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• W2914417811 abstract "Background: We aimed to provide a comprehensive literature review on the best practice management of patients with nonmetastatic muscle-invasive bladder cancer (MIBC) using neoadjuvant chemotherapy (NAC). Method: Between July and September 2018, we conducted a systematic review using MEDLINE and EMBASE electronic bibliographic databases. The search strategy included the following terms: Neoadjuvant Therapy and Urinary Bladder Neoplasms. Results: There is no benefit of a single-agent platinum-based chemotherapy. Platinum-based NAC is the gold standard therapy and mainly consists of a combination of cisplatin, vinblastine, methotrexate, doxorubicin, gemcitabine or even epirubicin (MVAC). At 5 years, the absolute overall survival benefit of MVAC was 5% and the absolute disease-free survival was improved by 9%. This effect was observed independently of the type of local treatment and did not vary between subgroups of patients. Moreover, a ypT0 stage (complete pathological response) after radical cystectomy was a surrogate marker for improved oncological outcomes. High-density MVAC has been shown to decrease toxicity (with a grade 3–4 toxicity ranging from 0% to 26%) without impacting oncological outcomes. To date, there is no role for carboplatin administration in the neoadjuvant setting in patients that are unfit for cisplatin-based NAC administration. So far, there is no published trial evaluating the role of immunotherapy in a neoadjuvant setting, but many promising studies are ongoing. Conclusion: There is a strong level of evidence supporting the clinical use of a high-dose-intensity combination of methotrexate, vinblastine, doxorubicin and cisplatin in a neoadjuvant setting. The landscape of MIBC therapies should evolve in the near future with emerging immunotherapies." @default.
• W2914417811 created "2019-02-21" @default.
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• W2914417811 date "2019-01-01" @default.
• W2914417811 modified "2023-10-18" @default.
• W2914417811 title "Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer" @default.
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• W2914417811 doi "https://doi.org/10.1177/1756287218823678" @default.
• W2914417811 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/6350113" @default.
• W2914417811 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/30728860" @default.
• W2914417811 hasPublicationYear "2019" @default.
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