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KMID : 1001020150130020066
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Korean Journal of Urological Oncology
2015 Volume.13 No. 2 p.66 ~ p.74
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Treatment of MIBC - Neoadjuvant Chemotherapy: New Standard of Care
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권휘안:Kwon Whi-An
서호경:Seo Ho-Kyung
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Abstract
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The standard management for patients with muscle invasive bladder cancer(MIBC) involves radical cystectomy and pelvic lymph node dissection. Although this treatment may be curative, a large proportion of patients will develop recurrence and will ultimately die of metastatic disease. Prospective, randomized clinical trial data demonstrate a survival advantage for those patients who receive neoadjuvant chemotherapy(NAC) prior to radical cystectomy and this concept was confirmed by meta-analysis. The administration of cisplatin-based combination NAC has consistently demonstrated a survival benefit of 5%. The pathologic downstaging is used as a surrogate end point. The efficacy of NAC for MIBC was established primarily with methotrexate, vinblastine, doxorubicin, and cisplatin(MVAC), with complete response rates(pT0) as high as 38%. Dose dense M-VAC(DDMAVC) is preferred over standard MVAC, and gemcitabine/cisplatin is a reasonable alternative to standard M-VAC for NAC. In Korea, while NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.
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KEYWORD
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Urinary bladder neoplasms, Neoadjuvant therapy, Efficacy, Cisplatin
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