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. 2022 Mar 11;8(1):5-17.
doi: 10.3233/BLC-201511. eCollection 2022.

Systematic Review and Meta-Analysis of Cisplatin Based Neoadjuvant Chemotherapy in Muscle Invasive Bladder Cancer

Raed Benkhadra  1 , Tarek Nayfeh  2 , Sai Krishna Patibandla  3 , Chelsea Peterson  1 , Larry Prokop  4 , Omar Alhalabi  5 , M Hassan Murad  2 , Shifeng S Mao  3
Affiliations

Systematic Review and Meta-Analysis of Cisplatin Based Neoadjuvant Chemotherapy in Muscle Invasive Bladder Cancer

Raed Benkhadra et al. Bladder Cancer. .

Abstract

Background: Cisplatin-based neoadjuvant chemotherapy is the standard of care for muscle invasive bladder cancer (MIBC).

Objective: To compare the efficacy and safety of the two most commonly used cisplatin-based regimens; gemcitabine, and cisplatin (GC) vs. accelerated (dose-dense: dd) or conventional methotrexate, vinblastine, adriamycin, and cisplatin (MVAC).

Methods: We searched MEDLINE, Embase, Scopus and other sources. Outcomes of interest included overall survival, downstaging to pT≤1, pathologic complete response (pCR), recurrence, and toxicity. Meta-analysis was conducted using the random-effects model.

Results: We identified 24 studies. Efficacy outcomes were comparable between MVAC and GC for MIBC. dd-MVAC was associated with favorable efficacy compared to GC in terms of downstaging (OR 1.45; 95%CI 1.15-1.82) and all-cause mortality at longest follow-up (OR 0.63; 95%CI 0.44-0.81). However, GC was associated with a better safety profile in terms of febrile neutropenia (OR 0.32; 95%CI 0.13-0.80), anemia (OR 0.32; 95%CI 0.18-0.54), nausea and vomiting (OR 0.27; 95%CI 0.12-0.65) compared to dd-MVAC. Compared to MVAC, patients receiving GC had an increased risk of developing grade 3-4 thrombocytopenia (OR 4.70; 95%CI 1.59-13.89) and a lower risk of nausea and vomiting (OR 0.05; 95%CI 0.01-0.31). Certainty in the estimates was very low for most outcomes.

Conclusions: Efficacy and safety outcomes were comparable between MVAC and GC for MIBC. Including non-peer-reviewed studies showed higher efficacy with dd-MVAC. A phase III randomized trial comparing the two regimens is needed to guide clinical practice.

Keywords: Bladder cancer; cisplatin.

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Conflict of interest statement

Raed Benkhadra, Tarek Nayfeh, Sai Krishna Patibandla, Chelsea Peterson, Larry Prokop, Omar Alhalabi, M. Hassan Murad and Shifeng S. Mao declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart demonstrating the process of study selection.
Fig. 2
Fig. 2
Forest plot comparing the rates of achieving pathological complete response between patients receiving GC and MVAC stratified by the type of publication.
Fig. 3
Fig. 3
Forest plot comparing the rates of achieving a pT≤1 stage of between patients receiving GC and MVAC stratified by the type of publication.
Fig. 4
Fig. 4
Forest plot comparing all-cause mortality rates at the longest follow up between patients receiving GC and dd-MVAC stratified by the type of publication.
Fig. 5
Fig. 5
Forest plot comparing the rates of achieving a pT≤1 stage between patients receiving GC and dd-MVAC stratified by the type of publication.
See this image and copyright information in PMC

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