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Thomas Flaig, MD


ASCO 2023: 5-Year Survival Data on Perioperative Chemotherapy in Muscle-Invasive Bladder Cancer

By: Celeste L. Dixon
Posted: Friday, June 16, 2023

Follow-up data from the 500-patient phase III VESPER trial showed that, at the 5-year point after randomization, dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), compared with gemcitabine and cisplatin, provided significantly better overall survival and significantly improved disease-specific survival as perioperative chemotherapy for muscle-invasive bladder cancer. This final analysis continues the trend of better results for dose-dense MVAC that were seen after 3 years from VESPER, reported Christian Pfister, MD, PhD, of Rouen University Hospital, France, and colleagues at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract LBA4507).

Between 2013 and 2018, 437 enrolled patients received neoadjuvant chemotherapy and 56 received adjuvant chemotherapy (results for the latter group were not conclusive because of its relatively small size). About half of the 437 in the neoadjuvant cohort were assigned to receive four cycles of gemcitabine and cisplatin, one every 3 weeks, prior to surgery (84% received all four). The other half were randomly assigned to receive six cycles of dose-dense MVAC, one every 2 weeks, before surgery (60% received all six). About 90% of each arm ultimately proceeded to surgery.

The 5-year overall survival rate was 64% with dose-dense MVAC versus 56% with gemcitabine/cisplatin (P = .078), and the 5-year disease-specific survival was 72% versus 59%, respectively (P =.004). In the entire cohort, the main cause of death was progression of bladder cancer (83%), noted the team. Other causes included cardiovascular events (4.2%) and second cancers (2.1%).

Disclosure: Dr. Pfister reported no conflicts of interest. The other study authors’ disclosure information can be found at

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