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
Bobbie J. Rimel, MD, of Cedars-Sinai Medical Center, and Kathleen N. Moore, MD, of the Stephenson Oklahoma Cancer Center at the University of Oklahoma, discuss phase III results from the MIRASOL trial, which showed that mirvetuximab soravtansine-gynx prolonged overall survival vs investigator’s choice chemotherapy in patients with platinum-resistant ovarian cancer with high folate receptor-alpha expression. The findings suggest a new standard of care for this disease (Abstract LBA5507).
The ASCO Post Staff
Lisa A. Carey, MD, of the University of North Carolina at Chapel Hill, and Javier Cortes, MD, PhD, of the International Breast Cancer Center and Universidad Europea de Madrid, discuss phase II findings showing that one in three patients with HER2-positive early breast cancer may safely omit chemotherapy. Among the chemotherapy-free patients treated with trastuzumab and pertuzumab, the 3-year invasive disease–free survival was 98.8%, with no distant metastases (Abstract LBA506).
The ASCO Post Staff
Amer Methqal Zeidan, MBBS, MHS, of Yale University and Yale Cancer Center, discusses phase III findings on the first-in-class telomerase inhibitor imetelstat, which was given to patients with heavily transfusion-dependent non-del(5q) lower-risk myelodysplastic syndromes that are resistant to erythropoiesis-stimulating agents. Imetelstat resulted in a significant and sustained red blood cell (RBC) transfusion independence in 40% of these heavily transfused patients. The response was also durable and accompanied by an impressive median hemoglobin rise of 3.6 g/dL, and seen in patients with and without ring sideroblasts. Importantly, reduced variant allele frequency was observed in the most commonly mutated myeloid genes which correlated with duration of transfusion independence and hemoglobin rise, therefore suggesting a disease-modifying potential of this agent (Abstract 7004).
The ASCO Post Staff
Shilpa Gupta, MD, of Cleveland Clinic, discusses the results from the EV-103 study and the unmet need for effective first-line therapies in cisplatin-ineligible patients with locally advanced or metastatic urothelial carcinoma. After nearly 4 years of follow-up, the trial findings showed that enfortumab vedotin-ejfv plus pembrolizumab continues to demonstrate promising survival trends with rapid and durable responses in this population (Abstract 4505).
The ASCO Post Staff
James Chih-Hsin Yang, MD, PhD, of the National Taiwan University Hospital and National Taiwan University Cancer Center, discusses the latest data from the phase III KEYNOTE-789 study, which evaluated the efficacy and safety of pemetrexed plus platinum chemotherapy (carboplatin or cisplatin) with or without pembrolizumab in the treatment of adults with EGFR tyrosine kinase inhibitor–resistant, EGFR–mutated, metastatic nonsquamous non–small cell lung cancer (NSCLC) (Abstract LBA9000).
