Neoadjuvant chemotherapy with methotrexate/vinblastine/doxorubicin/cisplatin vs. gemcitabine/cisplatin for muscle-invasive bladder cancer: a review and meta-analysis

Objective To systematically assess the efficacy of neoadjuvant chemotherapy (NAC) with methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) vs. gemcitabine/cisplatin (GC) for muscle-invasive bladder cancer (MIBC). Methods Randomized controlled trials (RCTs) or non-RCTs regrading the efficacy of NAC with MVAC vs. GC for MIBC were retrieved in Pubmed, Cochrane library, Sciverse, CNKI, VIP and Wanfang database from databases establishment to May 2016. According to the including and exclusion criterion, two reviewers independently reviewed the trials, conducted the Meta-analysis with RevMan 5.3 soft ware. Results A total of 13 non-randomized clinical controlled trials were eligible for the study including 1690 cases. The pooled results showed that MVAC group had a lower down staging rate (RR=0.77, 95%CI 0.61-0.97, P=0.03) and complete response rate (RR=0.70, 95%CI 0.53-0.93, P=0.01). Statistically significant were observed. However, there was no significant difference in disease free survival (RR=0.88, 95%CI 0.60-1.29, P=0.53). Conclusion Compared with MVAC, NAC with GC had higher down staging rate and complete response rate. Therefore, NAC with GC should be considered as a preferable option for MIBC. Key words: Muscle invasive bladder cancer; Methotrexate/vinblastine/doxorubicin/cisplatin (MVAC); Gemcitabine/cisplatin (GC); Neoadjuvant chemotherapy; Meta analysis