The VESPER trial, a phase 3 study conducted across 28 French university hospitals or comprehensive cancer centers, aimed to determine the optimal perioperative chemotherapy for muscle-invasive bladder cancer patients. Participants, aged 18 to 80 with histologically confirmed muscle-invasive urothelial carcinoma, were randomly assigned to receive either dd-MVAC every 2 weeks for six cycles or GC every 3 weeks for four cycles. The study focused on overall survival and time to death due to bladder cancer at a 5-year follow-up.
Findings revealed no significant difference in overall survival between the dd-MVAC and GC groups in the perioperative setting (64% vs 56%). However, the neoadjuvant subgroup showed improved overall survival and reduced time to death due to bladder cancer with dd-MVAC (66% vs 57% and 24% vs 38%, respectively). The adjuvant subgroup's results were inconclusive due to a small sample size. The primary cause of death was bladder cancer progression, accounting for 83% of the 190 deaths reported.
The study concludes that while dd-MVAC did not offer an overall survival advantage in the perioperative setting, its use in the neoadjuvant setting is supported by the data. These findings are expected to influence clinical practice and future immunotherapy trials in bladder cancer treatment.
