Neoadjuvant Chemotherapy with Cisplatin and Methotrexate in Patients with Muscle-Invasive Bladder Tumours

Sengeløv, Lisa; Maase, Hans von der; Lundbeck, Finn; Barlebo, H.; Colstrup, Hans; Engelholm, Svend Aage; Krarup, T; Madsen, Ebbe Lindegård; Meyhoff, H. H.; Mommsen, S; Nielsen, Ole Steen; Pedersen, Dorte; Steven, Kenneth; Sørensen, Bent

doi:10.1080/028418602320405041

Cited by 70 publications

(26 citation statements)

References 35 publications

(26 reference statements)

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“…No difference in OS in patients treated with cisplatin alone before radiotherapy (pooled HR = 0.95, 95% CI: 0.76 to 1.19, P = 0.686) [25,29], GC before cystectomy (pooled HR=0.75, 95%CI: 0.50 to 1.12), MC-folinic acid before cystectomy (pooled HR = 0.84, 95% CI: 0.64 to 1.10, P = 0.210) [21,22], and MVAC before cystectomy (pooled HR = 1.22, 95% CI: 0.98 to 1.52, P = 0.076) [18,20,23]. Subgroup analysis of cystectomy or radiotherapy after NAC showed no significant difference in OS between patients who received NAC followed by cystectomy and those who received cystectomy alone (pooled HR = 0.96, 95% CI: 0.84 to 1.09, P = 0.527; Figure 5).…”

Section: Subgroup Analysesmentioning

confidence: 97%

“…Subsequently, 39 studies were excluded, including 16 single-arm studies, eight studies with irrelevant study design, five articles with irrelevant outcome, four articles with duplicated study population and six articles without full-text. Fourteen studies were included in the meta-analysis [20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

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Effect of cisplatin-based neoadjuvant chemotherapy on survival in patients with bladder cancer: a meta-analysis

Niu

et al. 2017

CIM

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Effect of cisplatin-based neoadjuvant chemotherapy on survival in patients with bladder cancer: a meta-analysis Abstract Purpose: Cisplatin-based neoadjuvant chemotherapy (NAC) has been shown to improve survival in patients with muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy as compared with patients who underwent surgery alone. It has also been suggested as current standard of care in surgically-fit patients with MIBC. This meta-analysis assessed the effect of cisplatin-based NAC on survival in patients with bladder cancer.Source: PubMed, CENTRAL, and Embase were searched until November 22, 2016. Two-arm randomized controlled trials that compared cisplatin-based neoadjuvant chemotherapy plus local treatment versus the same local treatment without neoadjuvant chemotherapy were selected. Patients with histologically-confirmed bladder cancer (adenocarcinoma, transitional, or squamous-cell carcinoma) were included. The primary outcome was overall survival (OS).Principal findings: Of the 292 articles initially identified, 14 were included in the final analysis. Patients in the NAC group had similar OS as the local treatment (i.e., radiation therapy or cystectomy) group (pooled hazard ratio [HR] = 0.92, 95% confidence interval [CI]: 0.84 to 1.00, P=0.056). No difference in progress-free survival between two groups was observed (P=0.725). Subgroup analysis showed that OS was similar in patients treated with NAC plus radiotherapy or cystectomy compared with patients who received local treatment alone.Conclusions: Platinum-based NAC was associated with similar survival benefit as patients undergoing cystectomy and/or radiotherapy. No conclusion can be drawn about the optimal platinum-based combination to be used in the neoadjuvant setting.

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Section: Subgroup Analysesmentioning

confidence: 97%

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Effect of cisplatin-based neoadjuvant chemotherapy on survival in patients with bladder cancer: a meta-analysis

Niu

et al. 2017

CIM

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“…Table 4 summarizes phase III studies of neoadjuvant chemotherapy as an adjunct to definitive radiotherapy in muscle-invasive bladder cancer. [53][54][55][56] The largest phase III neoadjuvant study that was carried out by an international cooperative group comprised 976 patients with T2 to T4 bladder cancer who were randomly assigned to receive either three cycles of chemotherapy with cisplatin, methotrexate, and vinblastine (CMV), followed by cystectomy or radiotherapy, or the same treatment without chemotherapy. 55 When this study was designed, the intent was to secure adequate patient accrual by allowing individual centers to continue their standard practice, and to randomize within patterns of practice-thus, institutions could elect to use radical radiotherapy or cystectomy as definitive treatment.…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

“…Survival trends in favor of neoadjuvant chemotherapy plus radiotherapy, compared with radiotherapy alone, were reported by the International Study 55 carried out by the European Organisation for Research and Treatment of Cancer, Medical Research Council, NCI Canada, Australian Bladder Cancer Study Group and collaborators, but this trend was not seen in the study conducted by the Danish Cancer Group. 56 In general, level 2 evidence suggests that chemoradiation yields superior outcomes to radiotherapy alone. The role of neoadjuvant chemotherapy followed by chemoradiation remains unclear, and has not been supported by any level 1 data.…”

Section: What Is the Optimum Approach For Invasive Bladder Cancer?mentioning

confidence: 99%

Chemotherapy for muscle-invasive bladder cancer treated with definitive radiotherapy: persisting uncertainties

Choueiri

2008

Nat Rev Clin Oncol

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Radical cystectomy for invasive bladder cancer remains the standard of care in many parts of the world, including North America and many parts of Europe; however, a large body of international experience from single institutions and cooperative groups indicates satisfactory results with bladder-sparing approaches in appropriately selected patients. Overall, selective bladder preservation with trimodality therapy, consisting of transurethral resection of the bladder tumor, radiation, and chemotherapy, can achieve complete response rates of 70%, long-term survival rates of 40-50%, and survival rates with an intact bladder of 30-45%. Neoadjuvant chemotherapy followed by radiotherapy might provide up to 5% additional long-term absolute survival benefit compared with radiotherapy alone, although the studies to support this are not appropriately powered. Concomitant chemoradiation provides high response rates and disease control, although the level of evidence for this approach and the follow-up data are even less robust than those for neoadjuvant chemotherapy. Although direct comparison of surgically based and radiotherapy-based approaches would be very useful, it is highly unlikely that such a trial could ever be completed among the patients treated by the clinicians who routinely deal with invasive bladder cancer.

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“…In a small randomized Danish trial, 120 patients were randomly assigned to 3 cycles of cisplatin (100 mg/m 2 ) and methotrexate (250 mg/m 2 ) prior to RT [31]. Patients enrolled in this study had a particularly poor prognosis, with 60% known to be lymph-node positive, only 16% to have had a grossly complete TUR, and 31% stage T4.…”

Section: Initial (Neoadjuvant) Chemotherapy Followed By Radiotherapymentioning

confidence: 99%

Combined chemotherapy and external beam radiotherapy for transitional cell carcinoma of the bladder

Ennis

2004

Curr Oncol Rep

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A growing body of evidence supports the treatment of invasive transitional cell carcinoma of the bladder with transurethral resection, chemotherapy, and external beam radiotherapy. Randomized trials have demonstrated the superiority of chemotherapy plus radiotherapy to radiotherapy alone. Several series with 10 years of follow-up demonstrate that the success of this approach can be maintained. Preservation of the urothelium, however, results in continued risk of de novo bladder cancer development in addition to the possibility of recurrence. Thus, continued close surveillance and treatment of subsequent superficial or invasive bladder cancer is an essential component of this bladder preservation approach. Concomitant cisplatin chemotherapy and radiotherapy or initial (neoadjuvant) combination cisplatin-based chemotherapy followed by radiotherapy are the two options best supported by the literature. How these regimens compare with each other and with cystectomy-based treatment remains to be defined.

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Neoadjuvant Chemotherapy with Cisplatin and Methotrexate in Patients with Muscle-Invasive Bladder Tumours

Cited by 70 publications

References 35 publications

Effect of cisplatin-based neoadjuvant chemotherapy on survival in patients with bladder cancer: a meta-analysis

Effect of cisplatin-based neoadjuvant chemotherapy on survival in patients with bladder cancer: a meta-analysis

Chemotherapy for muscle-invasive bladder cancer treated with definitive radiotherapy: persisting uncertainties

Combined chemotherapy and external beam radiotherapy for transitional cell carcinoma of the bladder

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