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).
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.
Jennifer A. Ligibel, MD, of Dana-Farber Cancer Institute, discusses a telephone-based weight loss intervention that induced clinically meaningful weight loss in patients with breast cancer who had overweight and obesity, across demographic and tumor factors. Additional tailoring of the intervention may possibly enhance weight loss in Black and younger patients as well (Abstract 12001).
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).
Jennifer L. Crombie, MD, of Dana-Farber Cancer Institute, discusses the historically poor outcomes for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Her study examined real-world data on the use of novel therapies in this population and found that outcomes with second- and third-line regimens of polatuzumab vedotin-piiq plus bendamustine and rituximab and tafasitamab plus lenalidomide remain suboptimal, with worse outcomes particularly after chimeric antigen receptor T-cell therapy (Abstract 7552).
Bradley J. Monk, MD, of the University of Arizona, Phoenix, and Creighton University, discusses phase III findings from the KEYNOTE-826 study of overall survival results in patients with persistent, recurrent, or metastatic cervical cancer. Study participants received first-line treatment of pembrolizumab plus chemotherapy, with or without bevacizumab, which reduced the risk of death by up to 40% in three different subsets of patients (Abstract 5500).
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