VESPER: 5-Year Overall Survival After Perioperative Chemotherapy Regimens for MIBC

Dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) provides a better overall survival (OS) at 5 years and significantly improves disease-specific survival (DSS) compared with gemcitabine and cisplatin (GC) in the perioperative setting for patients with muscle-invasive bladder cancer (MIBC), according to a late-breaking abstract presented at the American Society of Clinical Oncology 2023 Annual Meeting.

Previous results of the GETUG/AFU V05 VESPER phase 3 trial showed that dd-MVAC improved 3-year progression-free survival (PFS) compared with GC in the perioperative setting for patients with MIBC. In the neoadjuvant setting, better bladder control and significant difference in 3-year PFS were reported in the dd-MVAC group (P=.025).

Christian Pfister, MD, PhD, and colleagues reported the final analysis of VESPER, including OS data after 5 years of follow-up from randomization. A total of 437 patients received neoadjuvant chemotherapy, 60% of whom received the planned 6 cycles in the dd-MVAC arm, 84% received 4 cycles in the GC arm, and 91% and 90% of patients underwent surgery, respectively.

Results of the 5-year analysis showed that OS was improved in the dd-MVAC arm compared with the GC arm (64% vs 56%, respectively; hazard ratio [HR], 0.77; 95% CI, 0.58-1.03; P=.078), as was DSS (72% vs 59%, respectively; HR, 0.63; 95% CI, 0.46-0.86; P=.004).

Similarly, OS was significantly improved in the dd-MVAC arm in the neoadjuvant group (66% vs 57%, respectively; HR, 0.71; 95% CI, 0.52-0.97; P=.032) as was DSS (75% vs 60%, respectively; HR, 0.56; 95% CI, 0.39-0.80; P=.001).

Dr. Pfister and colleagues acknowledged that the main cause of death was bladder cancer progression (83%).

These results led authors to conclude that “dd-MVAC provides a better OS at 5 years and significantly improves DSS compared with GC in the perioperative setting of MIBC.”