VESPER (GETUG-AFU V05 / COGB 0402)

Clinical question

Which cisplatin-based neoadjuvant regimen is preferable before cystectomy: ddMVAC or gemcitabine-cisplatin?

Trial context

Population

493 patients with localized muscle-invasive bladder cancer eligible for cisplatin-based neoadjuvant chemotherapy

Intervention

Dose-dense MVAC vs gemcitabine-cisplatin before cystectomy

Key endpoint

5-year overall survival

Time horizon / follow-up

Long-term follow-up

Absolute Effect

What changes for patients?

VESPER established that dose-dense MVAC is a reasonable intensive neoadjuvant regimen, with higher pathologic response and favorable event-free outcomes compared with gemcitabine-cisplatin. Five-year OS was about 71% vs 66%, an absolute difference of 5 points (NNT 20), but the principal value of the trial is regimen selection rather than a large OS effect. NNT is based on 5-year OS.

NNT: 20

Treatment burden / harm

Grade 3–5 toxicity

NNH: Not quantified here; ddMVAC has a different toxicity profile and requires growth-factor support

Relative effect

HR: 0.77 for event-free survival in bladder/lymph-node population; OS difference modest

Trial primarily demonstrated regimen differences in downstaging and event-free outcomes

Clinical interpretation

VESPER supports dose-dense MVAC as a perioperative option for fit MIBC patients, particularly in the neoadjuvant setting, with treatment delivery and toxicity affecting the choice.

Primary publication

Pfister C, et al. Eur Urol. 2022;82:165–176.
Primary publication / source

← Return to The Absolute Effect

VESPER (GETUG-AFU V05 / COGB 0402)

Which cisplatin-based neoadjuvant regimen is preferable before cystectomy: ddMVAC or gemcitabine-cisplatin?

What changes for patients?

Current-practice context · reviewed 14 October 2026