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Glycan-targeted drug delivery for intravesical therapy: in the footsteps of uropathogenic bacteria. Ther Deliv 2014; 5:537-53. [DOI: 10.4155/tde.14.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The human urothelium belongs to the most efficient biobarriers, and represents a highly rewarding but challenging target for local drug administration. Inadequate urothelial bioavailability is a major obstacle for successful treatment of bladder cancer and other diseases, yet little research has addressed the development of advanced delivery concepts for the intravesical route. A prominent example of how to overcome the urothelial barrier by means of specific biorecognition is the efficient cytoinvasion of UPEC bacteria, mediated by the mannose-targeted lectin domain FimH. Similar mechanisms of non-bacterial origin may be exploited for enhancing drug uptake from the bladder cavity. This review covers the current status in the development of lectin-based delivery strategies for the urinary tract. Different concepts for preparing and optimizing carbohydrate-targeted delivery systems are presented, along with important design parameters, benefits and shortcomings. Bioconjugate- and nano-/microparticle-based systems are discussed in further detail with regard to their performance in preclinical testing.
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Intravesical thermo-chemotherapy based on conductive heat: a first pharmacokinetic study with Mitomycin C in superficial transitional cell carcinoma patients. Cancer Chemother Pharmacol 2014; 73:503-9. [DOI: 10.1007/s00280-014-2381-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
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53
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Neutsch L, Eggenreich B, Herwig E, Marchetti-Deschmann M, Allmaier G, Gabor F, Wirth M. Biomimetic Delivery Strategies at the Urothelium: Targeted Cytoinvasion in Bladder Cancer Cells via Lectin Bioconjugates. Pharm Res 2013; 31:819-32. [DOI: 10.1007/s11095-013-1204-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/12/2013] [Indexed: 10/25/2022]
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54
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Yang H, Li H, Wang Z, Gao J, Guo Y. Is urinary soluble Fas an independent predictor of non-muscle-invasive bladder cancer? A prospective chart study. Urol Int 2013; 91:456-61. [PMID: 23948854 DOI: 10.1159/000350752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/19/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate whether soluble Fas (sFas) in urine is an independent predictor of non-muscle-invasive bladder cancer (NMIBC). METHODS We performed a prospective chart review which included 128 subjects with NMIBC and 88 controls. The first morning voided urine sample (10-20 ml) was obtained from preoperative patients and controls. Expression levels of sFas in urine were analyzed using enzyme-linked immunosorbent assay. Clinical and pathological data, European Organisation for Research and Treatment of Cancer (EORTC) risk group category, follow-up data and urinary sFas values were gathered from each patient, and each prognostic outcome was evaluated. RESULTS sFas levels were significantly higher in the urine of patients with NMIBC than of those without NMIBC (p = 0.000). The level was significantly higher in cases with a higher stage or grade or high-risk and recurrent disease than in those with a lower stage or grade or low-risk and nonrecurrent disease (each p < 0.05). Kaplan-Meier estimates revealed a significant difference in time to recurrence based on sFas levels in the urine of the NMIBC patients (log-rank test; p = 0.000). On multivariate Cox regression analysis, EORTC risk group category (hazards ratio [HR] = 3.250, p = 0.000) and urinary sFas level (HR = 1.403, p = 0.015) were the independent predictors of NMIBC recurrence. CONCLUSIONS Our study indicated that urinary sFas assay results may help identify NMIBC patients at risk of tumor recurrence. These data can be used to design a future follow-up schedule and treatment strategy for NMIBC patients.
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Affiliation(s)
- Huixiang Yang
- Department of Andrology, First Hospital of Shijiazhuang, Shijiazhuang, China
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55
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Krpina K, Babarović E, Dorđević G, Fuckar Z, Jonjić N. The association between the recurrence of solitary non-muscle invasive bladder cancer and tumor infiltrating lymphocytes. Croat Med J 2013; 53:598-604. [PMID: 23275325 PMCID: PMC3541585 DOI: 10.3325/cmj.2012.53.598] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim To evaluate whether tumor infiltrating lymphocytes (TIL) in biopsy specimens are associated with the clinical outcome of non-muscle invasive bladder cancer. Methods We retrieved tumor specimens from 115 patients with solitary papillary non-muscle invasive bladder cancer treated between 1996 and 2006 and constructed tissue microarrays. Patients were divided in two groups: those with recurrent disease (N = 69) and those without recurrent disease (N = 46) during the follow up of minimum 5 years. All patients were treated with initial transurethral resection and none received adjuvant therapy. Immunhistochemical staining was performed with anti-CD3, CD4, CD8, and Granzyme B (GrB). The CD4+:CD8+ and GrB+:CD8 ratios were determined. Results Tumor infiltrating lymphocytes were predominantly observed within cancer stroma, and only rare individual cells were observed intraepithelially. The group without recurrent disease had lower levels of CD3+ and CD8+ lymphocytes than the group with recurrent disease (P = 0.0001, P = 0.0002, respectively). The CD4+:GrB+ and GrB+:CD8+ ratios were significantly higher in patients without recurrent disease (P = 0.0002, P = 0.039, respectively). Conclusion This study revealed a possible connection between TIL number and bladder cancer recurrence. TIL subset ratio showed different patterns in recurrent and non-recurrent tumors, which is why it could become a useful a prognostic clinical index if our findings are confirmed in randomized trials.
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Affiliation(s)
- Kristian Krpina
- Department of Urology, Clinical Hospital Center Rijeka, Tome Strizica 3, 51000 Rijeka, Croatia.
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56
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Xu T, Zhu Z, Zhang X, Wang X, Zhong S, Zhang M, Shen Z. Predicting recurrence and progression in Chinese patients with nonmuscle-invasive bladder cancer using EORTC and CUETO scoring models. Urology 2013; 82:387-93. [PMID: 23759377 DOI: 10.1016/j.urology.2013.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/24/2013] [Accepted: 04/02/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To validate the European Organization for Research and Treatment of Cancer (EORTC) model and the Spanish Urological Club for Oncological Treatment (CUETO) model in Chinese patients with nonmuscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS A retrospective study was performed of 363 Chinese patients with NMIBC treated at our hospital from January 2003 to September 2010. Most of these patients had undergone intravesical chemotherapy after transurethral resection of the bladder tumor. The scores for recurrence and progression were calculated using the 2 models. Next, all the patients were divided into 4 risk groups according to their scores. The Kaplan-Meier method was used to estimate the probabilities of recurrence and progression according to both models. Discrimination was assessed using the concordance index. RESULTS The EORTC model successfully stratified our patients into 4 groups with statistically significant different probabilities of recurrence. For progression, only the intermediate- and high-risk groups could be reasonably distinguished using the EORTC model. The CUETO model stratified neither the recurrence nor the progression risks. The concordance index using the EORTC and CUETO model was 0.711 and 0.663 for recurrence and 0.768 and 0.741 for progression, respectively. CONCLUSION Compared with the CUETO risk tables, the EORTC model showed more value in predicting recurrence and progression in Chinese patients with NMIBC, most of whom received intravesical chemotherapy after transurethral resection of the bladder tumor. Prospective multicenter studies should be performed of large cohorts to construct an ideal prognostic model for Chinese patients with NMIBC.
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Affiliation(s)
- Tianyuan Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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57
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UPEC biomimickry at the urothelial barrier: Lectin-functionalized PLGA microparticles for improved intravesical chemotherapy. Int J Pharm 2013; 450:163-76. [DOI: 10.1016/j.ijpharm.2013.04.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 11/23/2022]
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58
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Neutsch L, Wirth EM, Spijker S, Pichl C, Kählig H, Gabor F, Wirth M. Synergistic targeting/prodrug strategies for intravesical drug delivery--lectin-modified PLGA microparticles enhance cytotoxicity of stearoyl gemcitabine by contact-dependent transfer. J Control Release 2013; 169:62-72. [PMID: 23588390 DOI: 10.1016/j.jconrel.2013.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 04/03/2013] [Accepted: 04/08/2013] [Indexed: 02/04/2023]
Abstract
The direct access to the urothelial tissue via intravesical therapy has emerged as a promising means for reducing the high recurrence rate of bladder cancer. However, few advanced delivery concepts have so far been evaluated to overcome critical inherent efficacy limitations imposed by short exposure times, low tissue permeability, and extensive washout. This study reports on a novel strategy to enhance gemcitabine treatment impact on urothelial cells by combining a pharmacologically advantageous prodrug approach with the pharmacokinetic benefits of a glycan-targeted carrier system. The conversion of gemcitabine to its 4-(N)-stearoyl derivative (GEM-C₁₈) allowed for stable, homogeneous incorporation into PLGA microparticles (MP) without compromising intracellular drug activation. Fluorescence-labeled GEM-C₁₈-PLGA-MP were surface-functionalized with wheat germ agglutinin (WGA) or human serum albumin (HSA) to assess in direct comparison the impact of biorecognitive interaction on binding rate and anchoring stability. MP adhesion on urothelial cells of non-malignant origin (SV-HUC-1), and low- (5637) or high-grade (HT-1376) carcinoma was correlated to the resultant antiproliferative and antimetabolic effect in BrdU and XTT assays. More extensive and durable binding of the WGA-GEM-C₁₈-PLGA-MP induced a change in the pharmacological profile and substantially higher cytotoxicity, allowing for maximum response within the temporal restrictions of instillative administration (120 min). Mechanistically, a direct, contact-dependent transfer of stearoyl derivatives from the particle matrix to the urothelial membrane was found to account for this effect. With versatile options for future application, our results highlight the potential offered by the synergistic implementation of targeting/prodrug strategies in delivery systems tailored to the intravesical route.
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Affiliation(s)
- L Neutsch
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Vienna A 1090, Austria
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59
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Men K, Liu W, Li L, Duan X, Wang P, Gou M, Wei X, Gao X, Wang B, Du Y, Huang M, Chen L, Qian Z, Wei Y. Delivering instilled hydrophobic drug to the bladder by a cationic nanoparticle and thermo-sensitive hydrogel composite system. NANOSCALE 2013; 4:6425-33. [PMID: 22955255 DOI: 10.1039/c2nr31592k] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Some bladder disease therapies can benefit from intravesical drug delivery, which involves direct instillation of drug into the bladder via a catheter, to attain high local concentrations of the drug with minimal systemic effects. Deguelin is a potential anticancer agent, however, its poor water solubility and neurotoxicity restrict its clinical application. To address these challenges, we investigated the promising application of deguelin in the intravesical therapy of bladder cancer by designing a novel intravesical drug delivery system for deguelin. It was found that deguelin could efficiently kill bladder cancer cells and inhibit angiogenesis. Intravesically administrated deguelin had better tolerance than systemically applied deguelin. Encapsulation of deguelin in cationic DOTAP and monomethoxy poly(ethylene glycol)-poly(ε-caprolactone) (MPEG-PCL) hybrid nanoparticles (DMP) created the deguelin loaded DMP nanoparticles (D/DMP). They had a mean particle size of 35 nm and zeta potential of 21 mV, rendering deguelin completely dispersible in aqueous media. Encapsulation of deguelin in cationic DMP nanoparticles enhanced the anticancer activity of deguelin in vitro. In addition, D/DMP nanoparticles were incorporated into a thermo-sensitive Pluronic F127 hydrogel, forming a novel D/DMP-F system, which remained in a flowing liquid state at lower than 25 °C, but underwent gelation at higher temperatures. The DMP nanoparticles in the F127 hydrogel system (DMP-F) could significantly extend the hydrophobic drug residence time and increase the drug concentration within the bladder. These results suggested that DMP-F was a good intravesical drug delivery system and D/DMP-F may have promising applications in intravesical therapy of bladder cancer.
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Affiliation(s)
- Ke Men
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, PR China
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Sverrisson EF, Espiritu PN, Spiess PE. New therapeutic targets in the management of urothelial carcinoma of the bladder. Res Rep Urol 2013; 5:53-65. [PMID: 24400235 PMCID: PMC3826897 DOI: 10.2147/rru.s29131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Urothelial carcinoma of the bladder, despite the myriad of treatment approaches and our progressively increasing knowledge into its disease processes, remains one of the most clinically challenging problems in modern urological clinical practice. New therapies target biomolecular pathways and cellular mediators responsible for regulating cell growth and metabolism, both of which are frequently overexpressed in malignant urothelial cells, with the intent of inducing cell death by limiting cellular metabolism and growth, creating an immune response, or selectively delivering or activating a cytotoxic agent. These new and novel therapies may offer a potential for reduced toxicity and an encouraging hope for better treatment outcomes, particularly for a disease often refractory or not amenable to the current therapeutic approaches.
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Affiliation(s)
- Einar F Sverrisson
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Patrick N Espiritu
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA
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Simonato F, Ventura L, Sartori N, Cappellesso R, Fassan M, Busund LT, Fassina A. Detection of microRNAs in archival cytology urine smears. PLoS One 2013; 8:e57490. [PMID: 23469001 PMCID: PMC3585351 DOI: 10.1371/journal.pone.0057490] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 01/22/2013] [Indexed: 01/22/2023] Open
Abstract
MicroRNAs’ dysregulation and profiling have been demonstrated to be clinically relevant in urothelial carcinoma (UC). Urine cytology is commonly used as the mainstay non-invasive test for secondary prevention and follow-up of UC patients. Ancillary tools are needed to support cytopathologists in the diagnosis of low-grade UC. The feasibility and reliability of microRNAs profiling by qRT-PCR analysis (miR-145 and miR-205) in archival routine urine cytology smears (affected by fixation/staining [Papanicolau] and room temperature storage) was tested in a series of 15 non-neoplastic and 10 UC urine specimens. Only samples with >5,000 urothelial cells and with <50% of inflammatory cells/red blood cells clusters were considered. Overall, a satisfactory amount of total RNA was obtained from all the considered samples (mean 1.27±1.43 µg, range 0.06–4.60 µg). Twenty nanograms of total RNA have been calculated to be the minimal total RNA concentration for reliable and reproducible miRNAs expression profiling analysis of archival cytological smears (slope = -3.4084; R-squared = 0.99; efficiency = 1.94). miR-145 and miR-205 were significantly downregulated in UC samples in comparison to non-tumor controls. These findings demonstrate that urine archival cytology smears are suitable for obtaining high-quality RNA to be used in microRNAs expression profiling. Further studies should investigate if miRNAs profiling can be successfully translated into clinical practice as diagnostic or prognostic markers.
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Affiliation(s)
- Francesca Simonato
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - Laura Ventura
- Department of Statistics, University of Padua, Padua, Italy
| | - Nicola Sartori
- Department of Statistics, University of Padua, Padua, Italy
| | - Rocco Cappellesso
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - Matteo Fassan
- Department of Pathology & Diagnostics, Surgical Pathology & Cytopathology Unit, University of Verona, Verona, Italy
| | - Lill-Tove Busund
- Department of Clinical Pathology, University Hospital of North Norway, Institute of Medical Biology, University of Tromso, Tromso, Norway
| | - Ambrogio Fassina
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
- * E-mail:
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Zhou D, Zhang G, Gan Z. c(RGDfK) decorated micellar drug delivery system for intravesical instilled chemotherapy of superficial bladder cancer. J Control Release 2013; 169:204-10. [PMID: 23388072 DOI: 10.1016/j.jconrel.2013.01.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/25/2012] [Accepted: 01/18/2013] [Indexed: 01/17/2023]
Abstract
The aim of this work was to develop a targeted drug delivery system with potentials for intravesical instilled chemotherapy of superficial bladder cancer. The amphiphilic diblock copolymer poly(ε-caprolactone)-b-poly(ethylene oxide) (PCL-b-PEO) was first conjugated with the cyclic (Arginine-Glycine-Aspartic acid-d-Phenylalanine-Lysine) (c(RGDfK)) and fluorescein isothiocyannate (FITC) via the functional terminal groups of hydrophilic block, and then assembled into micelles. The interaction between micelles and various model cells was well studied by means of confocal laser scanning microscopy and flow cytometry. The c(RGDfK) on the surface of the micelle was confirmed by (1)H NMR analysis and cell affinity with human glioblastoma-astrocytoma cells (U87MG). The cell viability of bladder cancer cells (T-24 cells) after incubation with doxorubicin (DOX) loaded polymeric micelles was evaluated by in vitro cytotoxicity assay. The results revealed that c(RGDfK) modified micelles showed strong affinity to T-24 cells and strong inhibitory effect on the proliferation of T-24 cells when doxorubicin drug was loaded, indicating the high affinity of c(RGDfK) to bladder cancer cells. The c(RGDfK) modified micelles assembled from PCL-b-PEO diblock copolymers developed in this study are of great potentials as nano-scaled drug delivery system for intravesical instilled chemotherapy of superficial bladder cancer.
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Affiliation(s)
- Danhua Zhou
- CAS Key Laboratory of Engineering Plastics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
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63
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Lee CT, Barocas D, Globe DR, Oefelein MG, Colayco DC, Bruno A, O'Day K, Bramley T. Economic and Humanistic Consequences of Preventable Bladder Tumor Recurrences in Nonmuscle Invasive Bladder Cancer Cases. J Urol 2012; 188:2114-9. [DOI: 10.1016/j.juro.2012.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | | | - Ken O'Day
- Xcenda, L.L.C., Palm Harbor, Florida
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Tadin T, Krpina K, Štifter S, Babarović E, Fučkar Ž, Jonjić N. Lower cyclooxygenase-2 expression is associated with recurrence of solitary non-muscle invasive bladder carcinoma. Diagn Pathol 2012; 7:152. [PMID: 23126361 PMCID: PMC3527228 DOI: 10.1186/1746-1596-7-152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 10/30/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A new modality is necessary to prevent recurrence of superficial bladder cancer after complete transurethral resection because of the high recurrence rate even with current prophylaxis protocols. METHODS In order to analyze the predictive value of cyclooxygenase-2 (COX-2) expression and tumor infiltrating lymphocytes (TILs) in recurrence of this disease tumor specimens from 127 patients with solitary papillary non-muscle invasive bladder cancer (NMIBC), 78 with recurrent disease and 49 without recurrence during follow up of minimum 5 years, were retrieved for tissue microarrays construction and immunohistochemical analysis. COX-2 expression was scored according to Allred's scoring protocol, while presence of TILs was categorized as absent (no) or present (yes) on whole tissue sections. RESULTS COX-2 immunoreactivity was presented in 70 (71%), weak in 16% and strong in 55% of cases, while 29 (29%) tumors were negative. TILs were present in 64 (58%) NMIBC, while 44 cases (41%) did not reveal mononuclear infiltration in tumoral stroma. Statistical analysis demonstrated a higher proportion of patients with recurrence in the group with the COX-2 score 0, and lower in the group with score 2 (p=0.0001, p=0.0101, respectively). In addition, a higher proportion of recurrent patients in the group with no TILs, and lower proportion in the group with TILs were found (p=0.009, p=0.009, respectively). Univariate and multivariate analysis revealed overexpression of COX-2 and presence of TILs as negative predictors. CONCLUSION Patients with lower COX-2 expression and absence of TILs in NMIBC need to be followed up more vigorously and probably selected for adjuvant therapy. VIRTUAL SLIDE The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1411318819790406.
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Affiliation(s)
- Tomislav Tadin
- Ultrasound Diagnostic Service, Health Centre Rijeka, Martina Kontuša 18, Rijeka, 51000, Croatia
- Tomislav Tadin, MD M.Sc., Ultrasound Diagnostic Service, Martina Kontuša 18, Rijeka, 51000, Croatia
| | - Kristian Krpina
- Department of Urology, University Hospital Centre Rijeka, Tome Strižića 3, Rijeka, 51000, Croatia
| | - Sanja Štifter
- Department of Pathology, Faculty of Medicine, University of Rijeka, B. Branchetta 20, Rijeka, 51000, Croatia
| | - Emina Babarović
- Department of Pathology, Faculty of Medicine, University of Rijeka, B. Branchetta 20, Rijeka, 51000, Croatia
| | - Željko Fučkar
- Department of Urology, University Hospital Centre Rijeka, Tome Strižića 3, Rijeka, 51000, Croatia
| | - Nives Jonjić
- Department of Pathology, Faculty of Medicine, University of Rijeka, B. Branchetta 20, Rijeka, 51000, Croatia
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Li Y, Xu X, Song L, Hou Y, Li Z, Tsang S, Li F, Im KM, Wu K, Wu H, Ye X, Li G, Wang L, Zhang B, Liang J, Xie W, Wu R, Jiang H, Liu X, Yu C, Zheng H, Jian M, Nie L, Wan L, Shi M, Sun X, Tang A, Guo G, Gui Y, Cai Z, Li J, Wang W, Lu Z, Zhang X, Bolund L, Kristiansen K, Wang J, Yang H, Dean M, Wang J. Single-cell sequencing analysis characterizes common and cell-lineage-specific mutations in a muscle-invasive bladder cancer. Gigascience 2012; 1:12. [PMID: 23587365 PMCID: PMC3626503 DOI: 10.1186/2047-217x-1-12] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 08/02/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cancers arise through an evolutionary process in which cell populations are subjected to selection; however, to date, the process of bladder cancer, which is one of the most common cancers in the world, remains unknown at a single-cell level. RESULTS We carried out single-cell exome sequencing of 66 individual tumor cells from a muscle-invasive bladder transitional cell carcinoma (TCC). Analyses of the somatic mutant allele frequency spectrum and clonal structure revealed that the tumor cells were derived from a single ancestral cell, but that subsequent evolution occurred, leading to two distinct tumor cell subpopulations. By analyzing recurrently mutant genes in an additional cohort of 99 TCC tumors, we identified genes that might play roles in the maintenance of the ancestral clone and in the muscle-invasive capability of subclones of this bladder cancer, respectively. CONCLUSIONS This work provides a new approach of investigating the genetic details of bladder tumoral changes at the single-cell level and a new method for assessing bladder cancer evolution at a cell-population level.
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Affiliation(s)
- Yingrui Li
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Xun Xu
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Luting Song
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
- CAS-Max Planck Junior Research Group, State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences (CAS), 32# Jiao-chang Road, Kunming, Yunnan, 650223, People’s Republic of China
- Graduate University of the Chinese Academy of Sciences, 19A Yuquanlu, Beijing, 100049, People’s Republic of China
- College of Life Sciences, Wuhan University, Luojia Hill, Wuhan, 430072, People’s Republic of China
| | - Yong Hou
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
- School of Biological Science and Medical Engineering, Southeast University, Sipailou 2#, Nanjing, 210096, People’s Republic of China
- State Key Laboratory of Bioelectronics, Southeast University, Sipailou 2#, Nanjing, 210096, People’s Republic of China
| | - Zesong Li
- Shenzhen Key Laboratory of Genitourinary Tumor, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, People’s Republic of China
- Department of Urology, Shenzhen Second People’s Hospital, Shenzhen, 518035, People’s Republic of China
- The Institute of Urogenital Diseases, Shenzhen University, Shenzhen, 518060, People’s Republic of China
| | - Shirley Tsang
- BioMatrix, LLC, 3029 Windy Knoll Court, Rockville, MD, 20850, USA
| | - Fuqiang Li
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Kate McGee Im
- Cancer and Inflammation Program, National Cancer Institute at Frederick, Building 560, Frederick, MD, 21702, USA
| | - Kui Wu
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Hanjie Wu
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
- School of Bioscience and Biotechnology, Guangzhou Higher Education Mega Centre, South China University of Technology, Panyu District, Guangzhou, 510006, People’s Republic of China
| | - Xiaofei Ye
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Guibo Li
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Linlin Wang
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Bo Zhang
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Jie Liang
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Wei Xie
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
- School of Biological Science and Medical Engineering, Southeast University, Sipailou 2#, Nanjing, 210096, People’s Republic of China
- State Key Laboratory of Bioelectronics, Southeast University, Sipailou 2#, Nanjing, 210096, People’s Republic of China
| | - Renhua Wu
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Hui Jiang
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Xiao Liu
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Chang Yu
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Hancheng Zheng
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Min Jian
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Liping Nie
- Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology, Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, 1120 Lian Hua Road, Futian District, Shenzhen, 518036, People’s Republic of China
| | - Lei Wan
- Department of Urology, Longgang Central Hospital, Shenhui Road, Longgang Town, Shenzhen, 518116, People’s Republic of China
| | - Min Shi
- Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology, Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, 1120 Lian Hua Road, Futian District, Shenzhen, 518036, People’s Republic of China
| | - Xiaojuan Sun
- Shenzhen Key Laboratory of Genitourinary Tumor, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, People’s Republic of China
- Department of Urology, Shenzhen Second People’s Hospital, Shenzhen, 518035, People’s Republic of China
- The Institute of Urogenital Diseases, Shenzhen University, Shenzhen, 518060, People’s Republic of China
| | - Aifa Tang
- Shenzhen Key Laboratory of Genitourinary Tumor, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, People’s Republic of China
- Department of Urology, Shenzhen Second People’s Hospital, Shenzhen, 518035, People’s Republic of China
- The Institute of Urogenital Diseases, Shenzhen University, Shenzhen, 518060, People’s Republic of China
| | - Guangwu Guo
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Yaoting Gui
- Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology, Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, 1120 Lian Hua Road, Futian District, Shenzhen, 518036, People’s Republic of China
| | - Zhiming Cai
- Department of Urology, Shenzhen Second People’s Hospital, Shenzhen, 518035, People’s Republic of China
- The Institute of Urogenital Diseases, Shenzhen University, Shenzhen, 518060, People’s Republic of China
- Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology, Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, 1120 Lian Hua Road, Futian District, Shenzhen, 518036, People’s Republic of China
| | - Jingxiang Li
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Wen Wang
- CAS-Max Planck Junior Research Group, State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences (CAS), 32# Jiao-chang Road, Kunming, Yunnan, 650223, People’s Republic of China
| | - Zuhong Lu
- School of Biological Science and Medical Engineering, Southeast University, Sipailou 2#, Nanjing, 210096, People’s Republic of China
- State Key Laboratory of Bioelectronics, Southeast University, Sipailou 2#, Nanjing, 210096, People’s Republic of China
| | - Xiuqing Zhang
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Lars Bolund
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
- Institute of Human Genetics, University of Aarhus, Aarhus, 8100, Denmark
| | - Karsten Kristiansen
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
- The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Ole Maaløes Vej 5, Copenhagen, DK, 2200, Denmark
| | - Jian Wang
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Huanming Yang
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
| | - Michael Dean
- Cancer and Inflammation Program, National Cancer Institute at Frederick, Building 560, Frederick, MD, 21702, USA
| | - Jun Wang
- BGI-Shenzhen, Beishan Industrial Zone, Beishan Road, Yantian, Shenzhen, 518083, People’s Republic of China
- The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Ole Maaløes Vej 5, Copenhagen, DK, 2200, Denmark
- Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, Copenhagen, DK, 2200, Denmark
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Surveillance and treatment of non-muscle-invasive bladder cancer in the USA. Adv Urol 2012; 2012:421709. [PMID: 22645607 PMCID: PMC3357503 DOI: 10.1155/2012/421709] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/22/2012] [Indexed: 11/17/2022] Open
Abstract
Seventy percent of newly diagnosed bladder cancers are classified as non-muscle-invasive bladder cancer (NMIBC) and are often associated with high rates of recurrence that require lifelong surveillance. Currently available treatment options for NMIBC are associated with toxicities that limit their use, and actual practice patterns vary depending upon physician and patient characteristics. In addition, bladder cancer has a high economic and humanistic burden in the United States (US) population and has been cited as one of the most costly cancers to treat. An unmet need exists for new treatment options associated with fewer complications, better patient compliance, and decreased healthcare costs. Increased prevention of recurrence through greater adherence to evidence-based guidelines and the development of novel therapies could therefore result in substantial savings to the healthcare system.
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Abstract
Transurethral resection is an effective therapy for non-muscle-invasive bladder cancer. However, the high rates of recurrence and significant risk of progression in higher grade tumors mandates additional therapy with intravesical agents. In this review we discuss the role of various intravesical agents currently in use including the immunomodualtory agent BCG and chemotherapeutic agents. We discuss the current guidelines and the role of these therapeutic agents in the context of higher grade Ta and T1 tumors.
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Affiliation(s)
- M Manoharan
- Department of Urology, University of Miami, Miami, FL, USA
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68
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Shariat SF, Karakiewicz PI, Godoy G, Lerner SP. Use of nomograms for predictions of outcome in patients with advanced bladder cancer. Ther Adv Urol 2011; 1:13-26. [PMID: 21789050 DOI: 10.1177/1756287209103923] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Accurate estimates of risk are essential for physicians if they are to recommend a specific management to patients with bladder cancer. In this review, we discuss the criteria for the evaluation of nomograms and review current available nomograms for advanced bladder cancer. METHODS A retrospective review of the Pubmed database between 2002 and 2008 was performed using the keywords 'nomogram' and 'bladder'. We limited the articles to advanced bladder cancer. We recorded input variables, prediction form, number of patients used to develop the prediction tools, the outcome being predicted, prediction tool-specific features, predictive accuracy, and whether validation was performed. RESULTS We discuss the characteristics needed to evaluate nomograms such as predictive accuracy, calibration, generalizability, level of complexity, effect of competing risks, conditional probabilities, and head-to-head comparison with other prediction methods. The predictive accuracies of the pre-cystectomy tools (n = 2) range from ∼65-75% and that of the post-cystectomy tools (n = 5) range from ∼75-80%. While some of these nomograms are well-calibrated and outperform AJCC staging, none has been externally validated. To date, four studies demonstrated a statistically significant improvement in predictive accuracy of nomograms by including biomarkers. CONCLUSIONS Nomograms provide accurate individualized estimates of outcomes. They currently represent the most accurate and discriminatory decision-making aids tools for predicting outcomes in patients with bladder cancer. Use of current nomograms could improve current selection of patients for standard therapy and investigational trial design by ensuring homogeneous groups. The addition of biological markers to the currently available nomograms using clinical and pathologic data holds the promise of improving prediction and refining management of patients with bladder cancer.
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Affiliation(s)
- Shahrokh F Shariat
- Division of Urology; Sidney Kimmel Center for Prostate and Urologic Cancer, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 27, New York, NY 10065, USA
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Prasad SM, Decastro GJ, Steinberg GD. Urothelial carcinoma of the bladder: definition, treatment and future efforts. Nat Rev Urol 2011; 8:631-42. [PMID: 21989305 DOI: 10.1038/nrurol.2011.144] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The identification of patients with high-risk bladder cancer is important for the timely and appropriate treatment of this lethal disease. The understanding of the natural history of bladder cancer has improved; however, the criteria used to define high-risk disease and the relevant treatment strategies have remained the same for the past several decades, despite multiple large, randomized, prospective clinical trials that have evaluated the use of intravesical, surgical and systemic therapies. The genetic signature of high-risk bladder cancer has been a focus of investigation and has led to the discovery of potential molecular targets for disease identification, risk stratification and therapy. These advances, combined with a comprehensive risk assessment profile that incorporates available pathological and clinical characteristics, might improve the diagnosis and treatment of patients with bladder cancer.
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Affiliation(s)
- Sandip M Prasad
- Section of Urology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
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Neutsch L, Plattner VE, Polster-Wildhofen S, Zidar A, Chott A, Borchard G, Zechner O, Gabor F, Wirth M. Lectin Mediated Biorecognition as a Novel Strategy for Targeted Delivery to Bladder Cancer. J Urol 2011; 186:1481-8. [DOI: 10.1016/j.juro.2011.05.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Indexed: 01/03/2023]
Affiliation(s)
- Lukas Neutsch
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Austria
| | - Verena E. Plattner
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Austria
| | | | - Agnes Zidar
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Austria
| | - Andreas Chott
- Department of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
| | - Gerrit Borchard
- Laboratory of Pharmaceutics and Biopharmaceutics, University of Geneva, Switzerland
| | - Othmar Zechner
- Department of Urology, Wilhelminenspital, Vienna, Austria
| | - Franz Gabor
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Austria
| | - Michael Wirth
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Austria
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Tilki D, Burger M, Dalbagni G, Grossman HB, Hakenberg OW, Palou J, Reich O, Rouprêt M, Shariat SF, Zlotta AR. Urine Markers for Detection and Surveillance of Non–Muscle-Invasive Bladder Cancer. Eur Urol 2011; 60:484-92. [DOI: 10.1016/j.eururo.2011.05.053] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 05/27/2011] [Indexed: 12/13/2022]
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Aldousari S, Kassouf W. Update on the management of non-muscle invasive bladder cancer. Can Urol Assoc J 2011; 4:56-64. [PMID: 20165581 DOI: 10.5489/cuaj.777] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Non-muscle invasive bladder cancer (NMIBC) is a heterogeneous population of tumours accounting for 80% of bladder cancers. Over the years, the management of this disease has been changing with improvements in results and outcomes. In this review, we focus on the latest updates on the management of NMIBC.
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Affiliation(s)
- Saad Aldousari
- Division of Urology, McGill University Health Centre, Montréal, QC
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73
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Shang PF, Kwong J, Wang ZP, Tian J, Jiang L, Yang K, Yue ZJ, Tian JQ. Intravesical Bacillus Calmette-Guérin versus epirubicin for Ta and T1 bladder cancer. Cochrane Database Syst Rev 2011:CD006885. [PMID: 21563157 DOI: 10.1002/14651858.cd006885.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bladder cancer accounts for approximately 4.4% of adult malignancies, and approximately 80% of bladder cancer presents initially as transitional cell carcinoma that is confined to the urothelium (stage Ta) or lamina propria (stage T1). Intravesical administration of Bacillus Calmette-Guérin (BCG) and epirubicin (EPI) has been proven to reduce tumour recurrence and prevent or delay progression to muscle invasion and metastases. However, comparison of the effectiveness and safety of intravesical BCG and EPI in bladder cancer has yet to be explored. OBJECTIVES To compare the effectiveness and safety of BCG with EPI in the treatment of Ta and T1 bladder cancer. SEARCH STRATEGY A comprehensive search of MEDLINE (1966 to April 2010), EMBASE (1980 to April 2010), Health Services Technology, Administration, and Research (HealthSTAR), the Cochrane Central Register of Controlled Trials (CENTRAL), CancerLit, and Database of Abstracts of Reviews of Effectiveness (DARE), was performed, and handsearching of relevant journals was undertaken. SELECTION CRITERIA All randomised or quasi-randomised trials (in which allocation was obtained by alternation - e.g., alternate medical records, date of birth, or other predictable methods) in patients with Ta or T1 bladder cancer that compared intravesical BCG with EPI were included. No language restrictions were applied. DATA COLLECTION AND ANALYSIS Trial eligibility, methodological quality and data extraction were assessed independently by two reviewers. We compared dichotomous outcomes (frequency of tumour recurrence, progressive disease by stage, mortality, distant metastases, local and systemic adverse effects, treatment delayed or stopped due to adverse effects) using risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS Five trials of 1111 participants were included in this review. For BCG, 549 patients were treated, and 562 with EPI. Of the evaluated patients, 35.5% (195/549) in the BCG group and 51.4% (289/562) in the EPI group had tumour recurrence (P < 0.05). For disease progression (BCG, 44/549; EPI, 58/562) and distant metastases (BCG, 23/487; EPI, 31/495), there were no significant differences (P = 0.19 and P = 0.29, respectively). Only two trials, including 769 patients, had sufficient data for us to analyze disease-specific (BCG, 22/383; EPI, 26/386) and overall mortality (BCG, 125/383; EPI, 147/386). Neither comparison was significant (P = 0.93 and P = 0.12, respectively). In four studies reporting toxicity, BCG was associated with significantly more drug-induced cystitis [BCG, 54.1% (232/429); EPI, 31.7% (140/441)] and haematuria [BCG, 30.8% (132/429); EPI, 16.1% (71/440)]. Similarly, in three studies reporting systemic toxicity, BCG had significantly higher toxicity than the EPI (34.8% (134/385) versus 1.3% (5/393), respectively). In a meta-analysis comparing 'treatment delayed or stopped' (BCG, 40/431; EPI, 33/441), there was no significant difference between BCG and EPI treatments (P = 0.82). AUTHORS' CONCLUSIONS The data from the present meta-analysis indicate that intravesical BCG treatment is more efficacious than EPI in reducing tumour recurrence for Ta and T1 bladder cancer. However, BCG appears to be associated with a higher incidence of adverse effects, such as drug-induced cystitis, haematuria and systemic toxicity, than EPI. The overall quality of the evidence is rather low. Well-designed, high quality randomised controlled trials with good allocation concealment are required.
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Affiliation(s)
- Pan Feng Shang
- Department of Urology, Second Hospital of Lanzhou University, No. 82, Cui Ying Men Street, Lanzhou City, Gansu, China, 730030
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Chade DC, Shariat SF, Dalbagni G. Intravesical therapy for urothelial carcinoma of the urinary bladder: a critical review. Int Braz J Urol 2010; 35:640-50; discussion 651. [PMID: 20028569 DOI: 10.1590/s1677-55382009000600002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2009] [Indexed: 01/01/2023] Open
Abstract
The management of non-muscle-invasive urothelial carcinoma of the bladder (UCB) is a challenge for physicians and patients alike. This is largely due to the heterogeneous natural history of this disease, in which tumors range from indolent to rapidly progressive and eventually fatal. Moreover, the high rate of recurrence and progression cause significant morbidity, expense, and detriment to quality of life. The advent of effective and safe intravesical therapies has improved the management of non-muscle-invasive UCB. Nevertheless, despite over 30 years of research and clinical experience, the mechanism, risks, benefits, and optimal regimens and treatment algorithms remain unclear. Although immunotherapy with bacillus Calmette-Guerin (BCG) has been the mainstay of intravesical treatment and represents a significant advance in the interaction of immunology and oncology, its clinical effectiveness is accompanied by a wide range of adverse events. Here, we review the literature on intravesical immunotherapy and chemotherapy with the aim of evaluating the clinical utility of the different treatments and providing recommendations. Many studies over the years have compared efficacy and toxicities of different agents and regimens, and certain conclusions are now well supported by high-level evidence. Future perspectives and promising advances in drug development are discussed and areas of improvement are identified in order to promote better cancer control and decrease the rate and severity of side-effects.
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Affiliation(s)
- Daher C Chade
- Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Colombo R, Salonia A, Leib Z, Pavone-Macaluso M, Engelstein D. Long-term outcomes of a randomized controlled trial comparing thermochemotherapy with mitomycin-C alone as adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC). BJU Int 2010; 107:912-8. [DOI: 10.1111/j.1464-410x.2010.09654.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sidorova AA, Kartsova LA, Grigoriev AV, Protoschak VV, Murashko EA. Determination of mitomycin C in urinary bladder tissue by reversed-phase high-performance liquid chromatography. JOURNAL OF ANALYTICAL CHEMISTRY 2010. [DOI: 10.1134/s1061934810080137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chen JP, Leu YL, Fang CL, Chen CH, Fang JY. Thermosensitive hydrogels composed of hyaluronic acid and gelatin as carriers for the intravesical administration of cisplatin. J Pharm Sci 2010; 100:655-66. [PMID: 20799367 DOI: 10.1002/jps.22309] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 05/02/2010] [Accepted: 06/30/2010] [Indexed: 11/12/2022]
Abstract
The aim of this work was to evaluate the use of thermosensitive hydrogels for intravesical cisplatin delivery into the bladder. Poly(N-isopropylacrylamide) (PNIPAM) was grafted onto hyaluronic acid (HA) to synthesize an HPN copolymer, which was further grafted with gelatin to form an HPNG copolymer. A 3% concentration of HPN and HPNG was sufficient to exert a thermosensitive response, whereas a concentration of 8% was needed for PNIPAM to form the hydrogel. The physicochemical and drug delivery properties were examined by scanning electron microscopy (SEM), the lower critical solution temperature (LCST), hydration ratio, and in vitro cisplatin release. The incorporation of HA and gelatin produced a different microstructure compared to the parent PNIPAM hydrogel. Gelatin conjugation increased the fibrous structure in the matrix. The LCSTs of PNIPAM, HPN, and HPNG were 32.3, 32.0, and 30.7°C, respectively. The copolymers showed an eightfold increase in the hydration capacity compared to PNIPAM, with no significant difference in values between HPN and HPNG. The release of cisplatin from an aqueous solution (control) was nearly complete after 8 h, compared to 85, 80, and 52% release from PNIPAM, HPN, and HPNG, respectively. In vivo evaluation of cisplatin levels in bladder tissues was performed following intravesical instillation in rats. When the dwell time was extended to 6 h, PNIPAM showed a sevenfold enhancement in the drug concentration in the bladder wall. HPNG also showed a twofold increase in the drug concentration. The administration of cisplatin by the HPN carrier did not change the drug accumulation compared to the control. Confocal laser scanning microscopic results confirmed the trend of drug absorption from various systems. A histological examination showed no adverse change in the urothelium with HPN or HPNG application. PNIPAM caused partial desquamation of umbrella cells. The thermosensitive hydrogels prepared in this study may be promising carriers for targeted drug delivery to the bladder.
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Affiliation(s)
- Jyh-Ping Chen
- Department of Chemical and Materials Engineering, Chang Gung University, Kweishan, Taoyuan, Taiwan
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78
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Abstract
In Japan, until now, the treatment of bladder cancer has been based on guidelines from overseas. The problem with this practice is that the options recommended in overseas guidelines are not necessarily suitable for Japanese clinical practice. A relatively large number of clinical trials have been conducted in Japan in the field of bladder cancer, and the Japanese Urological Association (JUA) considered it appropriate to formulate their own guidelines. These Guidelines present an overview of bladder cancer at each clinical stage, followed by clinical questions that address problems frequently faced in everyday clinical practice. In this English translation of a shortened version of the original Guidelines, we have abridged each overview, summarized each clinical question and its answer, and only included the references we considered of particular importance.
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Burger M, Thiounn N, Denzinger S, Kondas J, Benoit G, Chapado MS, Jimenz-Cruz FJ, Kisbenedek L, Szabo Z, Zsolt D, Grimm MO, Romics I, Thüroff JW, Kiss T, Tombal B, Wirth M, Munsell M, Mills B, Koh T, Sherman J. The application of adjuvant autologous antravesical macrophage cell therapy vs. BCG in non-muscle invasive bladder cancer: a multicenter, randomized trial. J Transl Med 2010; 8:54. [PMID: 20529333 PMCID: PMC2893125 DOI: 10.1186/1479-5876-8-54] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 06/08/2010] [Indexed: 11/18/2022] Open
Abstract
Introduction While adjuvant immunotherapy with Bacille Calmette Guérin (BCG) is effective in non-muscle-invasive bladder cancer (BC), adverse events (AEs) are considerable. Monocyte-derived activated killer cells (MAK) are discussed as essential in antitumoural immunoresponse, but their application may imply risks. The present trial compared autologous intravesical macrophage cell therapy (BEXIDEM®) to BCG in patients after transurethral resection (TURB) of BC. Materials and methods This open-label trial included 137 eligible patients with TaG1-3, T1G1-2 plurifocal or unifocal tumours and ≥ 2 occurrences within 24 months and was conducted from June 2004 to March 2007. Median follow-up for patients without recurrence was 12 months. Patients were randomized to BCG or mononuclear cells collected by apheresis after ex vivo cell processing and activation (BEXIDEM). Either arm treatment consisted of 6 weekly instillations and 2 cycles of 3 weekly instillations at months 3 and 6. Toxicity profile (primary endpoint) and prophylactic effects (secondary endpoint) were assessed. Results Patient characteristics were evenly distributed. Of 73 treated with BCG and 64 with BEXIDEM, 85% vs. 45% experienced AEs and 26% vs. 14% serious AEs (SAE), respectively (p < 0.001). Recurrence occurred significantly less frequent with BCG than with BEXIDEM (12% vs. 38%; p < 0.001). Discussion This initial report of autologous intravesical macrophage cell therapy in BC demonstrates BEXIDEM treatment to be safe. Recurrence rates were significantly lower with BCG however. As the efficacy of BEXIDEM remains uncertain, further data, e.g. marker lesions studies, are warranted. Trial registration The trial has been registered in the ISRCTN registry http://isrctn.org under the registration number ISRCTN35881130.
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Affiliation(s)
- Maximilian Burger
- Department of Urology, Caritas St, Josef Medical Centre, University of Regensburg, Regensburg, Germany.
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May M, Brookman-Amissah S, Roigas J, Hartmann A, Störkel S, Kristiansen G, Gilfrich C, Borchardt R, Hoschke B, Kaufmann O, Gunia S. Prognostic Accuracy of Individual Uropathologists in Noninvasive Urinary Bladder Carcinoma: A Multicentre Study Comparing the 1973 and 2004 World Health Organisation Classifications. Eur Urol 2010; 57:850-8. [DOI: 10.1016/j.eururo.2009.03.052] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 03/23/2009] [Indexed: 11/26/2022]
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Fang J, Wu P, Fang C, Chen C. Intravesical delivery of 5‐aminolevulinic acid from water‐in‐oil nano/submicron‐emulsion systems. J Pharm Sci 2010; 99:2375-85. [DOI: 10.1002/jps.22006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Smaldone MC, Casella DP, Welchons DR, Gingrich JR. Investigational therapies for non-muscle invasive bladder cancer. Expert Opin Investig Drugs 2010; 19:371-83. [PMID: 20078248 DOI: 10.1517/13543780903563372] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Bacillus Calmette-Guérin (BCG) is currently the most effective adjuvant intravesical agent at preventing disease recurrence and the only therapy shown to inhibit disease progression in non-muscle invasive bladder cancer (NMIBC). However, recurrence rates as high as 30% and significant local/systemic toxicity have resulted in an increased interest in the use of alternative intravesical agents. AREAS COVERED IN THE REVIEW Our aim is to discuss recent clinical trial evidence utilizing novel intravesical agents for treatment of NMIBC. A systematic literature review was performed via the National Center for Biotechnology Information databases to identify pertinent studies from 2000-2009. WHAT THE READER WILL GAIN A durable response has been demonstrated with alternative agents in patients refractory to or intolerant of BCG. This review compares the merits and shortcomings of these emerging agents, focusing on clinical trial safety and efficacy results. TAKE HOME MESSAGE Despite recent enthusiasm for novel agents, radical cystectomy remains the treatment of choice for patients with NMIBC who have failed intravesical therapy. However, evidence is accumulating that novel agents provide an efficacious alternative in patients refractory or intolerable to BCG or unfit for cystectomy. Further randomized prospective data are required to demonstrate a recurrence- and progression-free benefit compared with BCG.
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Affiliation(s)
- Marc C Smaldone
- University of Pittsburgh Medical Center, Department of Urology, Kaufmann Building, 3471 5th Avenue, Pittsburgh, PA 15213, USA.
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Serretta V, Morgia G, Altieri V, Di Lallo A, Ruggiero G, Salzano L, Battaglia M, Falsaperla M, Zito A, Sblendorio D, Melloni D, Allegro R. A 1-year maintenance after early adjuvant intravesical chemotherapy has a limited efficacy in preventing recurrence of intermediate risk non-muscle-invasive bladder cancer. BJU Int 2010; 106:212-7. [DOI: 10.1111/j.1464-410x.2009.09153.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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84
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Saika T, Tsushima T, Nasu Y, Miyaji Y, Saegusa M, Takeda K, Kumon H. Two instillations of epirubicin as prophylaxis for recurrence after transurethral resection of Ta and T1 transitional cell bladder cancer: a prospective, randomized controlled study. World J Urol 2010; 28:413-8. [DOI: 10.1007/s00345-009-0502-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 12/23/2009] [Indexed: 10/20/2022] Open
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85
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Van Rhijn BW, Van Der Kwast TH, Kakiashvili DM, Fleshner NE, Van Der Aa MN, Alkhateeb S, Bangma CH, Jewett MA, Zlotta AR. Pathological stage review is indicated in primary pT1 bladder cancer. BJU Int 2009; 106:206-11. [DOI: 10.1111/j.1464-410x.2009.09100.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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86
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Burger M, Wieland WF, Otto W, Denzinger S, Stief CG, Zaak D, Stenzl A, Jocham D. Reply. Urology 2009. [DOI: 10.1016/j.urology.2009.07.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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87
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Laihia JK, Pylkkänen L, Laato M, Boström PJ, Leino L. Protodynamic therapy for bladder cancer:in vitroresults of a novel treatment concept. BJU Int 2009; 104:1233-8. [DOI: 10.1111/j.1464-410x.2009.08611.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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88
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Addeo R, Caraglia M, Bellini S, Abbruzzese A, Vincenzi B, Montella L, Miragliuolo A, Guarrasi R, Lanna M, Cennamo G, Faiola V, Del Prete S. Randomized phase III trial on gemcitabine versus mytomicin in recurrent superficial bladder cancer: evaluation of efficacy and tolerance. J Clin Oncol 2009; 28:543-8. [PMID: 19841330 DOI: 10.1200/jco.2008.20.8199] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Approximately 30% to 40% patients with a superficial bladder cancer treated with Bacille Calmette-Guerin (BCG) or epirubicin do not respond; of the initial responders, 35% have a relapse within 5 years. We compare the therapeutic efficacy and toxicity of intravescical infusions of gemcitabine (GEM) with mitomycin (MMC) in patients with a recurrent superficial bladder cancer. PATIENTS AND METHODS Patients with a history of a previously treated, recurrent Ta-T1, G1-G3 bladder transitional cell carcinoma were enrolled in the study. The patients received a 6-week course of GEM infusions or 4-week course of MMC. In both arms, for the initial responders who remained free of recurrences, maintenance therapy consisted of 10 monthly treatments during the first year. RESULTS A total of 120 patients were enrolled and randomly assigned to either the MMC or GEM treatment arm. At the end of the study, 109 patients (55 in MMC and 54 in GEM) were assessable. The median duration of follow-up was 36 months for either arm. In the GEM arm, 39 (72%) of 54 patients remained free of recurrence versus 33 (61%) of 55 in MMC arm. Among patients with recurrences, 10 in the MMC arm and six in the GEM arm also had a progressive disease by stage. The incidence of chemical cystitis in the MMC arm was statistically higher than in the GEM arm (P = .012). CONCLUSION This study demonstrates that GEM has better efficacy and lower toxicity than MMC; therefore, GEM appears as a logical candidate for intrabladder therapy in patients with refractory transitional cancer.
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Affiliation(s)
- Raffaele Addeo
- Oncologica Operative Unit S. Giovanni di Dio Hospital, ASL Napoli3, Frattaminore, Naples, Italy.
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89
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Permeation enhancer-containing water-in-oil nanoemulsions as carriers for intravesical cisplatin delivery. Pharm Res 2009; 26:2314-23. [PMID: 19653070 DOI: 10.1007/s11095-009-9947-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 07/20/2009] [Indexed: 12/31/2022]
Abstract
PURPOSE In the present work, we developed water-in-oil (w/o) nanoemulsions for the intravesical administration of cisplatin. METHODS The nanoemulsions were made up of soybean oil as the oil phase and Span 80, Tween 80, or Brij 98 as the emulsifier system. alpha-Terpineol and oleic acid were incorporated as permeation enhancers. The physicochemical characteristics of droplet size, zeta potential, and viscosity were determined. Nanoemulsions were administered intravesically for 1 approximately 4 h to rats in vivo. Animals were subsequently sacrificed, and the bladders were harvested to examine drug accumulation and histology. RESULTS Ranges of the mean size and zeta potential were 30 approximately 90 nm and -3.4 to -9.3 mV, respectively. The addition of enhancers further reduced the size of the nanoemulsions. The viscosity of all systems exhibited Newtonian behavior. The cisplatin-loaded nanoemulsions were active against bladder cancer cells. The nanoemulsions with Brij 98 exhibited the complete inhibition of cell proliferation. The encapsulation of cisplatin and carboplatin, another derivative of cisplatin, in nanoemulsions resulted in slower and more-sustained release. The amount of drug which permeated into bladder tissues significantly increased when using carriers containing Brij 98, with the alpha-terpineol-containing formulation showing the best result. The nanoemulsion with alpha-terpineol prolonged the duration of higher drug accumulation to 3 approximately 4 h. At the later stage of administration (3 approximately 4 h), this system increased the bladder wall deposition of cisplatin and carboplatin by 2.4 approximately 3.3-fold compared to the control solution. Histological examination of the urothelium showed near-normal morphology in rats instilled with these nanoemulsions. alpha-Terpineol possibly caused slight desquamation of umbrella cells. CONCLUSIONS The nanoemulsions are feasible to load cisplatin for intravesical drug delivery.
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Matsui Y, Watanabe J, Ding S, Nishizawa K, Kajita Y, Ichioka K, Saito R, Kobayashi T, Ogawa O, Nishiyama H. Dicoumarol enhances doxorubicin-induced cytotoxicity in p53 wild-type urothelial cancer cells through p38 activation. BJU Int 2009; 105:558-64. [PMID: 19583730 DOI: 10.1111/j.1464-410x.2009.08732.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a combined treatment of 3-30-methylene-bis[4-hydroxycoumarin] (dicoumarol) with doxorubicin for the treatment of urothelial cancer, as doxorubicin is a common chemotherapeutic agent but its therapeutic efficacy is limited. MATERIALS AND METHODS The synergistic effect of dicoumarol with chemotherapeutic agents such as cisplatin, doxorubicin and paclitaxel was evaluated in RT112 urothelial cancer cells. Then, dicoumarol-mediated enhancement of doxorubicin-induced cytotoxicity was screened in urothelial cancer cell lines with different p53 statuses or RT112 stable transfectants with a dominant-negative mutant of p53 (p53DN). To clarify the importance of the modification of p53 function by dicoumarol to enhance doxorubicin toxicity, the change in the p53-p21 pathway and mitogen-activated protein kinase (MAPK)-mitochondria pathway by the combined treatment were elucidated by Western blot analysis. Finally, the effect of p21 knockdown in the susceptibility to doxorubicin was examined with RT112 stable transfectants with short hairpin RNA (shRNA) of p21. RESULTS Dicoumarol significantly increased the susceptibility of RT112 cells to cisplatin and doxorubicin, but not to paclitaxel in RT112 cells. Dicoumarol (100 microm) also enhanced the cytotoxicity of doxorubicin in other bladder cancer cell lines with wild-type p53 (wt-p53; three times in 253J and 13 times in KK47), but not in those with mutant-type p53 (TCCsup, J82 and EJ) or in RT112 p53DN. The combined treatment with dicoumarol suppressed p53/p21 induction by doxorubicin and resulted in sequential p38 MAPK activation, myeloid cell leukaemia 1 suppression and caspase cleavage. The synergistic effect of doxorubicin/dicoumarol was suppressed by the p38 MAPK inhibitor SB202190 and, furthermore, p21 knockdown with shRNA transfection made RT112 cells six times more susceptible to doxorubicin with p38 MAPK activation. CONCLUSION These results suggest that concomitant use of dicoumarol could enhance the cytotoxicity of doxorubicin in urothelial cancer cells with wt-p53 through the p53/p21/p38 MAPK pathways. This combined treatment may provide a new therapeutic option to overcome chemoresistance in bladder cancer.
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Affiliation(s)
- Yoshiyuki Matsui
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Optimization of epirubicin nanoparticles using experimental design for enhanced intravesical drug delivery. Int J Pharm 2009; 376:195-203. [DOI: 10.1016/j.ijpharm.2009.04.045] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 04/22/2009] [Accepted: 04/25/2009] [Indexed: 11/20/2022]
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Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol 2009; 56:430-42. [PMID: 19576682 DOI: 10.1016/j.eururo.2009.06.028] [Citation(s) in RCA: 514] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Accepted: 06/17/2009] [Indexed: 01/01/2023]
Abstract
CONTEXT This review focuses on the prediction of recurrence and progression in non-muscle invasive bladder cancer (NMIBC) and the treatments advocated for this disease. OBJECTIVE To review the current status of epidemiology, recurrence, and progression of NMIBC and the state-of-the art treatment for this disease. EVIDENCE ACQUISITION A literature search in English was performed using PubMed and the guidelines of the European Association of Urology and the American Urological Association. Relevant papers on epidemiology, recurrence, progression, and management of NMIBC were selected. Special attention was given to fluorescent cystoscopy, the new World Health Organisation 2004 classification system for grade, and the role of substaging of T1 NMIBC. EVIDENCE SYNTHESIS In NMIBC, approximately 70% of patients present as pTa, 20% as pT1, and 10% with carcinoma in situ (CIS) lesions. Bladder cancer (BCa) is the fifth most frequent type of cancer in western society and the most expensive cancer per patient. Recurrence (in < or = 80% of patients) is the main problem for pTa NMIBC patients, whereas progression (in < or = 45% of patients) is the main threat in pT1 and CIS NMIBC. In a recent European Organisation for Research and Treatment of Cancer analysis, multiplicity, tumour size, and prior recurrence rate are the most important variables for recurrence. Tumour grade, stage, and CIS are the most important variables for progression. Treatment ranges from transurethral resection (TUR) followed by a single chemotherapy instillation in low-risk NMIBC to, sometimes, re-TUR and adjuvant intravesical therapy in intermediate- and high-risk patients to early cystectomy for treatment-refractory high-risk NMIBC. CONCLUSIONS NMIBC is a heterogeneous disease with varying therapies, follow-up strategies, and oncologic outcomes for an individual patient.
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Wirth M, Plattner VE, Gabor F. Strategies to improve drug delivery in bladder cancer therapy. Expert Opin Drug Deliv 2009; 6:727-44. [DOI: 10.1517/17425240903022758] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Bladder Tumor Infiltrating Mature Dendritic Cells and Macrophages as Predictors of Response to Bacillus Calmette-Guérin Immunotherapy. Eur Urol 2009; 55:1386-95. [DOI: 10.1016/j.eururo.2009.01.040] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 01/20/2009] [Indexed: 11/19/2022]
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Burger M. Editorial comment on: prognostic accuracy of individual uropathologists in noninvasive urinary bladder carcinoma: a multicentre study comparing the 1973 and 2004 World Health Organisation classifications. Eur Urol 2009; 57:858. [PMID: 19346064 DOI: 10.1016/j.eururo.2009.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Whelan DP. Words of wisdom. Re: predictors of intravesical therapy for nonmuscle invasive bladder cancer: results from the Surveillance, Epidemiology and End Results Programme (SEER) 2003 Patterns of Care Project. Eur Urol 2009; 54:1443-4. [PMID: 19189439 DOI: 10.1016/j.eururo.2008.08.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- David P Whelan
- St James's University Hospital, Pyrah Department of Urology, 2nd Floor, Lincoln Wing, Beckett Street, Leeds, West Yorkshire LS9 7TF, United Kingdom.
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Follow-up of nonmuscle invasive transitional cell carcinoma of the bladder: how and how often? Curr Opin Urol 2008; 18:504-7. [PMID: 18670275 DOI: 10.1097/mou.0b013e32830b86a9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nonmuscle invasive bladder cancer represents a heterogeneous disease due to different natural history of its various appearances. The purpose of this article is to review recent literature regarding follow-up strategies. RECENT FINDINGS Management of nonmuscle invasive bladder cancer has become more complex in respect to diagnosis, treatment and follow-up. Follow-up should therefore be based on individual patient-risk assessment. In addition to improved diagnosis by fluorescence-guided cystoscopy and other new diagnostic tools like optical-coherence tomography management has concentrated on optimizing different concepts of intravesical therapy. SUMMARY The intent of nonmuscle invasive bladder cancer management is to control recurrence and progression and to identify invasive tumours at the earliest possible stage. To obtain exact staging, besides a proper transurethral resection of bladder, a restaging transurethral resection of bladder should be performed in T1 patients. Data from the literature supports the immediate postoperative intravesical instillation of different chemotherapeutic agents in low-risk patients. Multifocal papillary lesions might necessitate a more intensive adjuvant regimen, whereas intravesical immunotherapy using bacillus Calmette-Guerin is recommended in patients who are at a high-risk of progression. Early cystectomy should be considered in patients with recurrent T1 tumours or refractory carcinoma in situ to avoid unfavourable tumour progression.
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Lamm D, Colombel M, Persad R, Soloway M, Böhle A, Palou J, Witjes JA, Akaza H, Buckley R, Brausi M. Clinical Practice Recommendations for the Management of Non–Muscle Invasive Bladder Cancer. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eursup.2008.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Intravesical Chemotherapy and BCG for the Treatment of Bladder Cancer: Evidence and Opinion. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eursup.2008.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Shariat SF, Margulis V, Lotan Y, Montorsi F, Karakiewicz PI. Nomograms for Bladder Cancer. Eur Urol 2008; 54:41-53. [DOI: 10.1016/j.eururo.2008.01.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Accepted: 01/04/2008] [Indexed: 10/22/2022]
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