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
Narjust Florez, MD, of Dana-Farber Cancer Institute, and Ticiana Leal, MD, of Winship Cancer Institute of Emory University, discuss the use of tumor treating fields therapy, in which electric fields disrupt processes critical for cancer cell viability. Already approved by the FDA to treat glioblastoma and mesothelioma, the treatment has extended overall survival in this phase III study of patients with metastatic non–small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, without exacerbating systemic toxicities (Abstract LBA9005).
The ASCO Post Staff
Arlene O. Siefker-Radtke, MD, of The University of Texas MD Anderson Cancer Center, discusses the combination of erdafitinib and cetrelimab, which demonstrated clinically meaningful activity and was well tolerated in cisplatin-ineligible patients with metastatic urothelial carcinoma and fibroblast growth factor receptor alterations (Abstract 4504).
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
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.
