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 et al.
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In 30 seconds
This systematic review and network meta-analysis evaluated the efficacy of neoadjuvant treatment strategies for muscle-invasive bladder cancer (MIBC) in cisplatin-eligible patients. It compared dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) and durvalumab plus gemcitabine-cisplatin (D-GC) against gemcitabine-cisplatin (GC). Both ddMVAC and D-GC improved overall survival compared to GC (HR 0.75), with no significant difference between the two regimens.
Key findings
- ddMVAC and D-GC improved overall survival versus GC (HR 0.75).
- D-GC achieved a higher pathological complete response compared to GC (OR 1.57).
- No significant difference in pathological complete response was found between ddMVAC and D-GC.
- EV-P would need to achieve HR ≤ 0.45 to outperform ddMVAC and D-GC.
Why it matters
Understanding the comparative effectiveness of neoadjuvant therapies for MIBC is crucial for optimizing treatment strategies and improving patient outcomes. This analysis highlights the need for new therapies to demonstrate significant survival benefits to replace established regimens.
What to keep in mind
The analysis included few trials and relied on indirect comparisons.