Christian Pfister, MD, PhD, on Bladder Cancer: New Overall Survival Data on Perioperative Chemotherapy
2023 ASCO Annual Meeting
Christian Pfister, MD, PhD, of Rouen University Hospital, discusses phase III results from the VESPER trial, which showed that dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin provided a better overall survival rate at 5 years and improved disease-specific survival compared with gemcitabine as perioperative chemotherapy in patients with muscle-invasive bladder cancer (Abstract LBA4507).
Transcript
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
Since 20 year, VESPER is the only randomized [inaudible 00:00:12] trial comparing the efficacy of GC or dose-dense MVAC in perioperative setting in muscle-invasive bladder cancer. On a period of 5 years, we randomized 500 patients in 28 French cancer centers. 56 patient in the neoadjuvant group and the [inaudible 00:00:36] majority, 88% of patient in the neoadjuvant group. The primary endpoint of the VESPER trial was a progression-free survival of 3 years, with [inaudible 00:00:49]. On [inaudible 00:00:52], we present the overall survival at 5 year, and the disease-specific survival of the trial. Dose-dense MVAC allow better overall survival at 5 years than GC in the perioperative setting. In the neoadjuvant group, overall survival was significantly higher, with a 5-year wait of 66 verus 57 persons. Moreover, dose-dense MVAC improved significantly disease-specific survival at 5 years in the perioperative setting. Interestingly, we stratified the 5-year overall survival curve by [inaudible 00:01:36], and dose cisplatin receive.
This representation clearly divides the study population in three group, and confirms the importance of cumulative cisplatin dose. We have the first group pool of all survival with less than four full-dose cisplatin, median of overall survival for GC-arm with four full-dose cisplatin, and higher survival with dose-dense MVAC with four or more full-cisplatin dose. My take-home message are VESPER is worthy of milestone in the history of chemotherapy for muscle-invasive bladder cancer. Dose-dense MVAC provides a better overall survival at 5 years, and significantly improved disease-specific survival over GC in the perioperative setting. Our result confirms the indisputable superiority of dose-dense MVAC over GC as neoadjuvant chemotherapy. Finally, VESPER is practice-changing and showed tumoral impact on clinical cancer research in bladder cancer.
The ASCO Post Staff
Allison Betof Warner, MD, PhD, of Stanford University Medical Center, and Zeynep Eroglu, MD, of H. Lee Moffitt Cancer Center and Research Institute, discusses phase II findings showing that in patients with BRAF-mutant metastatic melanoma, dabrafenib plus trametinib and navitoclax (DTN) was associated with a complete response rate of 20% and an overall response rate of 84%. Additionally, there was a trend toward improved overall survival in patients treated with DTN compared with dabrafenib plus trametinib alone; the difference in overall survival was more pronounced in patients with a smaller tumor burden (Abstract 9511).
The ASCO Post Staff
Jennifer A. Woyach, MD, of The Ohio State University Comprehensive Cancer Center, discusses results of a phase III study showing that progression-free survival with ibrutinib plus obinutuzumab plus venetoclax is not superior to ibrutinib plus obinutuzumab for treatment-naive older patients with chronic lymphocytic leukemia (CLL) in the setting of the COVID-19 pandemic. Long-term follow-up will determine whether there are advantages to obinutuzumab plus venetoclax, with special attention to measurable residual disease and therapy discontinuation (Abstract 7500).
The ASCO Post Staff
Manali K. Kamdar, MD, of University of Colorado Hospital, discusses the treatment landscape for the 30% to 40% of patients with diffuse large B-cell lymphoma (DLBCL) whose disease will relapse. Patients who experience relapse within 1 year of chemoimmunotherapy have poor outcomes with autotransplantation, but chimeric antigen receptor T-cell therapy has shown efficacy and manageable toxicity.
The ASCO Post Staff
Rana R. McKay, MD, of the University of California, San Diego, and Brian I. Rini, MD, of Vanderbilt-Ingram Cancer Center, discuss the 5-year follow-up results with the combination of a checkpoint inhibitor plus a VEGFR tyrosine kinase inhibitor as first-line treatment for patients with advanced clear cell renal cell carcinoma (RCC). Pembrolizumab plus axitinib continued to demonstrate improved survival outcomes as well as overall response rate vs sunitinib for patients with previously untreated disease (Abstract LBA4501).
The ASCO Post Staff
Shailender Bhatia, MD, of the University of Washington and Fred Hutchinson Cancer Center, discusses phase I/II results on the efficacy of nivolumab with or without ipilimumab in patients with recurrent or metastatic Merkel cell carcinoma. The study found that, for this rare and aggressive skin cancer, nivolumab showed clinical activity in advanced disease. However, these results from CheckMate 358 do not suggest an additional benefit with ipilimumab added to nivolumab (Abstract 9506).
