Robert R. Dreicer, MD, presented “Neoadjuvant Cisplatin-Based Chemotherapy for Muscle-Invasive Bladder Cancer (MIBC)” during the Perspectives in Urology: Point Counterpoint 2020 virtual conference in November 2020.

How to cite: Dreicer, Robert R. “Neoadjuvant Cisplatin-Based Chemotherapy for Muscle-Invasive Bladder Cancer (MIBC)” November 2020. Accessed Mar 2024. https://grandroundsinurology.com/neoadjuvant-cisplatin-based-chemotherapy-for-muscle-invasive-bladder-cancer/

Neoadjuvant Cisplatin-Based Chemotherapy for Muscle-Invasive Bladder Cancer (MIBC) – Summary

Robert Dreicer, MD, MS, MACP, FASCO, Associate Director for Clinical Research and the Deputy Director of the University of Virginia Cancer Center, discusses phase 3 study evidence in support of cisplatin-based chemo which he argues is a secure alternative to immune-checkpoint inhibition, a more experimental treatment. He begins by paralleling support of immune-checkpoint inhibition to other oncological examples of physician claims of “I already know the answer.” Dr. Dreicer reflects on the 90s, specifically on the recommendation of high dose chemo for advanced breast cancer prior to the completion of studies. Once the studies were completed it became clear that high dose chemo did not demonstrate an improvement in treatment and may in fact have proved itself mostly harmful. He continues by reviewing a randomized trial comparing long-term survival results of patients treated with gemcitabine plus cisplatin against methotrexate, vinblastine, doxorubicin, and cisplatin in patients with bladder cancer. The trial found that cisplatin-based chemo had a 15.3% response rate. Dr. Dreicer overviews a phase 3 trial which found that cisplatin-based therapy reduced risk of death by 16%, corresponding to an increase in 10-year survival from 30% to 36%. He concludes with an argument for cisplatin-based treatment due to the availability of higher-quality evidence for its use than immune-checkpoint inhibition.

Click here for the immune-checkpoint inhibition perspective of this point-counterpoint series.

About the Perspectives in Urology: Point Counterpoint 2020 virtual conference:
Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, as well as Program Co-Chair Dan Theodorescu, MD, PhD, this virtual conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This two-day interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking. A focus on prostate cancer was given on Wednesday, November 11th, with a focus on bladder cancer given on Thursday, November 12th.