OBJECTIVE: To compare the outcomes of patients treated in the perioperative setting with methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) versus gemcitabine and cisplatin (GC). Systemic cisplatin-based chemotherapy regimens are the mainstay of treatment for patients with advanced bladder cancer. GC has often been used interchangeably with MVAC in neoadjuvant or adjuvant settings for patients with locally advanced (cT2N0M0-cT4N2M0) bladder cancer without adequate evidence. METHODS: A total of 114 patients treated with systemic chemotherapy for Stage T2-T4N0-N2M0 urothelial cell carcinoma of the bladder were included in the present study. The survival times were estimated and compared using the Kaplan-Meier method and log-rank test, respectively. Univariate and multivariate Cox proportional hazards models were used to determine the statistical significance. RESULTS: Of the 114 patients included in the present study, 37 (32%) were treated with GC and 77 (68%) with MVAC. In the neoadjuvant group, no difference was found between the 2 chemotherapeutic regimens in terms of the pathologic complete response rate at either cystectomy or during cystoscopy (14 [31%] of 45 MVAC patients vs 4 [25%] of 16 GC patients; P=.645). On multivariate analysis, the choice of regimen was not an independent predictor of cancer-specific death (hazard ratio 1.3, 95% confidence interval 0.67-2.57; P=.421) or overall survival (hazard ratio 1.3, 95% confidence interval 0.76-2.24; P=.330). CONCLUSION: Despite the lack of data on the relative efficacy of GC versus MVAC in the neoadjuvant and adjuvant settings, these regimens have been used interchangeably. The present investigation did not find the choice of cisplatin-based regimen to be an independent predictor of survival. A trend was seen toward improved survival and a greater complete response rate in the MVAC group.
OBJECTIVE: To compare the outcomes of patients treated in the perioperative setting with methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) versus gemcitabine and cisplatin (GC). Systemic cisplatin-based chemotherapy regimens are the mainstay of treatment for patients with advanced bladder cancer. GC has often been used interchangeably with MVAC in neoadjuvant or adjuvant settings for patients with locally advanced (cT2N0M0-cT4N2M0) bladder cancer without adequate evidence. METHODS: A total of 114 patients treated with systemic chemotherapy for Stage T2-T4N0-N2M0 urothelial cell carcinoma of the bladder were included in the present study. The survival times were estimated and compared using the Kaplan-Meier method and log-rank test, respectively. Univariate and multivariate Cox proportional hazards models were used to determine the statistical significance. RESULTS: Of the 114 patients included in the present study, 37 (32%) were treated with GC and 77 (68%) with MVAC. In the neoadjuvant group, no difference was found between the 2 chemotherapeutic regimens in terms of the pathologic complete response rate at either cystectomy or during cystoscopy (14 [31%] of 45 MVACpatients vs 4 [25%] of 16 GCpatients; P=.645). On multivariate analysis, the choice of regimen was not an independent predictor of cancer-specific death (hazard ratio 1.3, 95% confidence interval 0.67-2.57; P=.421) or overall survival (hazard ratio 1.3, 95% confidence interval 0.76-2.24; P=.330). CONCLUSION: Despite the lack of data on the relative efficacy of GC versus MVAC in the neoadjuvant and adjuvant settings, these regimens have been used interchangeably. The present investigation did not find the choice of cisplatin-based regimen to be an independent predictor of survival. A trend was seen toward improved survival and a greater complete response rate in the MVAC group.
Authors: Ming Yin; Monika Joshi; Richard P Meijer; Michael Glantz; Sheldon Holder; Harold A Harvey; Matthew Kaag; Elisabeth E Fransen van de Putte; Simon Horenblas; Joseph J Drabick Journal: Oncologist Date: 2016-04-06
Authors: Homayoun Zargar; Patrick N Espiritu; Adrian S Fairey; Laura S Mertens; Colin P Dinney; Maria C Mir; Laura-Maria Krabbe; Michael S Cookson; Niels-Erik Jacobsen; Nilay M Gandhi; Joshua Griffin; Jeffrey S Montgomery; Nikhil Vasdev; Evan Y Yu; David Youssef; Evanguelos Xylinas; Nicholas J Campain; Wassim Kassouf; Marc A Dall'Era; Jo-An Seah; Cesar E Ercole; Simon Horenblas; Srikala S Sridhar; John S McGrath; Jonathan Aning; Shahrokh F Shariat; Jonathan L Wright; Andrew C Thorpe; Todd M Morgan; Jeff M Holzbeierlein; Trinity J Bivalacqua; Scott North; Daniel A Barocas; Yair Lotan; Jorge A Garcia; Andrew J Stephenson; Jay B Shah; Bas W van Rhijn; Siamak Daneshmand; Philippe E Spiess; Peter C Black Journal: Eur Urol Date: 2014-09-23 Impact factor: 20.096
Authors: Brian R Winters; Navonil De Sarkar; Sonali Arora; Hamid Bolouri; Sujata Jana; Funda Vakar-Lopez; Heather H Cheng; Michael T Schweizer; Evan Y Yu; Petros Grivas; John K Lee; Lori Kollath; Sarah K Holt; Lisa McFerrin; Gavin Ha; Peter S Nelson; Robert B Montgomery; Jonathan L Wright; Hung-Ming Lam; Andrew C Hsieh Journal: JCI Insight Date: 2019-05-30
Authors: Charles C Peyton; Dominic Tang; Richard R Reich; Mounsif Azizi; Juan Chipollini; Julio M Pow-Sang; Brandon Manley; Philippe E Spiess; Michael A Poch; Wade J Sexton; Mayer Fishman; Jingsong Zhang; Scott M Gilbert Journal: JAMA Oncol Date: 2018-11-01 Impact factor: 31.777
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Authors: David C Johnson; Matthew E Nielsen; Jonathan Matthews; Michael E Woods; Eric M Wallen; Raj S Pruthi; Matthew I Milowsky; Angela B Smith Journal: BJU Int Date: 2014-03-14 Impact factor: 5.588