Perioperative Therapy for Muscle Invasive Bladder Cancer

Leow, Jeffrey J.; Fay, André P.; Mullane, Stephanie A.; Bellmunt, Joaquim

doi:10.1016/j.hoc.2014.11.002

Cited by 7 publications

(3 citation statements)

References 81 publications

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“…Muscle-invasive bladder cancer (MIBC) constitutes 25% of newly diagnosed BC cases (2), and in approximately 50% of these patients treated with radical cystectomy (RC), the disease recurs within two years (3). To date, cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for MIBC and is associated with a 5% absolute survival benefit at 5 years and a 14% relative risk reduction for death (4). Chemotherapy prior to RC has long been a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Treatment in Muscle-Invasive Bladder Cancer: From the Beginning to the Latest Developments

et al. 2022

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Urothelial carcinoma of the bladder is one of the most prevalent cancers worldwide, diagnosed as muscle invasive in 25% of cases. Although several studies have demonstrated an overall 5% absolute survival benefit at 5 years with cisplatin-based combination neoadjuvant treatment, administration of chemotherapy prior to radical cystectomy (RC) in muscle-invasive bladder cancer (MIBC) patients is still a matter of debate. This may be due to the perceived modest survival benefit, cisplatin-based chemotherapy ineligibility, or fear of delaying potentially curative surgery in non-responders. However, immunotherapy and novel targeted therapies have shown to prolong survival in advanced disease and are under investigation in the neoadjuvant and adjuvant settings to reduce systemic relapse and improve cure rates. Genomic characterization of MIBC could help select the most effective chemotherapeutic regimen for the individual patient. Large cohort studies on neoadjuvant treatments with immune checkpoint inhibitors (ICIs) and molecular therapies, alone or combined with chemotherapy, are ongoing. In this review, we trace the development of neoadjuvant therapy in MIBC and explore recent advances that may soon change clinical practice.

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Section: Introductionmentioning

confidence: 99%

Neoadjuvant Treatment in Muscle-Invasive Bladder Cancer: From the Beginning to the Latest Developments

et al. 2022

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“…Risk of recurrence, however, is >50% [7] and is not improved with the use of preoperative radiation therapy [8]. It is believed that the high recurrence rate is the result of micro-metastasis at the time of local treatment (cystectomy and/or radiotherapy), and this has been addressed with adjuvant or neoadjuvant chemotherapy (NAC) [9].…”

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confidence: 99%

“…Due to lack of data, it was not possible to perform subgroup analysis for OS in patients treated with both RT and cystectomy with or without NAC. Subgroup analysis of prognostic factors, such as lymphovascular invasion, micropapillary histology and p53 nuclear accumulation [40], and patient factors, such as age, race, performance status, obesity and smoking status [9], would also be helpful to further understand the benefits of NAC. This meta-analysis is not based on individual patient-level data since as these data were not available.…”

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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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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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