#DR. PANZARELLA TRIAL#
5 Similarly, the SWOG 8710 trial which randomized 317 MIBC patients to 3 cycles of methotrexate, vinblastine, doxorubicin, cisplatin (MVAC) followed by cystectomy or cystectomy alone, showed a median survival of 77 months with NC versus 46 months without NC and a 5-year overall survival of 57% versus 43% ( p = 0.06). NC had an absolute survival benefit of 5% and a relative risk reduction in death of 16% at 10 years.
In the MRC/EORTC (Medical Research Council/European Organization for Research and Treatment of Cancer) trial, 976 patients were randomized to 3 cycles of cisplatin, methotrexate and vinblastine or no neoadjuvant chemotherapy (NC) followed by cystectomy or radiation. Attempts to improve outcomes have therefore focused on the use of neoadjuvant cisplatin-based combination chemotherapy to improve overall survival. 2, 3 Recurrences often occur distantly, suggesting the presence of micrometastatic disease at the time of surgery. However, 5-year overall survival rates following radical cystectomy alone are only 50%, and fall to 37% and 31% in patients with extravesical extension and lymph node involvement, respectively.
1 For these patients, radical cystectomy arguably remains the standard of care.
According to the Canadian Cancer Society, bladder cancer is the fifth most common cancer overall, accounting for 7800 cases/year of these cases, about 15% to 20% are muscle invasive bladder cancers (MIBC).