Low Incidence of Perioperative Chemotherapy for Stage III Bladder Cancer 1998 to 2003: A Report From the National Cancer Data Base

David, Kevin A.; Milowsky, Matthew I.; Ritchey, Jamie; Carroll, Peter R.; Nanus, David M.

doi:10.1016/j.juro.2007.03.101

Cited by 220 publications

(127 citation statements)

References 13 publications

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“…52 Despite the evidence supporting the use of neoadjuvant chemotherapy, a review of more than 7000 patients treated for stage III bladder cancer in the United States between the years 1998 and 2003 showed that only 1.2% of patients received neoadjuvant treatment, and only 10.4% received adjuvant treatment. 193 The evidence for adjuvant therapy is primarily based on a meta-analysis of 6 small trials, totaling about 600 patients; although this study suggested a 25% relative decrease in the risk of death with chemotherapy compared with no therapy, the number of patients was insufficient to recommend adjuvant treatment. 194 Unfortunately, large trials evaluating adjuvant treatment have not been performed, and the smaller studies included in the above meta-analysis have been criticized for methodologic flaws.…”

Section: Urinary Diversionmentioning

confidence: 97%

Bladder Cancer in 2010: How Far have We Come?

Jacobs¹,

Lee

Montie

2010

CA: A Cancer Journal for Clinicians

300

275

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Bladder cancer is the fourth most common cancer and ranks eighth as a cause of death from cancer among men in the United States. Although guidelines assist in treatment, the art of managing bladder cancer, such as the decision to use neoadjuvant chemotherapy and the timing of cystectomy, is still variable. Bladder cancer has a propensity to recur, and with recurrence, a significant number of cases progress, which makes the early detection of high-risk patients imperative. Advances in detection, surveillance, and treatment of bladder cancer are reviewed in this article.

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Section: Urinary Diversionmentioning

confidence: 97%

Bladder Cancer in 2010: How Far have We Come?

Jacobs¹,

Lee

Montie

2010

CA: A Cancer Journal for Clinicians

300

275

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“…4,5 Despite the survival improvement established in randomized trials with the use of neoadjuvant methotrexate, vinblastine, doxorubicin, plus cisplatin (MVAC) or cisplatin, methotrexate, plus vinblastine 5 (CMV), concerns regarding the balance between the toxicity and efficacy of these regimens has contributed, at least in part, to the poor uptake of neoadjuvant chemotherapy. [4][5][6] In 2000, the results from a randomized phase 3 trial were published comparing gemcitabine plus cisplatin (GC) with standard MVAC in patients with metastatic bladder cancer. 7,8 GC was associated with similar efficacy compared with MVAC, albeit with less toxicity, leading to the adoption of this regimen as among the most commonly used systemic treatments for patients with metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of gemcitabine plus cisplatin versus methotrexate, vinblastine, doxorubicin, plus cisplatin as neoadjuvant therapy for muscle‐invasive bladder cancer

Galsky

Pal

Chowdhury

et al. 2015

Cancer

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167

101

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BACKGROUND: Gemcitabine plus cisplatin (GC) has been adopted as a neoadjuvant regimen for muscle-invasive bladder cancer despite the lack of Level I evidence in this setting. METHODS: Data were collected using an electronic data-capture platform from 28 international centers. Eligible patients had clinical T-classification 2 (cT2) through cT4aN0M0 urothelial cancer of the bladder and received neoadjuvant GC or methotrexate, vinblastine, doxorubicin, plus cisplatin (MVAC) before undergoing cystectomy. Logistic regression was used to compute propensity scores as the predicted probabilities of patients being assigned to MVAC versus GC given their baseline characteristics. These propensity scores were then included in a new logistic regression model to estimate an adjusted odds ratio comparing the odds of attaining a pathologic complete response (pCR) between patients who received MVAC and those who received GC. RESULTS: In total, 212 patients (146 patients in the GC cohort and 66 patients in the MVAC cohort) met criteria for inclusion in the analysis. The majority of patients in the MVAC cohort (77%) received dose-dense MVAC. The median age of patients was 63 years, they were predominantly men (74%), and they received a median of 3 cycles of neoadjuvant chemotherapy. The pCR rate was 29% in the MVAC cohort and 31% in the GC cohort. There was no significant difference in the pCR rate when adjusted for propensity scores between the 2 regimens (odds ratio, 0.91; 95% confidence interval, 0.48-1.72; P 5.77). In an exploratory analysis evaluating survival, the hazard ratio comparing hazard rates for MVAC versus GC adjusted for propensity scores was not statistically significant (hazard ratio, 0.78; 95% confidence interval, 0.40-1.54; P 5.48). CONCLUSIONS: Patients who received neoadjuvant GC and MVAC achieved comparable pCR rates in the current analysis, providing evidence to support what has become routine practice.

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“…A previous analysis from the UTUC collaboration, including 542 high risk UTUC patients (T3,4 and/or n+), could not identify a survival advantage of the use of adjuvant chemotherapy after RnU, possibly due to the underutilization of systemic chemotherapy and administration of adjuvant chemotherapy only in advanced stage of the disease (10). The underutilization of systemic chemotherapy is not surprising, considering the low incidence of peri-operative chemotherapy reported in bladder cancer and the absence of randomized trials demonstrating a survival benefit in patients with UTUC (11).…”

Section: Discussionmentioning

confidence: 99%

Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer: can oncologic outcomes be improved with multimodality therapy?

et al. 2013

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Purpose: To report the outcomes of patients with pathologic T4 UTUC and investigate the potential impact of peri-operative chemotherapy combined with radical nephroureterectomy (RnU) and regional lymph node dissection (LnD) on oncologic outcomes. Materials and Methods: Patients with pathologic T4 UTUC were identified from the cohort of 1464 patients treated with RnU at 13 academic centers between 1987 and 2007. Oncologic outcomes were stratified according to utilization of perioperative systemic chemotherapy and regional LnD as an adjunct to RnU. Results: The study included 69 patients, 42 males (61%) with median age 73 (range 43-98). Median follow-up was 17 months (range: 6-88). Lymphovascular invasion was found in 47 (68%) and regional lymph node metastases were found in 31 (45%). Peri--operative chemotherapy was utilized in 29 (42%) patients. Patients treated with peri--operative chemotherapy and RnU with LnD demonstrated superior oncologic outcomes compared to those not treated by chemotherapy and/or LnD during RnU (3Y-DFS: 35% vs. 10%; P = 0.02 and 3Y-CSS: 28% vs. 14%; P = 0.08). In multivariate Cox regression analysis, administration of peri-operative chemotherapy and utilization of LnD during RnU was associated with lower probability of recurrence (HR: 0.4, P = 0.01), and cancer specific mortality (HR: 0.5, P = 0.06). Conclusions: Pathological T4 UTUC is associated with poor prognosis. Peri-operative chemotherapy combined with aggressive surgery, including lymph node dissection, may improve oncological outcomes. Our findings support the use of aggressive multimodal treatment in patients with advanced UTUC.

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Low Incidence of Perioperative Chemotherapy for Stage III Bladder Cancer 1998 to 2003: A Report From the National Cancer Data Base

Cited by 220 publications

References 13 publications

Bladder Cancer in 2010: How Far have We Come?

Bladder Cancer in 2010: How Far have We Come?

Comparative effectiveness of gemcitabine plus cisplatin versus methotrexate, vinblastine, doxorubicin, plus cisplatin as neoadjuvant therapy for muscle‐invasive bladder cancer

Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer: can oncologic outcomes be improved with multimodality therapy?

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