Background:
In view of two independent meta-analyses of neoadjuvant cisplatin-based chemotherapy in TCC showing an overall slight survival benefit favoring this approach, a similar systematic review was undertaken to assess the benefits of adjuvant chemotherapy (AC) following definitive local therapy for invasive bladder TCC
Methods:
A comprehensive search of MEDLINE, CANCERLIT (Ovid), the Cochrane Library, PDQ internet and EMBASE databases was employed, supplemented by handsearching of published proceedings of major uro-oncology meetings and oncology textbooks. Randomized controlled trials (RCTs), meta-analyses and systemic reviews that reported comparisons of progression-free and/or overall survival between definitive local +/- AC were eligible. The hazard ratios (HR) and their variances for overall and progression-free survival (OS, PFS) data were provided by 1 author but otherwise were estimated and analyzed from published data.
Results:
6 RCTs comparing local therapy +/- AC were identified. 5 RCTs randomized 350 eligible patients (374 randomized) and reported survival data. 1 used single-agent and 4 cisplatin-based combination therapy. Two RCTs reported statistically significant improvements in PFS & one in OS. Three RCTs (n=190, 54% of eligible patients) provided PFS data suitable for pooling. The PFS HR was 0.51 [95% CI, 0.35-0.74]. Three RCTs (n=218, 62%) provided OS data suitable for pooling. The OS HR was 0.76 [95% CI, 0.54-1.09]. Significant methodologic and statistical problems were identified including the small number of trials and the total number of patients .
Conclusions:
Recognizing the short-comings with the analysis, the PFS result and OS trend were consistent in direction and magnitude with the benefits previously identified with neoadjuvant chemotherapy. Ongoing prospective trials (e.g. with p53 as prognostic marker and determinant of adjuvant therapy) will hopefully further elucidate the role of adjuvant chemotherapy in bladder TCC.

Back to Final Program