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• W2003935702 abstract "I nvasive bladder cancer is a common and dangerous disease that is becoming only more prevalent as the population ages. Radical surgical therapy with curative intent has been and continues to be a mainstay in the management of this condition; however, approximately half of clinically localized cases go on to develop distant metastases postoperatively. Platinum-based combination chemotherapy (methotrexate, vinblastine, doxorubicin, and cisplatin [MVAC]) emerged more than 20 years ago in studies pioneered by Dr. Alan Yagoda and associates at Memorial Sloan-Kettering as the first effective systemic therapy for metastatic urothelial carcinoma. Despite this major advance, as well as concomitant improvements in surgical and perioperative care, bladder cancer mortality rates have not seen a dramatic improvement in recent years. A review of survival outcomes of contemporary versus historical cystectomy series (before and after 1985) stratified by pathologic stage revealed only modest improvements in survival in the modern era, with 5year survival rates of 60% versus 67% for pT2, 33% versus 35% for pT3, and 21% versus 27% for pT4. The casual observer could be forgiven for a less than sanguine view of the state of the art in this setting; in 2008, there is clear room for improvement in the outcomes of patients with high-risk, muscle-invasive bladder cancer. The observation of responses in the primary tumor among patients with metastatic disease led to the evaluation of MVAC given before cystectomy for muscle-invasive bladder cancer. A body of literature has emerged over the past 2 decades supporting neoadjuvant platinum-based chemotherapy followed by radical cystectomy as a particularly promising strategy to improve patient outcomes. A recent meta-analysis of over 3000 patients, representing 98% of all patients in relevant randomized controlled trials, demonstrated a significant benefit associated with neoadjuvant cisplatin-based chemotherapy, equivalent to a 5% improvement in See referenced original article on pages 2471–7, this issue." @default.
• W2003935702 created "2016-06-24" @default.
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• W2003935702 date "2008-11-01" @default.
• W2003935702 modified "2023-09-25" @default.
• W2003935702 title "Neoadjuvant gemcitabine and cisplatin: Another step on the path toward improving the outcomes of patients with high-risk, invasive bladder cancer" @default.
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• W2003935702 doi "https://doi.org/10.1002/cncr.23849" @default.
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