Evidence map›Paper›PMID 42050770›Full record

SynthesisInternational journal of cancer2026

Indirect Comparison of Neoadjuvant Treatment Strategies for Muscle-Invasive Bladder Cancer: ddMVAC and Perioperative Durvalumab-Gemcitabine-Cisplatin Versus Gemcitabine-Cisplatin: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials.

Maurin Helen Mangold, Gloria Baumann, Victoria Luise Simone Wieland, Nicolas Carl, Luisa Vivienne Renner, Alexander Studier-Fischer, Hanna Menold, Stefanie Zschäbitz, Frederik Wessels, Niklas Westhoff and 3 more

Abstract readSystematic ReviewNetwork Meta-AnalysisComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International journal of cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Maurin Helen MangoldDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.ORCID https://orcid.org/0009-0003-5594-0083
Gloria BaumannDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Victoria Luise Simone WielandDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Nicolas CarlDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Luisa Vivienne RennerDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Alexander Studier-FischerDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Hanna MenoldDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Stefanie ZschäbitzDepartment of Medical Oncology, National Centre for Tumour Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
Frederik WesselsDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Niklas WesthoffDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Maurice Stephan MichelDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Karl-Friedrich KowalewskiDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
Caelán Max Haney-AubertDepartment of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

For cisplatin-eligible patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC), neoadjuvant cisplatin-based chemotherapy (NAC) is standard of care. More intensive regimens such as dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (ddMVAC) and chemoimmunotherapy with durvalumab plus gemcitabine-cisplatin (D-GC) have shown superior outcomes. This network meta-analysis (NMA) compares the efficacy of ddMVAC, D-GC and GC and explores the efficacy thresholds for emerging therapy options, such as enfortumab vedotin plus pembrolizumab (EV-P), to surpass current standards. Following PROSPERO registration (CRD420251077606), systematic searches of PubMed, CENTRAL and Web of Science were conducted to March 2025. Randomised controlled trials (RCTs) comparing neoadjuvant regimens in cisplatin-eligible MIBC were included. A random-effects NMA was performed. Simulations explored hypothetical hazard ratios (HRs) for EV-P. Three RCTs were included. ddMVAC (HR 0.75, 95% CI 0.58-0.98; p = 0.034) and D-GC (HR 0.75, 95% CI 0.66-0.85; p < 0.001) improved overall survival (OS) versus GC, without differences between ddMVAC and D-GC (HR 0.99, 95% CI 0.75-1.33; p = 0.97). Both regimens improved progression-free survival. D-GC achieved higher pathological complete response (pCR) versus GC (OR 1.57, 95% CI 1.21-2.03; p < 0.001), whereas ddMVAC did not. No significant difference in pCR was found between ddMVAC and D-GC. Simulation-NMA suggested EV-P would need to achieve HR ≤ 0.45 versus GC to outperform ddMVAC and D-GC. Limitations include few trials and indirect comparisons. DdMVAC and D-GC improve survival compared with GC in neoadjuvant MIBC. Alternative therapeutic strategies must demonstrate substantial survival benefits to warrant replacing established neoadjuvant regimens.

Indexed as

Antineoplastic Combined Chemotherapy ProtocolsNeoadjuvant TherapyUrinary Bladder NeoplasmsAntibodies, MonoclonalCisplatinCystectomyDeoxycytidineDoxorubicinGemcitabineHumansMethotrexateNeoplasm InvasivenessRandomized Controlled Trials as TopicVinblastineAntibodies, MonoclonalCisplatinDeoxycytidineDoxorubicindurvalumabGemcitabineMethotrexateVinblastinemuscle‐invasive bladder cancerneoadjuvant chemotherapynetwork meta‐analysis

Identifiers

PMID42050770
PMCPMC13495798

What OpenQuestion holds

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Registered trials

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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.