According to long-term data from the phase 3 VESPER trial, patients with muscle-invasive bladder cancer had a better 5-year overall survival (OS) and a significantly improved disease-specific survival (DSS) when treated with dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) as perioperative chemotherapy, compared with gemcitabine-cisplatin.

According to Christian Pfister, MD, Rouen University Hospital, Rouen, France, and coauthors, “the optimal perioperative chemotherapy for patients with muscle-invasive bladder cancer remains open to discussion.”

In this trial, 500 patients were randomized to receive either 4 cycles of gemcitabine-cisplatin chemotherapy every 3 weeks, or 6 cycles of dose-dense MVAC every 2 weeks, prior to surgery in the neoadjuvant group or after surgery in the adjuvant group. The primary end point of 3-year progression-free survival was previously reported, with MVAC providing benefit vs gemcitabine-cisplatin. This final analysis reports on overall survival (OS) after 5 years of follow-up.

The final median duration of follow-up from randomization was 5 years and 3 months. The 5-year OS rate in the MVAC arm was 64% compared to 56% in the gemcitabine-cisplatin arm (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.58 to 1.03; P = .078). The 5-year disease-specific survival was 72% vs 59%, respectively (HR, 0.63; 95% CI, 0.46 to 0.86; P = .004). In the neoadjuvant group, both the 5-year OS and DSS of those who received MVAC was significantly superior to those who received gemcitabine-cisplatin. Results were not conclusive in the adjuvant group, due to limited sample size.

There was a total of 190 deaths reported within the 5 years of follow-up, 83% were due to bladder cancer progression, 4.2% due to cardiovascular events, 2.1% due to toxic deaths, and 2.1% to second cancer. There were 4.7% and 4.2% of patients who died do to other or undocumented causes, respectively.

Dr Pfister and coauthors concluded “Dose-dense MVAC provided better OS at 5 years and improved significantly DSS over [gemcitabine-cisplatin] in the perioperative setting of MIBC.”

Source:

Pfister C, Gravis G, Flechon A, et al. Multicenter randomized phase III trial of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) or gemcitabine and cisplatin (GC) as perioperative chemotherapy for muscle-invasive bladder cancer (MIBC): Overall survival (OS) data at 5 years in the GETUG/AFU V05 VESPER trial. Presented at 2023 ASCO Annual Meeting; June 2-6, 2023; Chicago, IL. Abstract LBA4507