Benkhadra Raed, Nayfeh Tarek, Patibandla Sai Krishna, Peterson Chelsea, Prokop Larry, Alhalabi Omar, Murad M Hassan, Mao Shifeng S
Allegheny General Hospital, Pittsburgh, PA, USA.
Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA.
Bladder Cancer. 2022 Mar 11;8(1):5-17. doi: 10.3233/BLC-201511. eCollection 2022.
Cisplatin-based neoadjuvant chemotherapy is the standard of care for muscle invasive bladder cancer (MIBC).
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).
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.
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.
Efficacy and safety outcomes were comparable between MVAC and GC for MIBC. Including non-peer-reviewed studies showed higher efficacy with dd-MVAC. A phase III randomized trial comparing the two regimens is needed to guide clinical practice.
基于顺铂的新辅助化疗是肌肉浸润性膀胱癌（MIBC）的标准治疗方法。
比较两种最常用的基于顺铂的方案的疗效和安全性；吉西他滨和顺铂（GC）与加速（剂量密集：dd）或传统的甲氨蝶呤、长春碱、阿霉素和顺铂（MVAC）。
我们检索了MEDLINE、Embase、Scopus和其他来源。感兴趣的结果包括总生存期、降期至pT≤1、病理完全缓解（pCR）、复发和毒性。使用随机效应模型进行荟萃分析。
我们确定了24项研究。MVAC和GC对MIBC的疗效结果相当。在降期（OR 1.45；95%CI 1.15 - 1.82）和最长随访时的全因死亡率（OR 0.63；95%CI 0.44 - 0.81）方面，与GC相比，dd - MVAC具有更好的疗效。然而，在发热性中性粒细胞减少（OR 0.32；95%CI 0.13 - 0.80）、贫血（OR 0.32；95%CI 0.18 - 0.54）、恶心和呕吐（OR 0.27；95%CI 0.12 - 0.65）方面，与dd - MVAC相比，GC具有更好的安全性。与MVAC相比，接受GC的患者发生3 - 4级血小板减少的风险增加（OR 4.70；95%CI 1.59 - 13.89），恶心和呕吐的风险降低（OR 0.05；95%CI 0.01 - 0.31）。大多数结果估计的确定性非常低。
MVAC和GC对MIBC的疗效和安全性结果相当。纳入非同行评审研究显示dd - MVAC具有更高的疗效。需要进行一项比较这两种方案的III期随机试验来指导临床实践。
