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Comparison of Oncologic Outcomes of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis

SIMPLE SUMMARY: Currently, platinum-based neoadjuvant chemotherapy (NAC) is becoming a standard treatment for use in patients with muscle-invasive bladder cancer. However, comparisons of oncologic outcomes for the two most commonly used NAC regimens, ddMVAC (dose-dense methotrexate, vinblastine, dox...

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Autores principales: Chung, Doo Yong, Kang, Dong Hyuk, Kim, Jong Won, Ha, Jee Soo, Kim, Do Kyung, Cho, Kang Su
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199668/
https://www.ncbi.nlm.nih.gov/pubmed/34199565
http://dx.doi.org/10.3390/cancers13112770
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author Chung, Doo Yong
Kang, Dong Hyuk
Kim, Jong Won
Ha, Jee Soo
Kim, Do Kyung
Cho, Kang Su
author_facet Chung, Doo Yong
Kang, Dong Hyuk
Kim, Jong Won
Ha, Jee Soo
Kim, Do Kyung
Cho, Kang Su
author_sort Chung, Doo Yong
collection PubMed
description SIMPLE SUMMARY: Currently, platinum-based neoadjuvant chemotherapy (NAC) is becoming a standard treatment for use in patients with muscle-invasive bladder cancer. However, comparisons of oncologic outcomes for the two most commonly used NAC regimens, ddMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) and GC (gemcitabine and cisplatin), are controversial. We sought to compare the oncologic outcomes of these two regimens via a systematic review and meta-analysis of all the available studies published to date. Through this, we aimed to provide evidence on the optimal NAC regimen for use in muscle-invasive bladder cancer. ABSTRACT: Platinum-based neoadjuvant chemotherapy (NAC) is widely used for treating muscle-invasive bladder cancer (MIBC). A systematic review was performed following PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched up to December 2020. We conducted a meta-analysis to compare the oncologic outcomes of ddMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) and GC (gemcitabine and cisplatin), which are the most widely used NAC regimens. Endpoints included pathologic complete response (pCR), pathologic downstaging (pDS), overall survival (OS), and cancer-specific survival (CSS). Five studies, with a total of 1206 patients, were included for meta-analysis. pCR was observed in 35.2% of the ddMVAC arm and in 25.1% of the GC arm, and pCR was significantly higher in ddMVAC than in GC (odds ratio (OR), 1.45; 95% confidence interval (CI), 1.11–1.89; p = 0.006). There was no significant difference in pDS (OR, 1.37; CI, 0.84–2.21; p = 0.20). OS was significantly higher in ddMVAC than in GC (hazard ratio, 2.16; CI, 1.42–3.29; p = 0.0004). Only one study reported CSS outcomes. The results of this analysis indicate that ddMVAC is superior to GC in terms of pCR and OS, suggesting that ddMVAC is more effective than GC in NAC for MIBC. However, this should be interpreted with caution because of the inherent limitations of retrospective studies.
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spelling pubmed-81996682021-06-14 Comparison of Oncologic Outcomes of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis Chung, Doo Yong Kang, Dong Hyuk Kim, Jong Won Ha, Jee Soo Kim, Do Kyung Cho, Kang Su Cancers (Basel) Systematic Review SIMPLE SUMMARY: Currently, platinum-based neoadjuvant chemotherapy (NAC) is becoming a standard treatment for use in patients with muscle-invasive bladder cancer. However, comparisons of oncologic outcomes for the two most commonly used NAC regimens, ddMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) and GC (gemcitabine and cisplatin), are controversial. We sought to compare the oncologic outcomes of these two regimens via a systematic review and meta-analysis of all the available studies published to date. Through this, we aimed to provide evidence on the optimal NAC regimen for use in muscle-invasive bladder cancer. ABSTRACT: Platinum-based neoadjuvant chemotherapy (NAC) is widely used for treating muscle-invasive bladder cancer (MIBC). A systematic review was performed following PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched up to December 2020. We conducted a meta-analysis to compare the oncologic outcomes of ddMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) and GC (gemcitabine and cisplatin), which are the most widely used NAC regimens. Endpoints included pathologic complete response (pCR), pathologic downstaging (pDS), overall survival (OS), and cancer-specific survival (CSS). Five studies, with a total of 1206 patients, were included for meta-analysis. pCR was observed in 35.2% of the ddMVAC arm and in 25.1% of the GC arm, and pCR was significantly higher in ddMVAC than in GC (odds ratio (OR), 1.45; 95% confidence interval (CI), 1.11–1.89; p = 0.006). There was no significant difference in pDS (OR, 1.37; CI, 0.84–2.21; p = 0.20). OS was significantly higher in ddMVAC than in GC (hazard ratio, 2.16; CI, 1.42–3.29; p = 0.0004). Only one study reported CSS outcomes. The results of this analysis indicate that ddMVAC is superior to GC in terms of pCR and OS, suggesting that ddMVAC is more effective than GC in NAC for MIBC. However, this should be interpreted with caution because of the inherent limitations of retrospective studies. MDPI 2021-06-02 /pmc/articles/PMC8199668/ /pubmed/34199565 http://dx.doi.org/10.3390/cancers13112770 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Chung, Doo Yong
Kang, Dong Hyuk
Kim, Jong Won
Ha, Jee Soo
Kim, Do Kyung
Cho, Kang Su
Comparison of Oncologic Outcomes of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis
title Comparison of Oncologic Outcomes of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis
title_full Comparison of Oncologic Outcomes of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis
title_fullStr Comparison of Oncologic Outcomes of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis
title_full_unstemmed Comparison of Oncologic Outcomes of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis
title_short Comparison of Oncologic Outcomes of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis
title_sort comparison of oncologic outcomes of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddmvac) with gemcitabine and cisplatin (gc) as neoadjuvant chemotherapy for muscle-invasive bladder cancer: systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199668/
https://www.ncbi.nlm.nih.gov/pubmed/34199565
http://dx.doi.org/10.3390/cancers13112770
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