Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial
Neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy and pelvic lymph node dissection is the optimal treatment for patients with muscle-invasive bladder cancer. In recent years, the VESPER trial showed a statistically significant higher progression-free survival with dd-MVAC...
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MDPI AG
2023-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/6/1742 |
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| author | Stéphane Culine Valentin Harter Clémentine Krucker Gwenaelle Gravis Aude Fléchon Christine Chevreau Hakim Mahammedi Brigitte Laguerre Aline Guillot Florence Joly Jacqueline Fontugne Yves Allory Christian Pfister |
| author_facet | Stéphane Culine Valentin Harter Clémentine Krucker Gwenaelle Gravis Aude Fléchon Christine Chevreau Hakim Mahammedi Brigitte Laguerre Aline Guillot Florence Joly Jacqueline Fontugne Yves Allory Christian Pfister |
| author_sort | Stéphane Culine |
| collection | DOAJ |
| description | Neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy and pelvic lymph node dissection is the optimal treatment for patients with muscle-invasive bladder cancer. In recent years, the VESPER trial showed a statistically significant higher progression-free survival with dd-MVAC (dose dense methotrexate, vinblastine, doxorubicin, and cisplatin) compared to GC (gemcitabine and cisplatin). In the present report, we refine the characterization and outcome of patients whose cystectomy specimens were pathologically free of cancer (pathological complete response, pCR). We confirm that these patients portend a better outcome as compared to patients with invasive disease (≥pT1N0) at cystectomy. Nested variant and lymphovascular invasion were identified as adverse predictive factors of pCR. Progression-free survival probability three years after pCR on cystectomy was about 85%, regardless of the NAC regimen. A lower creatinine clearance and the delivery of less than four cycles were associated with a higher risk of relapse. Predicting the efficacy of NAC remains a major challenge. The planned analysis of molecular subtypes in the VESPER trial could help predict which patients may achieve complete response and better outcome. |
| first_indexed | 2024-03-11T06:49:00Z |
| format | Article |
| id | doaj.art-ca8d3117c5a94d2ca2791515dd65da35 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T06:49:00Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-ca8d3117c5a94d2ca2791515dd65da352023-11-17T10:06:34ZengMDPI AGCancers2072-66942023-03-01156174210.3390/cancers15061742Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) TrialStéphane Culine0Valentin Harter1Clémentine Krucker2Gwenaelle Gravis3Aude Fléchon4Christine Chevreau5Hakim Mahammedi6Brigitte Laguerre7Aline Guillot8Florence Joly9Jacqueline Fontugne10Yves Allory11Christian Pfister12Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Nord, Université de Paris Cité, Avenue Claude Vellefaux, 75010 Paris, FranceNorth-West Canceropole Data Center, Baclesse Cancer Center, 14000 Caen, FranceCNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, FranceDepartment of Medical Oncology, Paoli-Calmette Institute, 13009 Marseille, FranceDepartment of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, FranceDepartment of Medical Oncology, ICR-IUCT Oncopole, 31100 Toulouse, FranceDepartment of Medical Oncology, Jean Perrin Cancer Center, 63011 Clermont-Ferrand, FranceDepartment of Medical Oncology, Eugène Marquis Cancer Center, 35042 Rennes, FranceDepartment of Medical Oncology, Lucien Neuwirth Cancer Institute, 42270 St Priest en Jarez, FranceDepartment of Medical Oncology, Baclesse Cancer Center, 14000 Caen, FranceCNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, FranceCNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, FranceDepartment of Urology, Clinical Investigation Center, Inserm 1404, Charles Nicolle University Hospital, 76000 Rouen, FranceNeoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy and pelvic lymph node dissection is the optimal treatment for patients with muscle-invasive bladder cancer. In recent years, the VESPER trial showed a statistically significant higher progression-free survival with dd-MVAC (dose dense methotrexate, vinblastine, doxorubicin, and cisplatin) compared to GC (gemcitabine and cisplatin). In the present report, we refine the characterization and outcome of patients whose cystectomy specimens were pathologically free of cancer (pathological complete response, pCR). We confirm that these patients portend a better outcome as compared to patients with invasive disease (≥pT1N0) at cystectomy. Nested variant and lymphovascular invasion were identified as adverse predictive factors of pCR. Progression-free survival probability three years after pCR on cystectomy was about 85%, regardless of the NAC regimen. A lower creatinine clearance and the delivery of less than four cycles were associated with a higher risk of relapse. Predicting the efficacy of NAC remains a major challenge. The planned analysis of molecular subtypes in the VESPER trial could help predict which patients may achieve complete response and better outcome.https://www.mdpi.com/2072-6694/15/6/1742muscle-invasive bladder cancercisplatin-based chemotherapyneoadjuvant treatmentpathological complete response |
| spellingShingle | Stéphane Culine Valentin Harter Clémentine Krucker Gwenaelle Gravis Aude Fléchon Christine Chevreau Hakim Mahammedi Brigitte Laguerre Aline Guillot Florence Joly Jacqueline Fontugne Yves Allory Christian Pfister Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial Cancers muscle-invasive bladder cancer cisplatin-based chemotherapy neoadjuvant treatment pathological complete response |
| title | Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial |
| title_full | Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial |
| title_fullStr | Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial |
| title_full_unstemmed | Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial |
| title_short | Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial |
| title_sort | refining the characterization and outcome of pathological complete responders after neoadjuvant chemotherapy for muscle invasive bladder cancer lessons from the randomized phase iii vesper getug afu v05 trial |
| topic | muscle-invasive bladder cancer cisplatin-based chemotherapy neoadjuvant treatment pathological complete response |
| url | https://www.mdpi.com/2072-6694/15/6/1742 |
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