Pathologic down-staging following standard (SD) MVAC (methotrexate-vinblastine-doxorubicine-cisplatin) or dose-dense MVAC (DD) neoadjuvant chemotherapy (NC) for muscle-invasive urothelial bladder cancer (UC): A retrospective multicenter cohort of the French Genitourinary Tumor Group (GETUG/AFU).

Pouessel, Damien; Chevret, Sylvie; Bompas, Emmanuelle; Boudin, Laurys; Joly, Charlotte; Grellety, Thomas; Terrisse, Safae; Boyle, Helen Jane; Roubaud, Guilhem; Chevreau, Christine; Dauba, Jérôme; Moriceau, Guillaume; Alexandre, Ingrid; Deplanque, Gaël; Chapelle, Angélique; Vauléon, Élodie; Colau, A.; Audenet, François; Culine, Stéphane

doi:10.1200/jco.2014.32.15_suppl.4550

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“…Importantly, the dose-dense approach can decrease the time between the start of MVAC chemotherapy and the point of surgery, with a median time of 9.7 weeks reported in the study by Plimack et al 78 (compared with 16–19 weeks for the standard regimens 14,72 ). The results of these two prospective trials 77,78 (TABLE 4), as well as those from two retrospective studies 79,80 , are promising; however, the authors of an editorial 81 , which accompanied the trial publications, identified issues regarding patient selection that might limit the generalizability of the results. For example, both trials included patients with N1 disease, therapy for whom, as previously discussed, cannot truly be considered ‘neoadjuvant’.…”

Section: Improving On Standard Nact With Mvacmentioning

confidence: 99%

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

2016

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Many patients diagnosed with muscle-invasive bladder cancer (MIBC) will develop distant metastatic disease. Over the past three decades, perioperative cisplatin-based chemotherapy has been investigated for its ability to reduce the number of deaths from bladder cancer. Insufficient evidence is available to fully support the use of such chemotherapy in the adjuvant setting; however, neoadjuvant cisplatin-based combination chemotherapy has become a standard of care for eligible patients based on the improved disease-specific and overall survival demonstrated in two randomized phase III trials, compared with surgery alone. For patients with disease downstaging to non-MIBC at the time of radical cystectomy as a result of neoadjuvant chemotherapy, outcomes are outstanding, with 5-year overall survival of 80–90%. Nevertheless, the inability to define before treatment the patients who will and those who will not achieve such a response has impeded the achievement of better outcomes for patients with MIBC. High-throughput DNA and RNA profiling technologies might help to overcome this barrier and enable a more-personalized approach to the use of cytotoxic neoadjuvant chemotherapy. In the past 2 years, trial results have demonstrated the unprecedented ability of immune-checkpoint blockade to induce durable remissions in patients with metastatic disease that has progressed after chemotherapy; studies are now urgently needed to determine how best to incorporate this powerful therapeutic modality into the care of patients with MIBC. Herein, we review the evolution of chemotherapy and immunotherapy for muscle-invasive bladder cancer.

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