Abol-Enein, H., Bono, A. V., Boyer, M., Clarke, N. W., Coppin, C. M. L., Cortesi, E., Goebell, P. J., Groshen, S., Hall, R. R., Horwich, A., Malmstrom, P. U., Martinez-Pineiro, J. A., Parmar, M. K. B., Raghavan, D., Roberts, J. T. G., Sengelov, L., Sherif, A., Stewart, L. A., Stockle, M., Sylvester, R., Tierney, J. F., Torti, F. M., Vale, C. L., Wallace, D. M. A. (2003) Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. LANCET, 361 (9373). pp. 1927-1934. ISSN 0140-6736

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Abstract

Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Background: Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment 06 survival in patients with this disease. Methods We analysed updated data for 2688 individual patients from ten available randomised trials. Findings Platinum-based combination chemotherapy showed a significant benefit to overall survival (combined hazard ratio [HR] 0.87 [95% Cl 0.78-0.98, p=0.016]; 13% reduction in risk of death; 5% absolute benefit at 5 years [1-7]; overall survival increased from 45% to 50%). This effect was observed irrespective of the type of local treatment, and did not vary between subgroups of patients. The HR for all trials, including those using single-agent cisplatin, tended to favour neoadjuvant chemotherapy (HR=0.91, 95% Cl 0.83-1.01) although this tendency was not significant (p=0.084). Although platinum based combination chemotherapy was beneficial, there was no evidence to support the use of single-agent platinum; indeed, there was a significant difference in the effect between these groups of trials (p=0.044). Interpretation: This improvement in survival encourages the use of platinum-based combination chemotherapy for patients with invasive bladder cancer.

Item Type:	Article
Authors (ICR Faculty only):	Horwich, Alan
All Authors:	Abol-Enein, H., Bono, A. V., Boyer, M., Clarke, N. W., Coppin, C. M. L., Cortesi, E., Goebell, P. J., Groshen, S., Hall, R. R., Horwich, A., Malmstrom, P. U., Martinez-Pineiro, J. A., Parmar, M. K. B., Raghavan, D., Roberts, J. T. G., Sengelov, L., Sherif, A., Stewart, L. A., Stockle, M., Sylvester, R., Tierney, J. F., Torti, F. M., Vale, C. L., Wallace, D. M. A.
Uncontrolled Keywords:	TRANSITIONAL-CELL-CARCINOMA; INDIVIDUAL PATIENT DATA; RADICAL CYSTECTOMY; PROSPECTIVE TRIAL; PHASE-III; CISPLATIN; THERAPY; METAANALYSES; RADIATION
Research teams:	ICR divisions > Cancer Therapeutics > Cancer Biomarkers ICR divisions > Clinical Studies > Cancer Biomarkers ICR divisions > Radiotherapy and Imaging > Clinical Academic Radiotherapy (Horwich) Clinical Units > Urology Unit ICR divisions > Clinical Studies > Prostate Cancer Targeted Therapy Group
Depositing User:	EPrints Services
Date Deposited:	10 Aug 2007 20:42
Last Modified:	11 Jul 2017 14:28
URI:	http://publications.icr.ac.uk/id/eprint/1329

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