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. 2023 Aug;41(8):2185-2194.
doi: 10.1007/s00345-023-04478-w. Epub 2023 Jun 22.

Comparison between different neoadjuvant chemotherapy regimens and local therapy alone for bladder cancer: a systematic review and network meta-analysis of oncologic outcomes

Abdulmajeed Aydh  1   2 , Reza Sari Motlagh  1   3 , Abdulaziz Alamri  4 , Takafumi Yanagisawa  1   5 , Adil Ayed  6 , Pawel Rajwa  1   7 , Ekaterina Laukhtina  1   8 , Saeed M Alasiri  9 , Tatsushi Kawada  1   10 , Hadi Mostafai  1   11 , Abdulelah Ayidh  12 , Maximilian Pallauf  1   13 , Frederik König  1   14 , Mohammad Abufaraj  15   16 , Pierre I Karakiewicz  17 , Shahrokh F Shariat  18   19   20   21   22   23   24
Affiliations

Comparison between different neoadjuvant chemotherapy regimens and local therapy alone for bladder cancer: a systematic review and network meta-analysis of oncologic outcomes

Abdulmajeed Aydh et al. World J Urol. 2023 Aug.

Abstract

Purpose: The present systematic review and network meta-analysis (NMA) compared the current different neoadjuvant chemotherapy (NAC) regimes for bladder cancer patients to rank them.

Methods: We used the Bayesian approach in NMA of six different therapy regimens cisplatin, cisplatin/doxorubicin, (gemcitabine/cisplatin) GC, cisplatin/methotrexate, methotrexate, cisplatin, and vinblastine (MCV) and (MVAC) compared to locoregional treatment.

Results: Fifteen studies comprised 4276 patients who met the eligibility criteria. Six different regimes were not significantly associated with a lower likelihood of overall mortality rate compared to local treatment alone. In progression-free survival (PFS) rates, cisplatin, GC, cisplatin/methotrexate, MCV and MVAC were not significantly associated with a higher likelihood of PFS rate compared to locoregional treatment alone. In local control outcome, MCV, MVAC, GC and cisplatin/methotrexate were not significantly associated with a higher likelihood of local control rate versus locoregional treatment alone. Nevertheless, based on the analyses of the treatment ranking according to SUCRA, it was highly likely that MVAC with high certainty of results appeared as the most effective approach in terms of mortality, PFS and local control rates. GC and cisplatin/doxorubicin with low certainty of results was found to be the best second options.

Conclusion: No significant differences were observed in mortality, progression-free survival and local control rates before and after adjusting the type of definitive treatment in any of the six study arms. However, MVAC was found to be the most effective regimen with high certainty, while cisplatin alone and cisplatin/methotrexate should not be recommended as a neoadjuvant chemotherapy regime.

Keywords: Bladder cancer; Chemotherapy; Cisplatin; Neoadjuvant; Radical cystectomy.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Summary of the Bayesian network meta-analysis of overall mortality rate in patients treated with neoadjuvant chemotherapy for bladder cancer (A–C) and Sensitivity analyses (D–F). Cisplatin (Cis), cisplatin/doxorubicin (Cis_Doxo), or Cisplatin and Gemcitabine (Cis_Gem), cisplatin/methotrexate (Cis_MTX), methotrexate, cisplatin and vinblastine (MCV) and Methotrexate, Vinblastine, Doxorubicin (Adriamycin), and Cisplatin MVAC
Fig. 2
Fig. 2
Summary of the Bayesian network meta-analysis of overall mortality rate excluding RT-only studies in patients treated with neoadjuvant chemotherapy for bladder cancer. Cisplatin (Cis), cisplatin/doxorubicin (Cis_Doxo), or Cisplatin and Gemcitabine (Cis_Gem), cisplatin/methotrexate (Cis_MTX), cisplatin, methotrexate and vinblastine (CMV) and Methotrexate, Vinblastine, Doxorubicin (Adriamycin), and Cisplatin MVAC
Fig. 3
Fig. 3
Summary of the Bayesian network meta-analysis of progression-free survival rate in patients treated with neoadjuvant chemotherapy for bladder cancer. rate (PFS). Cisplatin (Cis), cisplatin/doxorubicin (Cis_Doxo), or Cisplatin and Gemcitabine (Cis_Gem), cisplatin/methotrexate (Cis_MTX), cisplatin, methotrexate and vinblastine (CMV) and Methotrexate, Vinblastine, Doxorubicin (Adriamycin), and Cisplatin MVAC
Fig. 4
Fig. 4
Summary of the Bayesian network meta-analysis of progression-free survival rate excluding RT-only studies in patients treated with neoadjuvant therapy for bladder cancer. Cisplatin (Cis), cisplatin/doxorubicin (Cis_Doxo), or Cisplatin and Gemcitabine (Cis_Gem), cisplatin/methotrexate (Cis_MTX), cisplatin, methotrexate and vinblastine (CMV) and Methotrexate, Vinblastine, Doxorubicin (Adriamycin), and Cisplatin MVAC
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References

    1. Ghoneim MA, El-Mekresh MM, Mokhtar AA, Gomha MA, El-Baz MA, El-Attar IA. A predictive model of survival after radical cystectomy for carcinoma of the bladder. BJU Int. 2000;85(7):811–816. doi: 10.1111/j.1464-410x.2000.00618.x. - DOI - PubMed
    1. Witjes JA, Compérat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG, Sherif A. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol. 2014;65(4):778–792. doi: 10.1016/j.eururo.2013.11.046. - DOI - PubMed
    1. North SJCUAJ. Why consider neoadjuvant chemotherapy for muscle-invasive transitional cell carcinoma of the bladder? Can Urol Assoc J. 2008;2(3):222. doi: 10.5489/cuaj.602. - DOI - PMC - PubMed
    1. Sternberg CN. Perioperative chemotherapy in muscle-invasive bladder cancer to enhance survival and/or as a strategy for bladder preservation. Semin Oncol. 2007;34(2):122–128. doi: 10.1053/j.seminoncol.2006.12.006. - DOI - PubMed
    1. Vale CL. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol. 2005;48(2):202–205. doi: 10.1016/j.eururo.2005.04.006. - DOI - PubMed

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