Curative Effect and Survival Assessment Comparing Gemcitabine and Cisplatin Versus Methotrexate, Vinblastine, Doxorubicin and Cisplatin as Neoadjuvant Therapy for Bladder Cancer: A Systematic Review and Meta-Analysis

Abstract

BackgroundNeoadjuvant chemotherapy has been accepted as an effective curative treatment for muscle-invasive bladder cancer patients and has resulted in better survival outcomes than radical cystectomy or a cisplatin-based regimen. In the present study, we aimed to compare the two most commonly used cisplatin-based neoadjuvant chemotherapies, gemcitabine plus cisplatin and methotrexate plus vinblastine plus doxorubicin plus cisplatin, by summarizing and analyzing clinical data and outcomes of published research.MethodsWe searched for qualified studies that compared these two types of neoadjuvant chemotherapy, including 4 randomized controlled trials and 14 retrospective studies. Data and information on pathological responses and long-term survival studies were extracted and analyzed separately.ResultsA total of 18 studies with 3116 patients were selected from 1188 studies, which contained data on pathological complete response, pathological partial response, and overall survival. In contrast to the results of previous studies, there was no significant difference in pathological complete response (odds ratio, 0.97; 95% confidence interval, 0.81-1.15), pathological partial response (odds ratio, 0.85; 95% confidence interval, 0.72-1.14), and overall survival (hazard ratio, 0.99; 95% confidence interval, 0.83-1.17) between GC and MVAC in this meta-analysis.ConclusionNo significant differences were observed between GC and MVAC in the muscle-invasive bladder cancer treatment due to the similar curative effect and parallel long survival outcomes due to the similar curative effect and parallel long survival outcomes. The priority selection of GC or MVAC in the clinic should be guided by further investigation, and the clinical standard strategy still counts on the results of more randomized controlled trials in the future.

Survival Outcome after Reduced-Port Laparoscopic Radical Cystectomy for Bladder Cancer: Long-Term Follow-Up Analysis

“…The role of NAC in the treatment of bladder cancer should be further investigated. Recent reports described the efficacy of NAC in bladder cancer [38,39], with the number of cases strongly increasing. However, whether all patients with MIBC should receive NAC is controversial [40].…”

A narrative review of management of muscle-invasive bladder cancer perioperative period: will continuous and combined treatment be the new trend?

“…Another phase III randomized controlled trial (RCT) concluded that MVAC and GC had comparable clinical effects, with the GC protocol having better tolerance and safety ( 15 ). Similarly, a meta-analysis of 3,116 patients from 18 studies found no statistical difference between GC regimen and MVAC regimen in terms of pCR and OS (P=0.69, P=0.87) ( 16 ). In general, the GC regimen has fewer side effects and better tolerance than the dd-MVAC regimen, but the latter has a higher rate of local control and clear advantages in pathological reaction.…”

Cardioprotective Effect of Hydroalcohol Extract of Andaliman (Zanthoxylum acanthopodium DC.) Fruits on Doxorubicin-Induced Rats

“…Doxorubicin can treat various types of cancer, including leukemia, lymphoma, soft tissue sarcomas, and solid tumors. Its cytotoxic effect is desirable on malignant cells; on the contrary, there is the potential for undesirable cardiotoxic effects [ 7 , 8 , 9 , 10 , 11 ], so cardiac protection is needed, which can contribute to heart preservation by reducing or even preventing heart damage [ 12 , 13 , 14 ]. The cardioprotective effects of several plants have recently been widely studied, one of which is to minimize the cardiotoxic potential of doxorubicin.…”