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Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review
Background: Neoadjuvant chemotherapy is the standard of care before radical cystectomy for muscle invasive bladder cancer. Recently, checkpoint inhibitors have been investigated as a neoadjuvant treatment after the reported efficacy of checkpoint inhibitors in metastatic urothelial carcinoma. Object...
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Published in: | Journal of personalized medicine 2021-11, Vol.11 (11), p.1195 |
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description | Background: Neoadjuvant chemotherapy is the standard of care before radical cystectomy for muscle invasive bladder cancer. Recently, checkpoint inhibitors have been investigated as a neoadjuvant treatment after the reported efficacy of checkpoint inhibitors in metastatic urothelial carcinoma. Objectives: The aim of this systematic review is to investigate the role of checkpoint inhibitors as a neoadjuvant treatment for muscle invasive bladder cancer before radical cystectomy. Methods: Based on the PRISMA statement, a systematic review of the literature was conducted through online databases and the American Society of Clinical Oncology (ASCO) Meeting Library. Suitable publications were subjected to full-text assessment. The primary outcome of this review was to identify the impact of neoadjuvant immunotherapy on the oncological outcomes and survival benefits. Results: From the retrieved 254 results, 8 studies including 404 patients were included. Complete response varied between 30% and 50%. Downstaging varied between 50% and 74%. ≥Grade 3 AEs were recorded in 8.6% of patients who received monotherapy with either Atezolizumab or Pembrolizumab. In patients who received combination treatment, the incidence of ≥Grade 3 AEs was 16.3% for chemoimmunotherapy and 36.5% for combined immunotherapy. A total of 373 patients (92%) underwent radical cystectomy. ≥Grade 3 Clavien-Dindo surgical complications were reported in 21.7% of the patients. One-year overall survival (OS) and relapse-free survival (RFS) varied between 81% and 92%, and 70% and 88%, respectively. Conclusion: The evidence on the use of immune checkpoint inhibitors in the setting of pre-radical cystectomy is quite limited, with noted variability within published trials. Combination with chemotherapy or another checkpoint inhibitor may boost response, although prospective studies with extended follow-up are needed to report on the survival advantages. |
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Recently, checkpoint inhibitors have been investigated as a neoadjuvant treatment after the reported efficacy of checkpoint inhibitors in metastatic urothelial carcinoma. Objectives: The aim of this systematic review is to investigate the role of checkpoint inhibitors as a neoadjuvant treatment for muscle invasive bladder cancer before radical cystectomy. Methods: Based on the PRISMA statement, a systematic review of the literature was conducted through online databases and the American Society of Clinical Oncology (ASCO) Meeting Library. Suitable publications were subjected to full-text assessment. The primary outcome of this review was to identify the impact of neoadjuvant immunotherapy on the oncological outcomes and survival benefits. Results: From the retrieved 254 results, 8 studies including 404 patients were included. Complete response varied between 30% and 50%. Downstaging varied between 50% and 74%. ≥Grade 3 AEs were recorded in 8.6% of patients who received monotherapy with either Atezolizumab or Pembrolizumab. In patients who received combination treatment, the incidence of ≥Grade 3 AEs was 16.3% for chemoimmunotherapy and 36.5% for combined immunotherapy. A total of 373 patients (92%) underwent radical cystectomy. ≥Grade 3 Clavien-Dindo surgical complications were reported in 21.7% of the patients. One-year overall survival (OS) and relapse-free survival (RFS) varied between 81% and 92%, and 70% and 88%, respectively. Conclusion: The evidence on the use of immune checkpoint inhibitors in the setting of pre-radical cystectomy is quite limited, with noted variability within published trials. Combination with chemotherapy or another checkpoint inhibitor may boost response, although prospective studies with extended follow-up are needed to report on the survival advantages.</description><identifier>ISSN: 2075-4426</identifier><identifier>EISSN: 2075-4426</identifier><identifier>DOI: 10.3390/jpm11111195</identifier><identifier>PMID: 34834547</identifier><language>eng</language><publisher>Basel: MDPI AG</publisher><subject>Bias ; Bladder cancer ; Cancer therapies ; Chemotherapy ; Clinical trials ; FDA approval ; Immune checkpoint inhibitors ; Immunotherapy ; Invasiveness ; Literature reviews ; Metastases ; Metastasis ; Patients ; Pembrolizumab ; Precision medicine ; Quantitative analysis ; Review ; Statistical analysis ; Survival ; Tumors ; Urothelial carcinoma</subject><ispartof>Journal of personalized medicine, 2021-11, Vol.11 (11), p.1195</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 by the authors. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c386t-aa0307502b9e55b81c4bc43c11cab7bf6043ee3f2398f5c6a26dead0aee6bef73</citedby><cites>FETCH-LOGICAL-c386t-aa0307502b9e55b81c4bc43c11cab7bf6043ee3f2398f5c6a26dead0aee6bef73</cites><orcidid>0000-0002-6094-5570 ; 0000-0002-3826-1519</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2602087440/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2602087440?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25752,27923,27924,37011,37012,44589,53790,53792,74997</link.rule.ids></links><search><creatorcontrib>SHSM, Hadi</creatorcontrib><creatorcontrib>Fahmy, Usama</creatorcontrib><creatorcontrib>Alhakamy, Nabil</creatorcontrib><creatorcontrib>Khairul-Asri, Mohd</creatorcontrib><creatorcontrib>Fahmy, Omar</creatorcontrib><title>Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review</title><title>Journal of personalized medicine</title><description>Background: Neoadjuvant chemotherapy is the standard of care before radical cystectomy for muscle invasive bladder cancer. Recently, checkpoint inhibitors have been investigated as a neoadjuvant treatment after the reported efficacy of checkpoint inhibitors in metastatic urothelial carcinoma. Objectives: The aim of this systematic review is to investigate the role of checkpoint inhibitors as a neoadjuvant treatment for muscle invasive bladder cancer before radical cystectomy. Methods: Based on the PRISMA statement, a systematic review of the literature was conducted through online databases and the American Society of Clinical Oncology (ASCO) Meeting Library. Suitable publications were subjected to full-text assessment. The primary outcome of this review was to identify the impact of neoadjuvant immunotherapy on the oncological outcomes and survival benefits. Results: From the retrieved 254 results, 8 studies including 404 patients were included. Complete response varied between 30% and 50%. Downstaging varied between 50% and 74%. ≥Grade 3 AEs were recorded in 8.6% of patients who received monotherapy with either Atezolizumab or Pembrolizumab. In patients who received combination treatment, the incidence of ≥Grade 3 AEs was 16.3% for chemoimmunotherapy and 36.5% for combined immunotherapy. A total of 373 patients (92%) underwent radical cystectomy. ≥Grade 3 Clavien-Dindo surgical complications were reported in 21.7% of the patients. One-year overall survival (OS) and relapse-free survival (RFS) varied between 81% and 92%, and 70% and 88%, respectively. Conclusion: The evidence on the use of immune checkpoint inhibitors in the setting of pre-radical cystectomy is quite limited, with noted variability within published trials. Combination with chemotherapy or another checkpoint inhibitor may boost response, although prospective studies with extended follow-up are needed to report on the survival advantages.</description><subject>Bias</subject><subject>Bladder cancer</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Clinical trials</subject><subject>FDA approval</subject><subject>Immune checkpoint inhibitors</subject><subject>Immunotherapy</subject><subject>Invasiveness</subject><subject>Literature reviews</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Patients</subject><subject>Pembrolizumab</subject><subject>Precision medicine</subject><subject>Quantitative analysis</subject><subject>Review</subject><subject>Statistical analysis</subject><subject>Survival</subject><subject>Tumors</subject><subject>Urothelial carcinoma</subject><issn>2075-4426</issn><issn>2075-4426</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNpdkU1P3DAQhq0KVNDCqX_AUi9IaKljO4nDAYlGLUWCVqJwtibOhPU2iYOdpNoj_xxvQRUwlxnNPPNqPgj5lLATIQr2ZT10yT8r0g9kn7M8XUrJs51X8R45DGHNoqmU84x9JHtCKiFTme-Tx5_ooF5PM_QjvV2hh2FD74Lt72m5QvNncDYWLvuVrezofKAVNs4jvYHaGmhpuQkjmtF1Gxrz9HoKpsXIzxDsjPRrC3WNnpbQG_Sn9Jz-3jZ0MFpDb3C2-PeA7DbQBjx88Qty9_3bbfljefXr4rI8v1oaobJxCcBE3IjxqsA0rVRiZGWkMElioMqrJmNSIIqGi0I1qcmAZzVCzQAxizPnYkHOnnWHqeqwNtiPHlo9eNuB32gHVr-t9Hal792sVZYoKXgUOHoR8O5hwjDqzgaDbQs9uinoeFrJWCG4iujnd-jaTb6P620pzlQuJYvU8TNlvAvBY_N_mITp7Xf1q--KJx6JmN0</recordid><startdate>20211113</startdate><enddate>20211113</enddate><creator>SHSM, Hadi</creator><creator>Fahmy, Usama</creator><creator>Alhakamy, Nabil</creator><creator>Khairul-Asri, Mohd</creator><creator>Fahmy, Omar</creator><general>MDPI AG</general><general>MDPI</general><scope>AAYXX</scope><scope>CITATION</scope><scope>8FE</scope><scope>8FH</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>LK8</scope><scope>M7P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6094-5570</orcidid><orcidid>https://orcid.org/0000-0002-3826-1519</orcidid></search><sort><creationdate>20211113</creationdate><title>Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review</title><author>SHSM, Hadi ; Fahmy, Usama ; Alhakamy, Nabil ; Khairul-Asri, Mohd ; Fahmy, Omar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c386t-aa0307502b9e55b81c4bc43c11cab7bf6043ee3f2398f5c6a26dead0aee6bef73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Bias</topic><topic>Bladder cancer</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Clinical trials</topic><topic>FDA approval</topic><topic>Immune checkpoint inhibitors</topic><topic>Immunotherapy</topic><topic>Invasiveness</topic><topic>Literature reviews</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Patients</topic><topic>Pembrolizumab</topic><topic>Precision medicine</topic><topic>Quantitative analysis</topic><topic>Review</topic><topic>Statistical analysis</topic><topic>Survival</topic><topic>Tumors</topic><topic>Urothelial carcinoma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SHSM, Hadi</creatorcontrib><creatorcontrib>Fahmy, Usama</creatorcontrib><creatorcontrib>Alhakamy, Nabil</creatorcontrib><creatorcontrib>Khairul-Asri, Mohd</creatorcontrib><creatorcontrib>Fahmy, Omar</creatorcontrib><collection>CrossRef</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Biological Sciences</collection><collection>Biological Science Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of personalized medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SHSM, Hadi</au><au>Fahmy, Usama</au><au>Alhakamy, Nabil</au><au>Khairul-Asri, Mohd</au><au>Fahmy, Omar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review</atitle><jtitle>Journal of personalized medicine</jtitle><date>2021-11-13</date><risdate>2021</risdate><volume>11</volume><issue>11</issue><spage>1195</spage><pages>1195-</pages><issn>2075-4426</issn><eissn>2075-4426</eissn><abstract>Background: Neoadjuvant chemotherapy is the standard of care before radical cystectomy for muscle invasive bladder cancer. 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Downstaging varied between 50% and 74%. ≥Grade 3 AEs were recorded in 8.6% of patients who received monotherapy with either Atezolizumab or Pembrolizumab. In patients who received combination treatment, the incidence of ≥Grade 3 AEs was 16.3% for chemoimmunotherapy and 36.5% for combined immunotherapy. A total of 373 patients (92%) underwent radical cystectomy. ≥Grade 3 Clavien-Dindo surgical complications were reported in 21.7% of the patients. One-year overall survival (OS) and relapse-free survival (RFS) varied between 81% and 92%, and 70% and 88%, respectively. Conclusion: The evidence on the use of immune checkpoint inhibitors in the setting of pre-radical cystectomy is quite limited, with noted variability within published trials. 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subjects | Bias Bladder cancer Cancer therapies Chemotherapy Clinical trials FDA approval Immune checkpoint inhibitors Immunotherapy Invasiveness Literature reviews Metastases Metastasis Patients Pembrolizumab Precision medicine Quantitative analysis Review Statistical analysis Survival Tumors Urothelial carcinoma |
title | Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review |
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