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Neoadjuvant Chemo MIBC — SCE Medical Oncology MCQ

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EasyUrological CancersNeoadjuvant Chemo MIBCSCE Medical Oncology

A 65-year-old man with muscle-invasive bladder cancer (T2 N0 M0) is planned for radical cystectomy. He is cisplatin-eligible. What neoadjuvant chemotherapy regimen is recommended?

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Correct answer: B — Neoadjuvant cisplatin-based combination chemotherapy (gemcitabine-cisplatin or dose-dense MVAC) for 3-4 cycles before cystectomy

Level 1 evidence supports neoadjuvant cisplatin-based chemotherapy before radical cystectomy for MIBC (T2-T4a N0 M0), providing approximately 5-8% absolute OS benefit at 5 years. Gemcitabine-cisplatin (4 cycles) or dose-dense MVAC (4 cycles) are the standard regimens. Approximately 30-40% of patients achieve pathological complete response (pT0), which is a strong prognostic indicator. Neoadjuvant ICI (nivolumab, pembrolizumab) is being evaluated but is not yet standard.

Reference: NICE NG2 Bladder cancer; ESMO 2024 Bladder Cancer; SW-ABCG meta-analysis; Grossman et al NEJM 2003