A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer

Joshua J. Meeks, Joaquim Bellmunt, Bernard H. Bochner, Noel W. Clarke, Siamak Daneshmand, Matthew D. Galsky, Noah M. Hahn, Seth P. Lerner, Malcolm Mason, Thomas Powles, Cora N. Sternberg, Guru Sonpavde*

*Corresponding author for this work

Research output: Contribution to journalReview article

133 Citations (Scopus)

Abstract

Context: Muscle-invasive bladder cancer (MIBC) is a disease with a pattern of predominantly distant and early recurrences. Neoadjuvant cisplatin-based combination chemotherapy has demonstrated improved outcomes for MIBC. Objective: To review the data supporting perioperative chemotherapy and emerging regimens for MIBC. Evidence acquisition: Medline databases were searched for original articles published before April 1, 2012, with the search terms bladder cancer, urothelial cancer, radical cystectomy, neoadjuvant chemotherapy, and adjuvant chemotherapy. Proceedings from the last 5 yr of major conferences were also searched. Novel and promising drugs that have reached clinical trial evaluation were included. Evidence synthesis: The major findings are addressed in an evidence-based fashion. Prospective trials and important preclinical data were analyzed. Conclusions: Cisplatin-based neoadjuvant combination chemotherapy is an established standard, improving overall survival in MIBC. Pathologic complete response appears to be an intermediate surrogate for survival, but this finding requires further validation. Definitive data to support adjuvant chemotherapy do not exist, and there are no data to support perioperative therapy in cisplatin-ineligible patients. Utilization of neoadjuvant cisplatin is low, attributable in part to patient/physician choice and the advanced age of patients, who often have multiple comorbidities including renal and/or cardiac dysfunction. Trials are using the neoadjuvant paradigm to detect incremental pathologic response to chemobiologic regimens and brief neoadjuvant single-agent therapy to screen for the biologic activity of agents.

Original languageEnglish (US)
Pages (from-to)523-533
Number of pages11
JournalEuropean urology
Volume62
Issue number3
DOIs
StatePublished - Sep 1 2012

Fingerprint

Adjuvant Chemotherapy
Urinary Bladder Neoplasms
Cisplatin
Muscles
Combination Drug Therapy
Drug Therapy
Survival
Cystectomy
Biological Factors
Comorbidity
Clinical Trials
Databases
Physicians
Kidney
Recurrence
Therapeutics
Pharmaceutical Preparations
Neoplasms

Keywords

  • Adjuvant therapy
  • Bladder cancer
  • Muscle invasive
  • Neoadjuvant therapy
  • Radical cystectomy
  • Urothelial cancer

ASJC Scopus subject areas

  • Urology

Cite this

Meeks, J. J., Bellmunt, J., Bochner, B. H., Clarke, N. W., Daneshmand, S., Galsky, M. D., ... Sonpavde, G. (2012). A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer. European urology, 62(3), 523-533. https://doi.org/10.1016/j.eururo.2012.05.048
Meeks, Joshua J. ; Bellmunt, Joaquim ; Bochner, Bernard H. ; Clarke, Noel W. ; Daneshmand, Siamak ; Galsky, Matthew D. ; Hahn, Noah M. ; Lerner, Seth P. ; Mason, Malcolm ; Powles, Thomas ; Sternberg, Cora N. ; Sonpavde, Guru. / A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer. In: European urology. 2012 ; Vol. 62, No. 3. pp. 523-533.
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title = "A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer",
abstract = "Context: Muscle-invasive bladder cancer (MIBC) is a disease with a pattern of predominantly distant and early recurrences. Neoadjuvant cisplatin-based combination chemotherapy has demonstrated improved outcomes for MIBC. Objective: To review the data supporting perioperative chemotherapy and emerging regimens for MIBC. Evidence acquisition: Medline databases were searched for original articles published before April 1, 2012, with the search terms bladder cancer, urothelial cancer, radical cystectomy, neoadjuvant chemotherapy, and adjuvant chemotherapy. Proceedings from the last 5 yr of major conferences were also searched. Novel and promising drugs that have reached clinical trial evaluation were included. Evidence synthesis: The major findings are addressed in an evidence-based fashion. Prospective trials and important preclinical data were analyzed. Conclusions: Cisplatin-based neoadjuvant combination chemotherapy is an established standard, improving overall survival in MIBC. Pathologic complete response appears to be an intermediate surrogate for survival, but this finding requires further validation. Definitive data to support adjuvant chemotherapy do not exist, and there are no data to support perioperative therapy in cisplatin-ineligible patients. Utilization of neoadjuvant cisplatin is low, attributable in part to patient/physician choice and the advanced age of patients, who often have multiple comorbidities including renal and/or cardiac dysfunction. Trials are using the neoadjuvant paradigm to detect incremental pathologic response to chemobiologic regimens and brief neoadjuvant single-agent therapy to screen for the biologic activity of agents.",
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author = "Meeks, {Joshua J.} and Joaquim Bellmunt and Bochner, {Bernard H.} and Clarke, {Noel W.} and Siamak Daneshmand and Galsky, {Matthew D.} and Hahn, {Noah M.} and Lerner, {Seth P.} and Malcolm Mason and Thomas Powles and Sternberg, {Cora N.} and Guru Sonpavde",
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Meeks, JJ, Bellmunt, J, Bochner, BH, Clarke, NW, Daneshmand, S, Galsky, MD, Hahn, NM, Lerner, SP, Mason, M, Powles, T, Sternberg, CN & Sonpavde, G 2012, 'A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer', European urology, vol. 62, no. 3, pp. 523-533. https://doi.org/10.1016/j.eururo.2012.05.048

A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer. / Meeks, Joshua J.; Bellmunt, Joaquim; Bochner, Bernard H.; Clarke, Noel W.; Daneshmand, Siamak; Galsky, Matthew D.; Hahn, Noah M.; Lerner, Seth P.; Mason, Malcolm; Powles, Thomas; Sternberg, Cora N.; Sonpavde, Guru.

In: European urology, Vol. 62, No. 3, 01.09.2012, p. 523-533.

Research output: Contribution to journalReview article

TY - JOUR

T1 - A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer

AU - Meeks, Joshua J.

AU - Bellmunt, Joaquim

AU - Bochner, Bernard H.

AU - Clarke, Noel W.

AU - Daneshmand, Siamak

AU - Galsky, Matthew D.

AU - Hahn, Noah M.

AU - Lerner, Seth P.

AU - Mason, Malcolm

AU - Powles, Thomas

AU - Sternberg, Cora N.

AU - Sonpavde, Guru

PY - 2012/9/1

Y1 - 2012/9/1

N2 - Context: Muscle-invasive bladder cancer (MIBC) is a disease with a pattern of predominantly distant and early recurrences. Neoadjuvant cisplatin-based combination chemotherapy has demonstrated improved outcomes for MIBC. Objective: To review the data supporting perioperative chemotherapy and emerging regimens for MIBC. Evidence acquisition: Medline databases were searched for original articles published before April 1, 2012, with the search terms bladder cancer, urothelial cancer, radical cystectomy, neoadjuvant chemotherapy, and adjuvant chemotherapy. Proceedings from the last 5 yr of major conferences were also searched. Novel and promising drugs that have reached clinical trial evaluation were included. Evidence synthesis: The major findings are addressed in an evidence-based fashion. Prospective trials and important preclinical data were analyzed. Conclusions: Cisplatin-based neoadjuvant combination chemotherapy is an established standard, improving overall survival in MIBC. Pathologic complete response appears to be an intermediate surrogate for survival, but this finding requires further validation. Definitive data to support adjuvant chemotherapy do not exist, and there are no data to support perioperative therapy in cisplatin-ineligible patients. Utilization of neoadjuvant cisplatin is low, attributable in part to patient/physician choice and the advanced age of patients, who often have multiple comorbidities including renal and/or cardiac dysfunction. Trials are using the neoadjuvant paradigm to detect incremental pathologic response to chemobiologic regimens and brief neoadjuvant single-agent therapy to screen for the biologic activity of agents.

AB - Context: Muscle-invasive bladder cancer (MIBC) is a disease with a pattern of predominantly distant and early recurrences. Neoadjuvant cisplatin-based combination chemotherapy has demonstrated improved outcomes for MIBC. Objective: To review the data supporting perioperative chemotherapy and emerging regimens for MIBC. Evidence acquisition: Medline databases were searched for original articles published before April 1, 2012, with the search terms bladder cancer, urothelial cancer, radical cystectomy, neoadjuvant chemotherapy, and adjuvant chemotherapy. Proceedings from the last 5 yr of major conferences were also searched. Novel and promising drugs that have reached clinical trial evaluation were included. Evidence synthesis: The major findings are addressed in an evidence-based fashion. Prospective trials and important preclinical data were analyzed. Conclusions: Cisplatin-based neoadjuvant combination chemotherapy is an established standard, improving overall survival in MIBC. Pathologic complete response appears to be an intermediate surrogate for survival, but this finding requires further validation. Definitive data to support adjuvant chemotherapy do not exist, and there are no data to support perioperative therapy in cisplatin-ineligible patients. Utilization of neoadjuvant cisplatin is low, attributable in part to patient/physician choice and the advanced age of patients, who often have multiple comorbidities including renal and/or cardiac dysfunction. Trials are using the neoadjuvant paradigm to detect incremental pathologic response to chemobiologic regimens and brief neoadjuvant single-agent therapy to screen for the biologic activity of agents.

KW - Adjuvant therapy

KW - Bladder cancer

KW - Muscle invasive

KW - Neoadjuvant therapy

KW - Radical cystectomy

KW - Urothelial cancer

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DO - 10.1016/j.eururo.2012.05.048

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