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Related Experiment Videos

CMV front-line chemotherapy in transitional bladder carcinoma

L Paz-Ares1, P Lianes, M Díaz-Puente

  • 1Medical Oncology Division, 12 de Octubre University Hospital, Madrid, Spain.

Annals of Oncology : Official Journal of the European Society for Medical Oncology
|February 1, 1993
PubMed
Summary

Up-front chemotherapy with cisplatin, methotrexate, and vinblastine (CMV) shows high response rates for muscle invasive bladder cancer. This approach can preserve bladders in many complete responders, offering an alternative to surgery.

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Area of Science:

  • Oncology
  • Urothelial Carcinoma Research
  • Neoadjuvant Chemotherapy

Background:

  • Muscle invasive bladder carcinoma (MIBC) often leads to distant metastasis despite standard treatments like surgery and radiotherapy.
  • Chemotherapy regimens, such as CMV (cisplatin, methotrexate, vinblastine), have shown efficacy in advanced bladder cancer with manageable toxicity.
  • Investigating neoadjuvant chemotherapy aims to eradicate micrometastatic disease and potentially avoid radical cystectomy.

Purpose of the Study:

  • To evaluate the efficacy and safety of upfront CMV chemotherapy in patients with muscle invasive bladder carcinoma.
  • To assess the response rates, including clinical complete response (cCR), after neoadjuvant CMV treatment.
  • To determine the feasibility of bladder preservation in patients achieving cCR.

Main Methods:

Related Experiment Videos

  • A total of 36 patients with muscle invasive bladder carcinoma received 3 cycles of CMV chemotherapy.
  • Patients underwent trans-urethral resection (TUR) at diagnosis, followed by CMV (cisplatin, methotrexate, vinblastine).
  • Clinical response was assessed via cystoscopy, TUR biopsies, and imaging; patients achieving cCR received additional CMV courses, while non-responders underwent cystectomy.

Main Results:

  • An overall response rate of 81% was observed after 3 CMV cycles, with 20 patients achieving a clinical complete response (cCR).
  • With a median follow-up of 23.5 months, 23 patients are alive, and 12 have successfully preserved their bladders.
  • Grade 3-4 hematological toxicity occurred in 8% of cycles, with no treatment-related deaths.

Conclusions:

  • The CMV regimen, administered after TUR, demonstrates a high response rate and acceptable toxicity for muscle invasive bladder carcinoma.
  • Bladder preservation is achievable in approximately half of the patients who achieve a complete response to neoadjuvant CMV therapy.
  • Upfront CMV chemotherapy represents a viable strategy for managing MIBC, potentially improving outcomes and organ preservation.