Korean J Urol Oncol.  2015 Aug;13(2):66-74. 10.0000/kjuo.2015.13.2.66.

Treatment of MIBC - Neoadjuvant Chemotherapy: New Standard of Care

• Kwon WA
• Seo HK

• KMID: 2307836
• DOI: http://doi.org/10.0000/kjuo.2015.13.2.66

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.

Keyword

Urinary bladder neoplasms; Neoadjuvant therapy; Efficacy; Cisplatin

MeSH Terms

Biomarkers
Cisplatin
Cystectomy
Doxorubicin
Drug Therapy*
Humans
Korea
Lymph Node Excision
Methotrexate
Neoadjuvant Therapy
Prospective Studies
Recurrence
Standard of Care*
Urinary Bladder Neoplasms
Vinblastine
Cisplatin
Doxorubicin
Methotrexate
Vinblastine