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...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Hadi SHSM, Usama A. Fahmy, Nabil A. Alhakamy, Mohd G. Khairul-Asri, Omar Fahmy
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	bladder cancer immunotherapy checkpoint inhibitors radical cystectomy chemotherapy Medicine R
Acceso en línea:	https://doaj.org/article/d88e7ab603b34b3a85ceb448a60dbfd3
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:d88e7ab603b34b3a85ceb448a60dbfd3
record_format	dspace
spelling	oai:doaj.org-article:d88e7ab603b34b3a85ceb448a60dbfd32021-11-25T18:07:56ZNeoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review10.3390/jpm111111952075-4426https://doaj.org/article/d88e7ab603b34b3a85ceb448a60dbfd32021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1195https://doaj.org/toc/2075-4426Background: 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.Hadi SHSMUsama A. FahmyNabil A. AlhakamyMohd G. Khairul-AsriOmar FahmyMDPI AGarticlebladder cancerimmunotherapycheckpoint inhibitorsradical cystectomychemotherapyMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1195, p 1195 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	bladder cancer immunotherapy checkpoint inhibitors radical cystectomy chemotherapy Medicine R
spellingShingle	bladder cancer immunotherapy checkpoint inhibitors radical cystectomy chemotherapy Medicine R Hadi SHSM Usama A. Fahmy Nabil A. Alhakamy Mohd G. Khairul-Asri Omar Fahmy Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review
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.
format	article
author	Hadi SHSM Usama A. Fahmy Nabil A. Alhakamy Mohd G. Khairul-Asri Omar Fahmy
author_facet	Hadi SHSM Usama A. Fahmy Nabil A. Alhakamy Mohd G. Khairul-Asri Omar Fahmy
author_sort	Hadi SHSM
title	Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review
title_short	Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review
title_full	Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review
title_fullStr	Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review
title_full_unstemmed	Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review
title_sort	neoadjuvant therapy using checkpoint inhibitors before radical cystectomy for muscle invasive bladder cancer: a systematic review
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/d88e7ab603b34b3a85ceb448a60dbfd3
work_keys_str_mv	AT hadishsm neoadjuvanttherapyusingcheckpointinhibitorsbeforeradicalcystectomyformuscleinvasivebladdercancerasystematicreview AT usamaafahmy neoadjuvanttherapyusingcheckpointinhibitorsbeforeradicalcystectomyformuscleinvasivebladdercancerasystematicreview AT nabilaalhakamy neoadjuvanttherapyusingcheckpointinhibitorsbeforeradicalcystectomyformuscleinvasivebladdercancerasystematicreview AT mohdgkhairulasri neoadjuvanttherapyusingcheckpointinhibitorsbeforeradicalcystectomyformuscleinvasivebladdercancerasystematicreview AT omarfahmy neoadjuvanttherapyusingcheckpointinhibitorsbeforeradicalcystectomyformuscleinvasivebladdercancerasystematicreview
_version_	1718411587792928768

Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review

Ejemplares similares