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Design of a randomized controlled phase III study of dose dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) or gemcitabine and cisplatin (GC) as peri-operative chemotherapy for patients with locally advanced transitional cell cancer of the bladder. The French GETUG/AFU V05 VESPER trial

Christian Pfister 1 Valentin Harter 2 Yves Allory 3 François Radvanyi 4 Stéphane Culine 5 G. Grawis G. Pignot 6 A. Flechon J.P. Fendler 7 C. Chevreau 8 M. Soulié 9 H. Mahammedi 10 L. Guy 11, 10 B. Laguerre 12 G. Verhoest 13 A. Guillot N. Mottet 14 F. Joly A. Doerfler 15 S. Abadie-Lacourtoisie A.R. Azzouzi 16 P. Mongiat L. Geoffrois 17 P. Eschwege 18 F. Di Fiore 19 G. Roubaud 20 J.L. Hoepffner P. Barthelemy 21 H. Lang E. Voog E. Mandron J.M. Tourani 22 C. Serrrate A. Colau C. Saldana A. de la Taille 23 T. Nguyen 24 F. Kleinclauss 25 Y. Loriot 26 J. Irani 27 J.C. Eymard S. Larre 28 O. Huillard M. Zerbib F. Rolland J. Rigaud 29 N. Houédé 30 S. Droupy 30 G. Malouf M. Roupret 31 M. El Demery 30 C. Legon S. Vieillot N. Letang 32 T. Lharidon N. Gaschignard W. Hilgers 33 J.L. Davin
13 Cancer du rein : bases moléculaires de la tumorogenèse
IGDR - Institut de Génétique et Développement de Rennes
Abstract : The main objective of the French GETUG/AFU V05 VESPER randomized phase III study was to assess the efficacy of dd-MVAC and GC in term of progression-free survival in patients for whom chemotherapy has been decided, before or after surgery. A total of 500 patients have been randomized in 28 reference centers. Inclusion criteria were urothelial carcinoma without neuro-endocrine variant, disease defined by a T2, T3 or T4a N0 (pelvic lymph node ≤ 10 mm on CT scan) M0 staging for patients receiving neoadjuvant chemotherapy or pT3 or pT4 or pN+ and M0 for patients receiving adjuvant chemotherapy. Secondary endpoints include overall survival, safety, response rate. The peri-operative chemotherapy schedule was experimental arm dd-MVAC for a total of 6 cycles versus standard arm GC 4 cycles. The toxicity was evaluated according to NCI CTCAE (v 4.0). The progression-free survival rate will be estimated at 3 years by the Kaplan-Meier method. All the patients will be followed for 5 years. The last patient was randomized in March 2018 and the primary endpoint results are expected for mid-2021. As the dd-MVAC schedule is associated with higher response rates in metastatic disease, the real question today is to confirm such benefit in the peri-operative setting, taking also in consideration the chemotherapy toxicity. Tomorrow, the challenge may be the best chemotherapy and immunotherapy association, the authors hope that final Vesper Trial results will help to determine the gold standard chemotherapy.
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Christian Pfister, Valentin Harter, Yves Allory, François Radvanyi, Stéphane Culine, et al.. Design of a randomized controlled phase III study of dose dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) or gemcitabine and cisplatin (GC) as peri-operative chemotherapy for patients with locally advanced transitional cell cancer of the bladder. The French GETUG/AFU V05 VESPER trial. Contemporary Clinical Trials Communications, Elsevier, 2020, 17, pp.100536. ⟨10.1016/j.conctc.2020.100536⟩. ⟨hal-02909542⟩

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