Treatment of MIBC - Neoadjuvant Chemotherapy: New Standard of Care
Korean Journal of Urological Oncology
;
: 66-74, 2015.
Article
in Korean
| WPRIM
| ID: wpr-65726
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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Recurrence
/
Vinblastine
/
Urinary Bladder Neoplasms
/
Biomarkers
/
Doxorubicin
/
Cystectomy
/
Methotrexate
/
Prospective Studies
/
Cisplatin
/
Neoadjuvant Therapy
Type of study:
Controlled clinical trial
/
Observational study
Limits:
Humans
Country/Region as subject:
Asia
Language:
Korean
Journal:
Korean Journal of Urological Oncology
Year:
2015
Type:
Article
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