Methotrexate-Paclitaxel-Epirubicin-Carboplatin (M-TEC) Combination Chemotherapy in Patients with Advanced Bladder Cancer: An Open Label Phase II Study

Tsavaris, Nicolas; Kosmas, Christos; H, Skopelitis; Dimitrakopoulos, Antonios; Kopterides, Petros; Bougas, D; Stravodimos, Konstantinos; Mitropoulos, Dionysios; Alamanis, Christos; Γιαννόπουλος, Αθανάσιος

doi:10.1179/joc.2005.17.4.444

Cited by 8 publications

(3 citation statements)

References 28 publications

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“…A sequential approach was similarly studied with dose-dense doxorubicin-gemcitabine followed by carboplatin-paclitaxel [51] . A four drug regimen of MTEC (methotrexate, paclitaxel, epirubicin, carboplatin) has been tested with a response rate of 60% (included CR rate of 30%) as first-line therapy [52] . Follow-up studies with this regimen studied patients refractory to GC [53] .…”

Section: Advanced Diseasementioning

confidence: 99%

Systemic therapy for bladder cancer – a medical oncologist’s perspective

Teply¹,

Kim²

2014

JST

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Advanced bladder cancer, both muscle-invasive localized disease and metastatic disease, is managed with systemic chemotherapy. Cisplatin-based multi-agent chemotherapy remains the cornerstone for systemic therapy. MVAC (methotrexate-vinblastine-doxorubicin-cisplatin) has been most rigorously studied, both neoadjuvantly and for palliation of metastatic disease. For metastatic disease, cisplatin-gemcitabine (GC) has compared favorably to MVAC due to improved tolerability with similar efficacy. GC has been adopted as standard therapy. Neoadjuvant chemotherapy for muscle-invasive bladder cancer improves survival among those patients eligible to receive cisplatin. Adjuvant chemotherapy is difficult to administer effectively given morbidity of radical cystectomy, and studies have shown mixed results about its benefit. Non-cisplatin regimens have been investigated but remain experimental and reserved for those not candidates for cisplatin in the metastatic setting. While multiple agents have been studied after metastatic disease progression after cisplatin-based therapy, there remain no FDA-approved therapies for the second line. Future trials with anti-VEGF therapy and immunotherapy are actively being investigated. This review examines the systemic therapy available to oncologists with current evidence and future directions.

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Section: Advanced Diseasementioning

confidence: 99%

Systemic therapy for bladder cancer – a medical oncologist’s perspective

Teply¹,

Kim²

2014

JST

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“…Interest in taxanes has emerged from trials in metastatic bladder cancer after the failure of platinum-based chemotherapy. [14][15][16][17] Taxanes in combination with cisplatin have also been evaluated in the neoadjuvant setting in bladder cancer. [18][19][20] Cabazitaxel, a novel taxane, is well-tolerated and effective in tumors both sensitive and resistant to other taxanes.…”

Section: Introductionmentioning

confidence: 99%

A Single-arm Phase II Trial of Neoadjuvant Cabazitaxel and Cisplatin Chemotherapy for Muscle-Invasive Transitional Cell Carcinoma of the Urinary Bladder

Challapalli¹,

Masson²,

White

et al. 2021

Clinical Genitourinary Cancer

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Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle-invasive bladder cancer. However, response rates and survival remain suboptimal. We sought to evaluate the efficacy, safety and tolerability of cisplatin in combination with cabazitaxel in this patient group. This combination can be considered well-tolerated and efficacious with higher response rates (57.7%), which compares favorably to that with cisplatin/gemcitabine (23%-26%). Introduction: Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle-invasive bladder cancer. However, response rates and survival remain suboptimal. We evaluated the efficacy, safety, and tolerability of cisplatin plus cabazitaxel. Methods: A phase II single-arm trial was designed to recruit at least 26 evaluable patients. This would give 80% power to detect the primary endpoint, an objective response rate defined as a pathologic complete response plus partial response (pathologic downstaging), measured by pathologic staging at cystectomy (p 0 = 0.35 and p 1 = 0.60, α = 0.05). Results: Objective response was seen in 15 of 26 evaluable patients (57.7%) and more than one-third of patients achieved a pathologic complete response (9/26; 34.6%). Seventy-eight percent of the patients (21/27) completed all cycles of treatment, with only 6.7% of the reported adverse events being graded 3 or 4. There were 6 treatment-related serious adverse event reported, but no suspected unexpected serious adverse reactions. In the patients who achieved an objective response, the median progression-free survival and overall survival were not reached (median follow-up of 41.5 months). In contrast, the median progression-free survival (7.2 months) and overall survival (16.9 months) were significantly worse ( P = .001, log-rank) in patients who did not achieve an objective response. Conclusion: Cabazitaxel plus cisplatin for neoadjuvant treatment of muscle-invasive bladder cancer can be considered a well-tolerated and effective regimen before definitive therapy with higher rates (57.7%) of objective response, comparing favorably to that with of cisplatin/gemcitabine (23%-26%). These results warrant further evaluation in a phase III study.

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“…Taxane‐based chemotherapy is currently a commonly used regimen for salvage chemotherapy . Methotrexate‐paclitaxel‐epirubicin‐carboplatin (M‐TEC) is one of the paclitaxel‐based regimens that has been applied for metastatic bladder TCC as first‐line treatment and seemed feasible in terms of toxicity . We conducted this phase II study administering the (M‐TEC) protocol as a second‐ line treatment for metastatic TCC of bladder.…”

Section: Introductionmentioning

confidence: 99%