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Giving three cycles of cisplatin-based chemotherapy before removing the bladder lengthened survival compared with surgery alone, and became the standard for fit patients with muscle-invasive bladder cancer.
Randomised trial of 317 patients with muscle-invasive urothelial bladder cancer (T2 to T4a) assigned to three cycles of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) followed by radical cystectomy, or cystectomy alone.
Median survival was 77 months with neoadjuvant chemotherapy against 46 months with surgery alone, and 38 percent of chemotherapy patients had no residual tumour at surgery compared with 15 percent, a finding tightly linked to long-term survival. The trial anchored neoadjuvant cisplatin-based chemotherapy as the standard of care.
Fit patients with muscle-invasive bladder cancer should be offered cisplatin-based chemotherapy before cystectomy; a complete pathological response predicts cure. Newer regimens such as gemcitabine-cisplatin and dose-dense MVAC, and now durvalumab, build on this result.
Shares Muscle-invasive and advanced bladder cancer, New England Journal of Medicine.
Shares Muscle-invasive and advanced bladder cancer, New England Journal of Medicine.
Shares Muscle-invasive and advanced bladder cancer, New England Journal of Medicine.