Re: A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer

摘要

The authors reviewed Medline databases of articles published before April 1, 2012, regarding use of perioperative chemotherapy for patients with muscle-invasive bladder cancer. In a meta-analysis of 11 randomized trials that included 3005 patients who received neoadjuvant chemotherapy with platinum-based combination regimens, there was a 5% increase in absolute overall 5-yr survival and a 9% absolute increase in 5-yr disease-free survival compared with patients who received primary cystectomy alone. More than 90% of the patients in the neoadjuvant groups received ciplatin, and the remainder received carboplatin. Current evidence does not show superiority of a specific regimen (ie, methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin [MVAC]; dose-dense MVAC; gemcitabine and cisplatin [GC]). Despite this level 1 evidence, the use of neoadjuvant chemotherapy for bladder cancer remains very low. In addition, the majority of patients who receive any perioperative chemotherapy are treated with adjuvant therapy despite the fact that evidence to support a benefit for such therapy does not exist.