIBC.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Hoimes CJ, Rosenberg JE, Petrylak DP, Carret A-S, Sasse C, Chaney MF, Flaig TW. Study EV-103: new cohorts testing enfortumab vedotin alone or in combination with pembrolizumab in muscle invasive urothelial cancer. J Clin Oncol. 2020. https://doi.org/10.1200/jco.2020.38.6_suppl.tps595.

    Article  PubMed  Google Scholar 

  46. Petrylak DP, Flaig TW, Mar N, Gourdin TS, Srinivas S, Rosenberg JE, Guseva M, Yu Y, Narayanan S, Hoimes CJ. Study EV-103 Cohort H: antitumor activity of neoadjuvant treatment with enfortumab vedotin monotherapy in patients (pts) with muscle invasive bladder cancer (MIBC) who are cisplatin-ineligible. J Clin Oncol. 2022. https://doi.org/10.1200/jco.2022.40.6_suppl.435.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Galsky MD, Necchi A, Shore ND, Plimack ER, Jia C, Sbar E, Homet Moreno B, Witjes JA. KEYNOTE-905/EV-303: perioperative pembrolizumab or pembrolizumab plus enfortumab vedotin (EV) and cystectomy compared to cystectomy alone in cisplatin-ineligible patients with muscle-invasive bladder cancer (MIBC). J Clin Oncol. 2021. https://doi.org/10.1200/jco.2021.39.6_suppl.tps507.

    Article  Google Scholar 

  48. Hoimes CJ, Bedke J, Loriot Y, Nishiyama H, Fang X, Kataria RS, Homet Moreno B, Galsky MD. KEYNOTE-B15/EV-304: randomized phase 3 study of perioperative enfortumab vedotin plus pembrolizumab versus chemotherapy in cisplatin-eligible patients with muscle-invasive bladder cancer (MIBC). J Clin Oncol. 2021. https://doi.org/10.1200/jco.2021.39.15_suppl.tps4587.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Powles T, Drakaki A, Teoh JY-C, et al. A phase 3, randomized, open-label, multicenter, global study of the efficacy and safety of durvalumab (D) + tremelimumab (T) + enfortumab vedotin (EV) or D + EV for neoadjuvant treatment in cisplatin-ineligible muscle-invasive bladder cancer (MIBC) (VOLGA). J Clin Oncol. 2022. https://doi.org/10.1200/jco.2022.40.6_suppl.tps579.

    Article  PubMed  PubMed Central  Google Scholar 

  50. van Allen EM, Mouw KW, Kim P, et al. Somatic ERCC2 mutations correlate with cisplatin sensitivity in muscle-invasive urothelial carcinoma. Cancer Discov. 2014. https://doi.org/10.1158/2159-8290.CD-14-0623.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Liu D, Plimack ER, Hoffman-Censits J, Garraway LA, Bellmunt J, van Allen E, Rosenberg JE. Clinical validation of chemotherapy response biomarker ERCC2 in muscle-invasive urothelial bladder carcinoma. JAMA Oncol. 2016. https://doi.org/10.1001/jamaoncol.2016.1056.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Galsky MD, Wang H, Hahn NM, et al. Phase 2 trial of gemcitabine, cisplatin, plus ipilimumab in patients with metastatic urothelial cancer and impact of DNA damage response gene mutations on outcomes. Eur Urol. 2018. https://doi.org/10.1016/j.eururo.2017.12.001.

    Article  PubMed  Google Scholar 

  53. Teo MY, Seier K, Ostrovnaya I, et al. Alterations in DNA damage response and repair genes as potential marker of clinical benefit from PD-1/PD-L1 blockade in advanced urothelial cancers. J Clin Oncol. 2018. https://doi.org/10.1200/JCO.2017.75.7740.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Iyer G, Ballman KV, Atherton PJ, Murray K, Kwok Y, Steen PD, Baghaie S, Rosenberg JE, Morris MJ. A phase II study of gemcitabine plus cisplatin chemotherapy in patients with muscle-invasive bladder cancer with bladder preservation for those patients whose tumors harbor deleterious DNA damage response (DDR) gene alterations (Alliance A031701). J Clin Oncol. 2022;40:TPS4615–TPS4615.

    Article  Google Scholar 

  55. Geynisman DM, Abbosh P, Ross EA, et al. A phase II trial of risk enabled therapy after initiating neoadjuvant chemotherapy for bladder cancer (RETAIN BLADDER): interim analysis. J Clin Oncol. 2021. https://doi.org/10.1200/jco.2021.39.6_suppl.397.

    Article  PubMed  Google Scholar 

  56. Chin RI, Chen K, Usmani A, Chua C, Harris PK, Binkley MS, Azad TD, Dudley JC, Chaudhuri AA. Detection of solid tumor molecular residual disease (MRD) using circulating tumor DNA (ctDNA). Mol Diagn Ther. 2019. https://doi.org/10.1007/s40291-019-00390-5.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Christensen E, Birkenkamp-Demtröder K, Sethi H, et al. Early detection of metastatic relapse and monitoring of therapeutic efficacy by ultra-deep sequencing of plasma cell-free DNA in patients with urothelial bladder carcinoma. J Clin Oncol. 2019. https://doi.org/10.1200/JCO.18.02052.

    Article  PubMed  Google Scholar 

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  1. Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill (UNC-CH), NC, Chapel Hill, USA

    Dillon C. Cockrell & Tracy L. Rose

  2. UNC Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA

    Tracy L. Rose

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Dillon Cockrell has no relevant conflicts of interests to disclose. Tracy Rose has received clinical trial funding to the institution from Merck.

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The original online version of this article was revised: We previously recommended changing "Gemcitabine + Cisplatin" in Table 1 to an abbreviated "GC" to improve formatting, but in the revised version it was changed to "GC + cisplatin" which is incorrect.

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Cockrell, D.C., Rose, T.L. Current Status of Perioperative Therapy in Muscle-Invasive Bladder Cancer and Future Directions. Curr Oncol Rep 25, 511–520 (2023). https://doi.org/10.1007/s11912-023-01390-9

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