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GU cancers

Neoadjuvant MVAC
2003
Bladder - advanced
BC2001 trial, RT w/wo chemo
2012
Bladder - advanced
Keynote 045
2017
Bladder - advanced
Checkmate 275
2017
Bladder - advanced
Erdafitinib trial
2019
Bladder - advanced
JAVELIN Bladder 100 Trial
2020
Bladder - advanced
Keynote 052
2020
Bladder - advanced
EV 301 trial (Enfortumab Vedotin)
2021
Bladder - advanced
Intermittent Androgen suppression
2012
Prostate - advanced
Hero Trial
2020
Prostate - advanced
ENACT Trial, enza vs active surveillance
2022
Prostate - early stage
Docetaxel and Estramustine vs Mitoxantrone
2004
Prostate - metastatic
Affirm Trial
2012
Prostate - metastatic
Prevail Trial
2014
Prostate - metastatic
CHAARTED trial (docetaxel)
2015
Prostate - metastatic
Latitude Trial
2017
Prostate - metastatic
Titan Trial
2019
Prostate - metastatic
Enzamet Trial
2019
Prostate - metastatic
TheraP Trial
2021
Prostate - metastatic
Vision Trial
2021
Prostate - metastatic
ARASENS trial, Docetaxel+ADT +/- Darolutamide
2022
Prostate - metastatic
Sunitinib versus INF-alfa
2007
RCC - advanced
Temsirolimus vs INF-alfa trial
2007
RCC - advanced
IMDC analysis
2009
RCC - advanced
AXIS trial
2011
RCC - advanced
Axitinib dose titration
2013
RCC - advanced
EXIST-2 trial
2013
RCC - advanced
Lenvatinib trial
2015
RCC - advanced
CheckMate 025 trial
2015
RCC - advanced
Surveillance in m-RCC
2016
RCC - advanced
METEOR trial
2016
RCC - advanced
CABOSUN trial
2017
RCC - advanced
IMmotion151 trial
2019
RCC - advanced
CheckMate 214 trial
2020
RCC - advanced
KEYNOTE-426 trial
2020
RCC - advanced
JAVELIN Renal 101 trial
2020
RCC - advanced
CLEAR trial
2021
RCC - advanced
Checkmate 9ER trial
2021
RCC - advanced
ASSURE trial (ECOG-ACRIN E2805)
2016
RCC - perioperative
S-TRAC trial
2016
RCC - perioperative
PROTECT trial
2017
RCC - perioperative
*KEYNOTE-564 trial
2021
RCC - perioperative
**CheckMate 914 trial
2021
RCC - perioperative

Neoadjuvant MVAC
Grossman HB et al, NEJM, 2003, PMID: 12944571

Bladder - advanced

Background: Randomized phase 3 trial included 317 patients with muscle-invasive bladder cancer to either neoadjuvant chemotherapy and cystectomy vs cystectomy alone in 1:1 ratio

 

Arm A: Neoadjuvant chemotherapy with 3 cycles M-VAC (Methotrexate, Vinblastine, Doxorubicin, Cisplatin)
Arm B: Cystectomy alone

 

Primary Endpoint: Overall Survival
mFollow up: 8.7 months

 

Median Survival: 77 months vs 46 months, Arm A vs B
5-yr OS: 57% vs 43%, P=.06
Disease specific survival: 54 deaths vs 77 deaths, HR 1.66 (95% CI 1.22-2.45); P=.002

 

Main Adverse events: Post Cystectomy, Grade 3 or higher adverse events: GI effects: 8 vs 10 patients, Arm A vs B, GU side effects 8 vs 8 patients, Arm A vs B.
Amongst 150 patients with neoadjuvant chemotherapy, grade 3 or higher events were mainly granulocytopenia 85 patients, Anemia 10 patients, thrombocytopenia 7 patients, stomatitis 15 patients.

 

Conclusions: Neoadjuvant chemotherapy has improved survival and less likelihood of residual cancer in cystectomy specimens when compared to patients who underwent cystectomy alone.

 

Summarized by Pragnan Kancharla, MD

 

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