Treatment of MIBC - Neoadjuvant Chemotherapy: New Standard of Care

, Whi-An Kwon; , Ho Kyung Seo

Review Article

The Korean Journal of Urological Oncology 2015;13(2):66-74.
Published online August 30, 2015.

근침윤성 방광암의 치료 - 술 전 항암화학요법: 새로운 표준치료

권휘안¹, 서호경²

^¹원광대학교 의과대학 원광대 산본병원 비뇨기과, ^²국립암센터 전립선암센터

Treatment of MIBC - Neoadjuvant Chemotherapy: New Standard of Care

Whi-An Kwon ¹, Ho Kyung Seo ²

⁰²¹Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea

Correspondence: Ho Kyung Seo

Abstract

The standard management for patients with muscle invasive bladder cancer(MIBC) involves radical cystectomy and pelvic lymph node dissection. Although this treatment may be curative, a large proportion of patients will develop recurrence and will ultimately die of metastatic disease. Prospective, randomized clinical trial data demonstrate a survival advantage for those patients who receive neoadjuvant chemotherapy(NAC) prior to radical cystectomy and this concept was confirmed by meta-analysis. The administration of cisplatin-based combination NAC has consistently demonstrated a survival benefit of 5%. The pathologic downstaging is used as a surrogate end point. The efficacy of NAC for MIBC was established primarily with methotrexate, vinblastine, doxorubicin, and cisplatin(MVAC), with complete response rates(pT0) as high as 38%. Dose dense M-VAC(DDMAVC) is preferred over standard MVAC, and gemcitabine/cisplatin is a reasonable alternative to standard M-VAC for NAC. In Korea, while NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice. (Korean J Urol Oncol 2015;13:66-74)

Key Words: Urinary bladder neoplasms, Neoadjuvant therapy, Efficacy, Cisplatin