Abstract
We conducted a meta-analysis to assess the efficacy and safety of dose-dense chemotherapy in the treatment of patients with urothelial carcinoma. A systematic search was conducted in PubMed, Medline, Embase, Web of Science and Cochrane Collaboration's Central register of controlled trials (CENTRAL) for relevant articles. Data was obtained from 10 trials with a total of 1093 patients. The pooled pathologic complete response (pCR) was 27.8% in the ten studies with a full cohort of 684 patients who received dose-dense methotrexate, vinblastine, adriamycin and cisplatin (dd-MVAC). In the controlled trials, although the difference was not significant, the pCR rate in the dd-MVAC group has a trend of increase (odds ratio (OR) 1.52; 95% confidence interval (CI) 0.78-2.98, P = 0.22) compared with classic MVAC group. A significant improvement of overall survival (OS) (hazard ratio (HR) 0.77, 95% CI 0.61–0.97, p = 0.03) was also observed. Hematologic toxicities were the most frequent grade ≥ 3 toxicities including neutropenia/febrile neutropenia (17.5%), anemia (9.4%) and thrombocytopenia (6.1%). Compared with the classic MVAC group, dd-MVAC was associated with significantly decreased risks of all-grade adverse events (AEs) such as anemia (OR 0.457, 95% CI 0.249–0.840, p = 0.012), febrile neutropenia (OR 0.398 95% CI 0.233–0.681, p = 0.001), and neutropenia (OR 0.373, 95% CI 0.201–0.691, p = 0.002). In conclusion, dose-dense chemotherapy was effective and tolerable in patients with urothelial carcinoma, which could be considered as a reasonable therapeutic option.
Highlights
Urothelial carcinoma (UC) is a significant health problem
Compared with the classic MVAC group, dd-MVAC was associated with significantly decreased risks of all-grade adverse events (AEs) such as anemia, febrile neutropenia, and neutropenia
Three [7, 9, 16] were controlled trials comparing dd-MVAC with classic MVAC, one [17] was another controlled trial comparing a dd-GC regimen with dd-MVAC which suggested that not superior to dd-MVAC, dd-GC was better tolerated, and one [11] was AG-TC which was doxorubicin plus gemcitabine followed by paclitaxel plus carboplatin
Summary
Urothelial carcinoma (UC) is a significant health problem. In 2008, it led to an estimated 150,200 deaths worldwide [1]. According to the European Urology Association (EAU), radical cystectomy (RC) with bilateral pelvic lymphadenectomy was the gold standard treatment for patients with muscle-invasive tumors [4]. The classic MVAC regimen (methotrexate, vinblastine, doxorubicin and cisplatin) [5] was established as the most effective regimen (4-week-per-cycle) in the neoadjuvant chemotherapy setting [6], and the first recognized option for patients with locally advanced or metastatic UC [7]. In 1993, the classic MVAC regimen was modified into dose-dense MVAC (dd-MVAC) which was administered in cycles of 14 days. To systematically review the safety and efficacy of dose-dense chemotherapy, we assessed the pathologic complete response (pCR), objective response rate (ORR), overall survival (OS) and adverse events (AEs) of dosedense chemotherapy, dd-MVAC in particular, in patients with UC. We compared the efficacy and safety of ddMVAC with classic MVAC
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
