Treatment of MIBC - Neoadjuvant Chemotherapy: New Standard of Care.
- Author:
Whi An KWON
1
;
Ho Kyung SEO
Author Information
1. Department of Urology, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University Sanbon Hospital, Gunpo, Korea.
- Publication Type:Clinical Trial ; Meta-Analysis ; Review
- Keywords:
Urinary bladder neoplasms;
Neoadjuvant therapy;
Efficacy;
Cisplatin
- MeSH:
Biomarkers;
Cisplatin;
Cystectomy;
Doxorubicin;
Drug Therapy*;
Humans;
Korea;
Lymph Node Excision;
Methotrexate;
Neoadjuvant Therapy;
Prospective Studies;
Recurrence;
Standard of Care*;
Urinary Bladder Neoplasms;
Vinblastine
- From:Korean Journal of Urological Oncology
2015;13(2):66-74
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The standard management for patients with muscle invasive bladder cancer (MIBC) involves radical cystectomy and pelvic lymph node dissection. Although this treatment may be curative, a large proportion of patients will develop recurrence and will ultimately die of metastatic disease. Prospective, randomized clinical trial data demonstrate a survival advantage for those patients who receive neoadjuvant chemotherapy (NAC) prior to radical cystectomy and this concept was confirmed by meta-analysis. The administration of cisplatin-based combination NAC has consistently demonstrated a survival benefit of 5%. The pathologic downstaging is used as a surrogate end point. The efficacy of NAC for MIBC was established primarily with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), with complete response rates (pT0) as high as 38%. Dose dense M-VAC (DDMAVC) is preferred over standard MVAC, and gemcitabine/cisplatin is a reasonable alternative to standard M-VAC for NAC. In Korea, while NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.
