Abstract
BackgroundNeoadjuvant chemotherapy has been accepted as an effective curative treatment for muscle-invasive bladder cancer patients and has resulted in better survival outcomes than radical cystectomy or a cisplatin-based regimen. In the present study, we aimed to compare the two most commonly used cisplatin-based neoadjuvant chemotherapies, gemcitabine plus cisplatin and methotrexate plus vinblastine plus doxorubicin plus cisplatin, by summarizing and analyzing clinical data and outcomes of published research.MethodsWe searched for qualified studies that compared these two types of neoadjuvant chemotherapy, including 4 randomized controlled trials and 14 retrospective studies. Data and information on pathological responses and long-term survival studies were extracted and analyzed separately.ResultsA total of 18 studies with 3116 patients were selected from 1188 studies, which contained data on pathological complete response, pathological partial response, and overall survival. In contrast to the results of previous studies, there was no significant difference in pathological complete response (odds ratio, 0.97; 95% confidence interval, 0.81-1.15), pathological partial response (odds ratio, 0.85; 95% confidence interval, 0.72-1.14), and overall survival (hazard ratio, 0.99; 95% confidence interval, 0.83-1.17) between GC and MVAC in this meta-analysis.ConclusionNo significant differences were observed between GC and MVAC in the muscle-invasive bladder cancer treatment due to the similar curative effect and parallel long survival outcomes due to the similar curative effect and parallel long survival outcomes. The priority selection of GC or MVAC in the clinic should be guided by further investigation, and the clinical standard strategy still counts on the results of more randomized controlled trials in the future.
Highlights
Bladder cancer is the second most common carcinoma in the urinary tract, and its occurrence rate continues to increase annually worldwide
The standards of retrieved document were in line with the principle of participants, interventions, comparators, outcomes, and study design (PICOS),which were shown as follows: Participants, patients diagnosed as Muscle-invasive bladder cancer (MIBC) who were willing to undergo radical cystectomy and patients who underwent systemic neoadjuvant chemotherapy; Interventions, MIBC patients who underwent systemic NCT using MVAC or dense dose MVAC; Comparators, MIBC patients who underwent systemic NCT using gemcitabine plus cisplatin (GC); Outcomes, comparison of pathologic (pathologic complete response (PCR), pathologic complete response (PPR) and prognostic outcomes [Overall Survival (OS)]; and Study design, both prospective randomized controlled trials (RCTs) and retrospective observational studies could be included for analyses
A survival advantage was seen with MVAC compared with cisplatin alone, MVAC still showed a high risk of nonnegligible toxicity
Summary
Bladder cancer is the second most common carcinoma in the urinary tract, and its occurrence rate continues to increase annually worldwide. Many randomized controlled trials (RCTs) have reported that cisplatin-based neoadjuvant chemotherapy (NCT) has superior curative effects to either radical cystectomy or locoregional treatment alone and could improve long-term survival outcomes. Considering the outcomes of the significant SWOG-8710 RCT, methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) were established as the most effective regimen in the NCT setting [3]. Another RCT showed that gemcitabine plus cisplatin (GC) had an advantage in terms of survival outcomes, and this regimen has been increasingly applied in the NCT setting over MVAC [4]. Neoadjuvant chemotherapy has been accepted as an effective curative treatment for muscle-invasive bladder cancer patients and has resulted in better survival outcomes than radical cystectomy or a cisplatin-based regimen. We aimed to compare the two most commonly used cisplatin-based neoadjuvant chemotherapies, gemcitabine plus cisplatin and methotrexate plus vinblastine plus doxorubicin plus cisplatin, by summarizing and analyzing clinical data and outcomes of published research
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