Dr. Tyson on Rationale For Neoadjuvant Chemotherapy in Bladder Cancer

Mark D. Tyson, MD, urologic oncologist, Mayo Clinic, discusses 2 trials that have shaped physicians’ opinions on the use of neoadjuvant chemotherapy in patients with bladder cancer.

A Medical Research Council trial showed the benefit of 3 cycles of cisplatin, methotrexate, and vinblastine in the neoadjuvant setting for patients receiving radiation, surgery, or radiation plus surgery. That trial showed 6% significance 8 years into the trial.

The SWOG 8710 trial was much more compelling. There was a 31-month survival benefit for patients in the surgical subset who received neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin (MVAC). The patients in the T3 subset experienced a 40-month benefit.

Tyson states that there’s most likely a beneficial effect of neoadjuvant chemotherapy. Whether or not physicians should give gemcitabine and cisplatin or dose-dense MVAC, and the correct number of cycles is still up for debate. Toxicity management still remains a challenge, especially in MVAC.