Current and recent clinical trials for perioperative systemic therapy for muscle invasive bladder cancer: a systematic reviewReportar como inadecuado

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BMC Cancer

, 14:966

Clinical oncology


BackgroundAlthough Muscle Invasive Bladder Cancer MIBC is increasing in incidence, treatment has largely remained limited to radical cystectomy with or without cisplatin-based neoadjuvant and-or adjuvant chemotherapy. We reviewed the current and recent clinical trials evaluating perioperative chemotherapy, targeted therapy, and novel therapeutic regimens for MIBC patients undergoing radical cystectomy.

MethodsAn overview of perioperative MIBC management was conducted initially using MEDLINE. The Clinical Trials Registry and MEDLINE were further searched specifically for perioperative MIBC chemotherapy, targeted therapy, and other novel therapeutic approaches. Trials involving non-perioperative management, operative management other than radical cystectomy, multiple tumors, or purely superficial or metastatic disease were excluded from selection. These criteria were not specifically fulfilled for mTOR inhibitor and immune therapy trials. Only phase III chemotherapy and phase II targeted therapy trials found in the Clinical Trials Registry were selected. MEDLINE searches of specific treatments were limited to January 2009 to January 2014 whereas the Clinical Trials Registry search had no timeline. Systematic MEDLINE searches had no phase restrictions. Trials known by the authors to fulfill search criteria but were not found via searches were also selected.

ResultsTwenty-five trials were selected from the Clinical Trials Registry including 7 phase III chemotherapy trials, 11 Phase II targeted therapy trials, 3 immune therapy trials, 1 mammalian target of rapamycin mTOR inhibitor trial, and 3 gene and vaccine therapy trials. Nine trials have been completed and 5 have been terminated early or withdrawn. Nine trials have data available when individually searched using MEDLINE and-or Google. Systematic searches of MEDLINE separately found 12 trials in the past 5 years. Two phase III chemotherapy trials were selected based on knowledge by the authors. No phase III trials of targeted therapy have been registered or published.

ConclusionsNew trials are currently being conducted that may revolutionize MIBC treatment preceding or following cystectomy. Head-to-head phase III trials of perioperative chemotherapy and further phase II and phase III trials of targeted therapy and other therapeutic approaches are necessary before the current cisplatin-based perioperative chemotherapy paradigm is altered.

KeywordsBladder cancer Radical cystectomy Perioperative chemotherapy Perioperative targeted therapy mTOR inhibitor Immune therapy Gene therapy Vaccine therapy AbbreviationsMIBCMuscle Invasive Bladder Cancer

MEDLINEMedical Literature Analysis and Retrieval System Online

MVACMethotrexate, Vinblastine, Adriamycin doxorubicin, and Cisplatin

GCGemcitabine and Cisplatin

PCaPaclitaxel and Carboplatin

CMVCisplatin, Methotrexate, Vinblastine

HDHigh Dose

DDDose Dense

SFKSrc Family Kinase

EGFREpidermal Growth Factor Receptor

VEGFVascular Epithelial Growth Factor

HER2RHuman Epidermal Growth Factor Receptor 2

BCGBacillus Calmette–Guérin

bHCGbeta-Human Chorionic Gonadotropin.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-14-966 contains supplementary material, which is available to authorized users.

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Autor: Vishal Vashistha - David I Quinn - Tanya B Dorff - Siamak Daneshmand


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