Dose-dense MVAC vs gemcitabine and cisplatin tied to better survival in bladder cancer patients
Dose-dense MVAC (methotrexate, vinblastine, doxorubicin and cisplatin), compared to gemcitabine and cisplatin, is associated with higher complete pathological response and improved survival rates in patients with locally advanced bladder cancer, a recent study has found.
A total of 319 patients who underwent neoadjuvant chemotherapy and radical cystectomy during the study period were included. The rate of ypT0N0 was significantly lower with gemcitabine and cisplatin than with dose-dense MVAC (14.6 percent vs 28.0 percent; p=0.005). A significantly lower rate of ypT1N0 or less was also observed in the gemcitabine and cisplatin arm (30.1 percent vs 41.0 percent; p=0.07).
The mean Kaplan-Meier estimates of overall survival were 4.2 years with gemcitabine and cisplatin and 7.0 years with dose-dense MVAC (p=0.001).
Multivariable Cox regression analysis based on preoperative data showed that the risk for death was higher in patients who received gemcitabine and cisplatin compared to those who received dose-dense MVAC (hazard ratio [HR], 2.07; 95 percent CI, 1.25–3.42; p=0.003). Lymph node invasion (HR, 1.97; 1.15–3.36; p=0.01) and hydronephrosis (HR, 2.18; 1.43–3.30; p<0.001) also correlated with higher death risk.
“A clinical trial is warranted to validate these hypothesis-generating results to test the superiority of neoadjuvant dose-dense MVAC in patients with locally advanced bladder cancer,” the authors said.
Records of patients with urothelial cancer who received neoadjuvant chemotherapy and underwent cystectomy from 2000–2015 were reviewed retrospectively. The authors selected patients with cT3-4aN0M0 disease for the analysis and compared the rates of ypT0N0 and ypT1N0 or less between gemcitabine and cisplatin and dose-dense MVAC regimens.