From Interferon to Checkpoint Inhibition Therapy-A Systematic Review of New Immune-Modulating Agents in Bacillus Calmette-Guérin (BCG) Refractory Non-Muscle-Invasive Bladder Cancer (NMIBC)
原文： 2022 年 发布于
Cancers (Basel)
44 卷 第 3 期 101592
浏览量：171次
作者：
Deininger S.
Törzsök P.
Mitterberger M.
Pallauf M.
Oswald D.
Deininger C.
Lusuardi L.
作者单位：
Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA. Academic Urology Unit, University of Sheffield, Sheffield, UK. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Department of Urology, Royal Devon and Exeter NHS Trust, Exeter, UK. USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. Department of Urology, University College London Hospital, London, UK. Department of Urology, Mayo Clinic, Rochester, MN, USA. Department of Urology, New York University, New York, NY, USA. Department of Urology, University of Kansas, Kansas City, KS, USA. Department of Urology, McGill University Health Center, Montreal, QC, Canada. Department of Urologic Science, University of British Columbia, Vancouver, BC, Canada. Service d'urologie, CHU vaudois, Lausanne, Switzerland. Academic Urology Unit, University of Sheffield, Sheffield, UK. Electronic address: j.catto@sheffield.ac.uk. USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. Electronic address: daneshma@med.usc.edu.
归属分类：
膀胱肿瘤治疗及预后证据
DOI：
10.1016/j.urolonc.2020.12.019
关键词：
Bladder cancer
Intra-arterial chemotherapy
Intravesical chemotherapy
Recurrence
Survival
BACKGROUND: Cisplatin-based neoadjuvant chemotherapy is the standard of care for muscle invasive bladder cancer (MIBC). OBJECTIVE: To compare the efficacy and safety of the two most commonly used cisplatin-based regimens; gemcitabine, and cisplatin (GC) vs. accelerated (dose-dense: dd) or conventional methotrexate, vinblastine, adriamycin, and cisplatin (MVAC). METHODS: We searched MEDLINE, Embase, Scopus and other sources. Outcomes of interest included overall survival, downstaging to pT <= 1, pathologic complete response (pCR), recurrence, and toxicity. Meta-analysis was conducted using the random-effects model. RESULTS: We identified 24 studies. Efficacy outcomes were comparable between MVAC and GC for MIBC. dd-MVAC was associated with favorable efficacy compared to GC in terms of downstaging (OR 1.45; 95% CI 1.15-1.82) and all-cause mortality at longest follow-up (OR 0.63; 95% CI 0.44-0.81). However, GC was associated with a better safety profile in terms of febrile neutropenia (OR 0.32; 95% CI 0.13-0.80), anemia (OR 0.32; 95% CI 0.18-0.54), nausea and vomiting (OR 0.27; 95% CI 0.12-0.65) compared to dd-MVAC. Compared to MVAC, patients receiving GC had an increased risk of developing grade 3-4 thrombocytopenia (OR 4.70; 95% CI 1.59-13.89) and a lower risk of nausea and vomiting (OR 0.05; 95% CI 0.01-0.31). Certainty in the estimates was very low for most outcomes. CONCLUSIONS: Efficacy and safety outcomes were comparable between MVAC and GC for MIBC. Including non-peerreviewed studies showed higher efficacy with dd-MVAC. A phase III randomized trial comparing the two regimens is needed to guide clinical practice.