Evidence map›Paper›PMID 29329894›Full record

ArticleThe Journal of urology2018

Neoadjuvant Dose Dense MVAC versus Gemcitabine and Cisplatin in Patients with cT3-4aN0M0 Bladder Cancer Treated with Radical Cystectomy.

Homayoun Zargar, Jay B Shah, Bas W van Rhijn, Siamak Daneshmand, Trinity J Bivalacqua, Philippe E Spiess, Peter C Black, Wassim Kassouf, Collaborators

Registry-linked trialAbstract readComparative StudyEvaluation StudyMulticenter Study
PubMed Publisher
In one paragraph

Article in The Journal of urology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04047693 (Efficacy and Safety of Neoadjuvant Chemotherapy With Dose Dense MVAC Followed by Radical Surgery in Patients With MIBC and Locally Advanced Urothelial Carcinoma of Bladder), which is not on this map. Cited by 40 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 4 pooled it
12.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04047693 phase2unknown statusnot on this mapstarted 2019, after this paper: background citation

Efficacy and Safety of Neoadjuvant Chemotherapy With Dose Dense MVAC Followed by Radical Surgery in Patients With MIBC and Locally Advanced Urothelial Carcinoma of Bladder: Phase II, Single-arm Study

TypeinterventionalSponsorPusan National University Yangsan HospitalRan2019 to 2022Enrolled32ConditionsMuscle Invasive Bladder Cancer, Urothelial Carcinoma, Neoadjuvant ChemotherapyArmsdose dense MVAC with pegylated GCSF
3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 4 syntheses or guidelines pooled it, 80 citations in OpenAlex.

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  13. Neoadjuvant chemotherapy with dose-dense MVAC in muscle-invasive bladder cancer: a tertiary center experience.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 7 institutions in 3 countries.

Homayoun ZargarVancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada.
Jay B ShahDepartment of Urology, M. D. Anderson Cancer Center, Houston, Texas.
Bas W van RhijnDepartment of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Siamak DaneshmandInstitute of Urology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
Trinity J BivalacquaDepartment of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, Maryland.
Philippe E SpiessDepartment of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Peter C BlackVancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada.
Wassim KassoufDivision of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada. Electronic address: Wassim.kassouf@muhc.mcgill.ca.
Collaborators
University of British Columbia · CAJohns Hopkins University · USMcGill University Health Centre · CAMoffitt Cancer Center · USThe Netherlands Cancer Institute · NLThe University of Texas MD Anderson Cancer Center · USUniversity of Southern California · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeLevel I evidence supports the usefulness of neoadjuvant cisplatin based chemotherapy for muscle invasive bladder cancer. Since dose dense MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) has mostly replaced traditional MVAC, we compared pathological response and survival rates in patients with locally advanced bladder cancer who received neoadjuvant chemotherapy with dose dense MVAC vs gemcitabine and cisplatin. MATERIALS AND

methodsWe retrospectively reviewed the records of patients with urothelial cancer who received neoadjuvant chemotherapy and underwent cystectomy at a total of 20 contributing institutions from 2000 to 2015. Patients with cT3-4aN0M0 disease were selected for this analysis. The rates of ypT0N0 and ypT1N0 or less were compared between the gemcitabine and cisplatin, and dose dense MVAC regimens. Two multivariable Cox proportional hazards regression models of overall mortality were generated using preoperative and postoperative data.

resultsOf the patients who underwent neoadjuvant chemotherapy and radical cystectomy during the study period 319 met our inclusion criteria. A significantly lower rate of ypT0N0 was observed in the gemcitabine and cisplatin arm than in the dose dense MVAC arm (14.6% vs 28.0%, p = 0.005). The rate of ypT1N0 or less was 30.1% for gemcitabine and cisplatin compared to 41.0% for dose dense MVAC (p = 0.07). The mean Kaplan-Meier estimates of overall survival in the gemcitabine and cisplatin, and dose dense MVAC groups were 4.2 and 7.0 years, respectively (p = 0.001). On multivariable cox regression analysis based on preoperative data patients who received gemcitabine and cisplatin were at higher risk for death than patients who received dose dense MVAC (HR 2.07, 95% CI 1.25-3.42, p = 0.003). Lymph node invasion (HR 1.97, 95% CI 1.15-3.36, p = 0.01) and hydronephrosis (HR 2.18, 95% CI 1.43-3.30, p <0.001) were also associated with higher risk of death.

conclusionsIn our retrospective cohort of patients with locally advanced bladder cancer dose dense MVAC was associated with higher complete pathological response and improved survival rates compared to gemcitabine and cisplatin. A clinical trial is warranted to validate these hypothesis generating results to test the superiority of neoadjuvant dose dense MVAC in patients with locally advanced bladder cancer.

Indexed as

CystectomyAgedAntineoplastic Combined Chemotherapy ProtocolsCarcinoma, Transitional CellCisplatinDeoxycytidineDoxorubicinFemaleFollow-Up StudiesGemcitabineHumansKaplan-Meier EstimateMaleMethotrexateMiddle AgedNeoadjuvant TherapyCisplatinDeoxycytidineDoxorubicinGemcitabineMethotrexateVinblastinecisplatingemcitabinemortalityM-VAC protocolurinary bladder neoplasms

Identifiers

PMID29329894
OpenAlexW2782762180

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.