Neoadjuvant chemotherapy for muscle-invasive bladder cancer: A systematic review and two-step meta-analysis

Ming Yin, Monika Joshi, Richard P. Meijer, Michael Glantz, Sheldon Holder, Harold A. Harvey, Matthew Kaag, Elisabeth E.Fransen Van De Putte, Simon Horenblas, Joseph J. Drabick

Research output: Contribution to journalReview article

65 Citations (Scopus)

Abstract

Background. Platinum-based neoadjuvant chemotherapy has been shown to improve survival outcomes in muscle-invasive bladder cancer patients. We performed a systematic review and meta-analysis to provide updated results of previous findings. We also summarized published data to compare clinical outcomes of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) versus gemcitabine and cisplatin/carboplatin (GC) in the neoadjuvant setting. Methods. A meta-analysis of 15 randomized clinical trials was performed to compare neoadjuvant chemotherapy plus local treatment with the same local treatment alone. Because no randomized trials have investigated MVAC versus GC in the neoadjuvant setting, a meta-analysis of 13 retrospective studies was performed to compare MVAC with GC. Results. A total of 3,285 patients were included in 15 randomized clinical trials. There was a significant overall survival (OS) benefit associated with cisplatin-based neoadjuvant chemotherapy (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.79-0.96). A total of 1,766 patients were included in 13 retrospective studies. There was no significant difference in pathological complete response between MVAC and GC. However, GC was associated with a significantly reduced overall survival (HR, 1.26; 95% CI, 1.01-1.57). After excluding carboplatin data, GC still seemed to be inferior to MVAC in OS (HR, 1.31; 95% CI, 0.99-1.74), but the difference was no longer statistically significant. Conclusion. These results support the use of cisplatin-based combination neoadjuvant chemotherapy in muscle-invasive bladder cancer. Although GC and MVAC had similar treatment response rates, the different survival outcome observed in this study requires further investigation.

Original languageEnglish (US)
Pages (from-to)708-715
Number of pages8
JournalOncologist
Volume21
Issue number6
DOIs
StatePublished - Jun 2016

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Urinary Bladder Neoplasms
gemcitabine
Cisplatin
Meta-Analysis
Drug Therapy
Muscles
Carboplatin
Vinblastine
Methotrexate
Doxorubicin
Survival
Confidence Intervals
Randomized Controlled Trials
Retrospective Studies
Combination Drug Therapy
Platinum
Therapeutics
Survival Rate

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

@article{a796fb5531c748c287c9163a911d729e,
title = "Neoadjuvant chemotherapy for muscle-invasive bladder cancer: A systematic review and two-step meta-analysis",
abstract = "Background. Platinum-based neoadjuvant chemotherapy has been shown to improve survival outcomes in muscle-invasive bladder cancer patients. We performed a systematic review and meta-analysis to provide updated results of previous findings. We also summarized published data to compare clinical outcomes of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) versus gemcitabine and cisplatin/carboplatin (GC) in the neoadjuvant setting. Methods. A meta-analysis of 15 randomized clinical trials was performed to compare neoadjuvant chemotherapy plus local treatment with the same local treatment alone. Because no randomized trials have investigated MVAC versus GC in the neoadjuvant setting, a meta-analysis of 13 retrospective studies was performed to compare MVAC with GC. Results. A total of 3,285 patients were included in 15 randomized clinical trials. There was a significant overall survival (OS) benefit associated with cisplatin-based neoadjuvant chemotherapy (hazard ratio [HR], 0.87; 95{\%} confidence interval [CI], 0.79-0.96). A total of 1,766 patients were included in 13 retrospective studies. There was no significant difference in pathological complete response between MVAC and GC. However, GC was associated with a significantly reduced overall survival (HR, 1.26; 95{\%} CI, 1.01-1.57). After excluding carboplatin data, GC still seemed to be inferior to MVAC in OS (HR, 1.31; 95{\%} CI, 0.99-1.74), but the difference was no longer statistically significant. Conclusion. These results support the use of cisplatin-based combination neoadjuvant chemotherapy in muscle-invasive bladder cancer. Although GC and MVAC had similar treatment response rates, the different survival outcome observed in this study requires further investigation.",
author = "Ming Yin and Monika Joshi and Meijer, {Richard P.} and Michael Glantz and Sheldon Holder and Harvey, {Harold A.} and Matthew Kaag and {Van De Putte}, {Elisabeth E.Fransen} and Simon Horenblas and Drabick, {Joseph J.}",
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Neoadjuvant chemotherapy for muscle-invasive bladder cancer : A systematic review and two-step meta-analysis. / Yin, Ming; Joshi, Monika; Meijer, Richard P.; Glantz, Michael; Holder, Sheldon; Harvey, Harold A.; Kaag, Matthew; Van De Putte, Elisabeth E.Fransen; Horenblas, Simon; Drabick, Joseph J.

In: Oncologist, Vol. 21, No. 6, 06.2016, p. 708-715.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Neoadjuvant chemotherapy for muscle-invasive bladder cancer

T2 - A systematic review and two-step meta-analysis

AU - Yin, Ming

AU - Joshi, Monika

AU - Meijer, Richard P.

AU - Glantz, Michael

AU - Holder, Sheldon

AU - Harvey, Harold A.

AU - Kaag, Matthew

AU - Van De Putte, Elisabeth E.Fransen

AU - Horenblas, Simon

AU - Drabick, Joseph J.

PY - 2016/6

Y1 - 2016/6

N2 - Background. Platinum-based neoadjuvant chemotherapy has been shown to improve survival outcomes in muscle-invasive bladder cancer patients. We performed a systematic review and meta-analysis to provide updated results of previous findings. We also summarized published data to compare clinical outcomes of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) versus gemcitabine and cisplatin/carboplatin (GC) in the neoadjuvant setting. Methods. A meta-analysis of 15 randomized clinical trials was performed to compare neoadjuvant chemotherapy plus local treatment with the same local treatment alone. Because no randomized trials have investigated MVAC versus GC in the neoadjuvant setting, a meta-analysis of 13 retrospective studies was performed to compare MVAC with GC. Results. A total of 3,285 patients were included in 15 randomized clinical trials. There was a significant overall survival (OS) benefit associated with cisplatin-based neoadjuvant chemotherapy (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.79-0.96). A total of 1,766 patients were included in 13 retrospective studies. There was no significant difference in pathological complete response between MVAC and GC. However, GC was associated with a significantly reduced overall survival (HR, 1.26; 95% CI, 1.01-1.57). After excluding carboplatin data, GC still seemed to be inferior to MVAC in OS (HR, 1.31; 95% CI, 0.99-1.74), but the difference was no longer statistically significant. Conclusion. These results support the use of cisplatin-based combination neoadjuvant chemotherapy in muscle-invasive bladder cancer. Although GC and MVAC had similar treatment response rates, the different survival outcome observed in this study requires further investigation.

AB - Background. Platinum-based neoadjuvant chemotherapy has been shown to improve survival outcomes in muscle-invasive bladder cancer patients. We performed a systematic review and meta-analysis to provide updated results of previous findings. We also summarized published data to compare clinical outcomes of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) versus gemcitabine and cisplatin/carboplatin (GC) in the neoadjuvant setting. Methods. A meta-analysis of 15 randomized clinical trials was performed to compare neoadjuvant chemotherapy plus local treatment with the same local treatment alone. Because no randomized trials have investigated MVAC versus GC in the neoadjuvant setting, a meta-analysis of 13 retrospective studies was performed to compare MVAC with GC. Results. A total of 3,285 patients were included in 15 randomized clinical trials. There was a significant overall survival (OS) benefit associated with cisplatin-based neoadjuvant chemotherapy (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.79-0.96). A total of 1,766 patients were included in 13 retrospective studies. There was no significant difference in pathological complete response between MVAC and GC. However, GC was associated with a significantly reduced overall survival (HR, 1.26; 95% CI, 1.01-1.57). After excluding carboplatin data, GC still seemed to be inferior to MVAC in OS (HR, 1.31; 95% CI, 0.99-1.74), but the difference was no longer statistically significant. Conclusion. These results support the use of cisplatin-based combination neoadjuvant chemotherapy in muscle-invasive bladder cancer. Although GC and MVAC had similar treatment response rates, the different survival outcome observed in this study requires further investigation.

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