SWOG 8710: neoadjuvant MVAC chemotherapy before cystectomy for muscle-invasive bladder cancer
Giving three cycles of cisplatin-based chemotherapy before removing the bladder lengthened survival compared with surgery alone, and became the standard for fit patients with muscle-invasive bladder cancer.
Overview
Randomised trial of 317 patients with muscle-invasive urothelial bladder cancer (T2 to T4a) assigned to three cycles of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) followed by radical cystectomy, or cystectomy alone.
Median survival was 77 months with neoadjuvant chemotherapy against 46 months with surgery alone, and 38 percent of chemotherapy patients had no residual tumour at surgery compared with 15 percent, a finding tightly linked to long-term survival. The trial anchored neoadjuvant cisplatin-based chemotherapy as the standard of care.
- Median overall survival 77 months with neoadjuvant MVAC vs 46 months with cystectomy alone.
- Pathological complete response (pT0) in 38 percent vs 15 percent, with 85 percent five-year survival among pT0 patients.
Fit patients with muscle-invasive bladder cancer should be offered cisplatin-based chemotherapy before cystectomy; a complete pathological response predicts cure. Newer regimens such as gemcitabine-cisplatin and dose-dense MVAC, and now durvalumab, build on this result.
- The survival difference reached only borderline statistical significance in the primary analysis.
- Slow accrual over eleven years; MVAC has largely been replaced by better-tolerated cisplatin regimens.
Similar pages
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