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Efficacy and toxicity of intravesical Bacillus Calmette-Guérin therapy in elderly patients with non-muscle-invasive bladder cancer. Curr Urol 2021; 15:16-21. [PMID: 34084117 PMCID: PMC8137001 DOI: 10.1097/cu9.0000000000000011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives: This study aimed to compare the efficacy and toxicity of intravesical Bacillus Calmette-Guérin (BCG) therapy between elderly and younger patients with non-muscle-invasive bladder cancer (NMIBC). Material and methods: This retrospective study included 87 NMIBC patients who received intravesical BCG between January 2011 and December 2018. We compared the treatment outcomes of patients ≥75 and <75 years old. Our primary endpoint was intravesical recurrence-free survival after treatment. The secondary endpoint was the toxicity caused by intravesical BCG. Results: The elderly and younger patients included 38 and 49 patients with mean ages of 80.6 and 66.3 years (p < 0.01), respectively. Their baseline parameters were similar, aside from age. The elderly and younger patients’ 5-year recurrence-free survival rates were 59.4% and 51.6%, respectively, and were not significantly different (log-rank test, p = 0.72). Moderate to severe pain on micturition requiring prescription medications was observed more frequently in the elderly patients than in the younger patients (p < 0.01). No elderly patients required hospitalization for any adverse events. However, 3 (6.1%) younger patients were treated for urinary tract infection in the hospital. Conclusions: The efficacy and toxicity of intravesical BCG therapy for NMIBC patients are not associated with age. Therefore, elderly patients with high-risk NMIBC should be treated in the same manner as younger patients in clinical practice.
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Burggraaf MJ, Waanders L, Verlaan M, Maaskant J, Houben D, Luirink J, Bitter W, Kuijl C, Molthoff CF. Surface Labeling with Adhesion Protein FimH Improves Binding of Immunotherapeutic Agent Salmonella Ty21a to the Bladder Epithelium. Bladder Cancer 2021; 7:79-90. [PMID: 38993217 PMCID: PMC11181684 DOI: 10.3233/blc-200382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/16/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bladder cancer is the ninth most common cancer in men. 70% of these tumors are classified as non-muscle invasive bladder cancer and those patients receive 6 intravesical instillations with Mycobacterium bovis BCG after transurethral resection. However, 30% of patients show recurrences after treatment and experience severe side effects that often lead to therapy discontinuation. Recently, another vaccine strain, Salmonella enterica typhi Ty21a, demonstrated promising antitumor activity in vivo. Here we focus on increasing bacterial retention in the bladder in order to reduce the number of instillations required and improve antitumor activity. OBJECTIVE To increase the binding of Ty21a to the bladder wall by surface labeling of the bacteria with adhesion protein FimH and to study its effect in a bladder cancer mouse model. METHODS Binding of Ty21a with surface-labeled FimH to the bladder wall was analyzed in vitro and in vivo. The antitumor effect of a single instillation of Ty21a+FimH in treatment was determined in a survival experiment. RESULTS FimH-labeled Ty21a showed significant (p < 0.0001) improved binding to mouse and human cell lines in vitro. Furthermore, FimH labeled bacteria showed ∼5x more binding to the bladder than controls in vivo. Enhanced binding to the bladder via FimH labeling induced a modest improvement in median but not in overall mice survival. CONCLUSIONS FimH labeling of Ty21a significantly improved binding to bladder tumor cells in vitro and the bladder wall in vivo. The improved binding leads to a modest increase in median survival in a single bladder cancer mouse study.
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Affiliation(s)
- Maroeska J. Burggraaf
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Center (AUMC), Location VU Medical Center (VUMC), Amsterdam, The Netherlands
| | - Lisette Waanders
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Center (AUMC), Location VU Medical Center (VUMC), Amsterdam, The Netherlands
| | - Mariska Verlaan
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center (AUMC), Location VU Medical Center (VUMC), Amsterdam, The Netherlands
| | - Janneke Maaskant
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Center (AUMC), Location VU Medical Center (VUMC), Amsterdam, The Netherlands
| | - Diane Houben
- Section Molecular Microbiology, AIMMS, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Wilbert Bitter
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Center (AUMC), Location VU Medical Center (VUMC), Amsterdam, The Netherlands
- Section Molecular Microbiology, AIMMS, Vrije Universiteit, Amsterdam, The Netherlands
| | - Coen Kuijl
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Center (AUMC), Location VU Medical Center (VUMC), Amsterdam, The Netherlands
| | - Carla F.M. Molthoff
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center (AUMC), Location VU Medical Center (VUMC), Amsterdam, The Netherlands
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Koterazawa S, Watanabe J, Uemura Y, Uegaki M, Shirahase T, Taki Y. A case of infectious thoracic aortic aneurysm after intravesical Bacillus Calmette-Guérin instillation therapy for a superficial bladder cancer. Urol Case Rep 2021; 36:101574. [PMID: 33552915 PMCID: PMC7844116 DOI: 10.1016/j.eucr.2021.101574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
Abstract
Intravesical Bacillus Calmette-Guérin instillation therapy after transurethral resection of bladder tumor is considered as the most effective treatment for prophylaxis against the recurrence of high-risk, non-muscle bladder cancer. However, intravesical Bacillus Calmette-Guérin instillation therapy has some characteristic complications. Here, we report a case of infectious thoracic aortic aneurysm related to prior intravesical Bacillus Calmette-Guérin instillation, which consequently allows the spread into the adjacent lung tissue and secretion in sputum of Mycobacterium bovis. BCG therapy after TURBT is effective against the recurrence of bladder cancer. Urologists should be aware of long-lasting latency of infection of M.bovis. Infectious aneurysm caused by M.bovis is a rare complication after BCG therapy.
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Affiliation(s)
- Shigeki Koterazawa
- Department of Urology, Toyooka Hospital, Tobera 1094, Toyooka, Hyogo, 668-8501, Japan
| | - Jun Watanabe
- Department of Urology, Toyooka Hospital, Tobera 1094, Toyooka, Hyogo, 668-8501, Japan
| | - Yuichi Uemura
- Department of Urology, Toyooka Hospital, Tobera 1094, Toyooka, Hyogo, 668-8501, Japan
| | - Masayuki Uegaki
- Department of Urology, Toyooka Hospital, Tobera 1094, Toyooka, Hyogo, 668-8501, Japan
| | - Toshiaki Shirahase
- Department of Urology, Toyooka Hospital, Tobera 1094, Toyooka, Hyogo, 668-8501, Japan
| | - Yoji Taki
- Department of Urology, Toyooka Hospital, Tobera 1094, Toyooka, Hyogo, 668-8501, Japan
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104
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Rutherford C, Patel MI, Tait MA, Smith DP, Costa DSJ, Sengupta S, King MT. Patient-reported outcomes in non-muscle invasive bladder cancer: a mixed-methods systematic review. Qual Life Res 2021; 30:345-366. [PMID: 32960394 DOI: 10.1007/s11136-020-02637-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Non-muscle invasive bladder cancer (NMIBC) is a chronic condition requiring repeated treatment and endoscopic examinations that can occur life-long. In this context, patient-reported outcomes (PROs) are important considerations to patients and managing clinicians. We undertook a systematic review to synthesise PRO results relevant to NMIBC treatment to explore trajectories overtime and differences between treatment options. METHODS We searched databases AMED, MEDLINE, EMbase, PsycINFO, Web of Knowledge and Scopus (inception to 5th December 2019), reference lists and contacted key authors to identify studies that reported PROs after NMIBC treatment. Two reviewers independently applied inclusion and quality criteria and extracted findings. Results for PROs were synthesised for treatment groups across three time periods: acute/during induction therapy; during maintenance therapy; and long-term follow-up (> 1 year). RESULTS Of 3193 papers screened, 29 were eligible. These provided evidence about induction treatment effects, but few reported maintenance or long-term evidence, and evidence about differences between NMIBC treatment options was lacking. A range of symptoms (pain in bladder area, urinary frequency and urgency, pain or burning during urination) were commonly experienced during and soon after treatment for NMIBC. Less common symptoms included fatigue, disrupted sleep and gastrointestinal problems. CONCLUSIONS Treatments for NMIBC can cause symptoms and functional impairment during the acute treatment phase and reduce quality of life. Clinicians should be aware of these impairments to prepare patients for short-term sequelae and enable those with treatment options to exercise preferences in choosing among them. However, gaps in current evidence limit our understanding of PRO trajectories from diagnosis through to long-term survivorship and treatment effects.
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Affiliation(s)
- Claudia Rutherford
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia.
| | - Manish I Patel
- Sydney Medical School, Discipline of Surgery, University of Sydney, Sydney, NSW, Australia
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | - Margaret-Ann Tait
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - David P Smith
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Daniel S J Costa
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Medical School, Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Shomik Sengupta
- Eastern Health Clinical School, Monash University, Box Hill, Vic, Australia
- Department of Urology, Eastern Health, Box Hill, Vic, Australia
- ANZUP Cancer Trials Group, Camperdown, NSW, Australia
| | - Madeleine T King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
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Brummelhuis ISG, Wimper Y, Witjes-van Os HGJM, Arends TJH, van der Heijden AG, Witjes JA. Long-Term Experience with Radiofrequency-Induced Hyperthermia Combined with Intravesical Chemotherapy for Non-Muscle Invasive Bladder Cancer. Cancers (Basel) 2021; 13:cancers13030377. [PMID: 33498535 PMCID: PMC7864165 DOI: 10.3390/cancers13030377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The recurrence rate of non-muscle invasive bladder cancer (NMIBC) is high, despite intravesical treatments. Importantly, patients are frequently unfit or unwilling to undergo a recommended radical cystectomy when standard intravesical treatments fail, due to the substantial risk of morbidity and mortality. For these patients, radiofrequency-induced hyperthermia combined with intravesical chemotherapy (RF-CHT) has shown promising results. We aim to determine treatment outcomes and assess the effect of (ablative) dose. METHODS 299 intensively pretreated patients treated with RF-CHT were included in safety analysis. Of these, 274 patients who fulfilled induction treatments were included in efficacy analysis. Six-month complete response (CR) and durable response were reported for (concomitant) carcinoma in situ (CIS) patients and recurrence-free survival (RFS) for papillary patients. RESULTS For CIS, six-month CR-rate was 56.0%; and durable response rates were 79.7%, 66.5%, and 40.3% at one-, two- and five-year, respectively. RFS rates for papillary patients were 77.9%, 57.5%, and 37.2%, respectively. Patients treated with ablative dose are less likely to develop recurrence (adjusted Hazard Ratio 0.54, p = 0.01), compared to adjuvant dose. CONCLUSIONS RF-CHT is effective in NMIBC patients in whom standard intravesical treatments have failed and should be considered in patients who are unwilling or unfit to undergo radical cystectomy. Patients with CIS or residual papillary tumor at baseline benefit from ablative dose.
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Affiliation(s)
- Iris S. G. Brummelhuis
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
- Correspondence: ; Tel.: +31-243619515
| | - Yvonne Wimper
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
| | - Hilde G. J. M. Witjes-van Os
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
| | - Tom J. H. Arends
- Department of Urology, Meander Medical Centre Amersfoort, 3813 TZ Amersfoort, The Netherlands;
| | - Antoine G. van der Heijden
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
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Supportive Care Needs of Patients on Surveillance and Treatment for Non-Muscle-Invasive Bladder Cancer. Semin Oncol Nurs 2021; 37:151105. [PMID: 33431233 DOI: 10.1016/j.soncn.2020.151105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This literature review provides an overview of non-muscle-invasive bladder cancer diagnosis (NMIBC), treatment, and surveillance. Existing evidence is reviewed to identify the NMIBC patient pathway, highlight its effect on quality of life, and identify supportive care needs of this patient group. A framework to guide nurses in the care of this underserved population is proposed. DATA SOURCES Electronic databases including CINAHL, Medline, PsychInfo, Cochrane, and Google Scholar were searched. CONCLUSION NMIBC is a chronic disease with high recurrence and progression rates with most patients requiring invasive treatment and burdensome surveillance schedules with frequent hospital visits. Treatment-related side effects may interrupt therapy and possibly result in its discontinuation. Patients' quality of life can be negatively affected at various stages of the cancer trajectory. Specialist nurses provide holistic care throughout all stages of the patient journey to optimize supportive care, information provision, and delivery of appropriate treatment and surveillance protocols. NMIBC research is historically underfunded with a paucity of evidence identifying the supportive care needs of this population. Further research is urgently required to fill the gaps identified. IMPLICATIONS FOR NURSING PRACTICE This timely paper raises the profile of unmet supportive care needs in an underserved research cancer population. Suggestions are proposed to improve the quality of nursing care through standardized practices and the development and integration of patient pathways. Evidence of the effect of NMIBC on family members or carers is absent from the literature. Future research implications and directions are proposed.
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107
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Bacillus Calmette Guerin (BCG) Balanitis: a Rare Organ Complication of Non-muscle Invasive Urinary Bladder Cancer Following Intravesical Immunotherapy. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02684-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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108
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Ruan Q, Ding D, Wang B, He C, Ren X, Feng Z, Pang Z, Wang J, Zhang X, Tang H, Wang J, He Q, Lei Z, Liao Q, Luo J, Cui S. A multi-institutional retrospective study of hyperthermic plus intravesical chemotherapy versus intravesical chemotherapy treatment alone in intermediate and high risk nonmuscle-invasive bladder cancer. Cancer Biol Med 2021; 18:308-317. [PMID: 33628603 PMCID: PMC7877165 DOI: 10.20892/j.issn.2095-3941.2020.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/10/2020] [Indexed: 11/11/2022] Open
Abstract
Objective: To compare the efficacy and safety of hyperthermic intravesical chemotherapy (HIVEC) and intravesical chemotherapy (IVEC) in patients with intermediate and high risk nonmuscle-invasive bladder cancer (NMIBC) after transurethral resection. Methods: We included 560 patients diagnosed with primary or recurrent NMIBC between April 2009 and December 2015 at 1 of 6 tertiary centers. We matched 364 intermediate or high risk cases and divided them into 2 groups: the HIVEC+IVEC group [chemohyperthermia (CHT) composed of 3 consecutive sessions followed by intravesical instillation without hyperthermia] and the IVEC group (intravesical instillation without hyperthermia). The data were recorded in the database. The primary endpoint was 2-year recurrence-free survival (RFS) in all NMIBC patients (n = 364), whereas the secondary endpoints were the assessment of radical cystectomy (RC) and 5-year overall survival (OS). Results: There was a significant difference in the 2-year RFS between the two groups in all patients (n = 364; HIVEC+IVEC: 82.42% vs. IVEC: 74.18%, P = 0.038). Compared with the IVEC group, the HIVEC+IVEC group had a lower incidence of RC (P = 0.0274). However, the 5-year OS was the same between the 2 groups (P = 0.1434). Adverse events (AEs) occurred in 32.7% of all patients, but none of the events was serious (grades 3–4). No difference in the incidence or severity of AEs between each treatment modality was observed. Conclusions: This retrospective study showed that HIVEC+IVEC had a higher 2-year RFS and a lower incidence of RC than IVEC therapy in intermediate and high risk NMIBC patients. Both treatments were well-tolerated in a similar manner.
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Affiliation(s)
- Qiang Ruan
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China.,The First Affiliated Hospital of Jinan University, the First Clinical Medical College of Jinan University, Guangzhou 510630, China
| | - Degang Ding
- Department of Urinary Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Bin Wang
- Department of Urinary Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Chaohong He
- Department of Urinary Surgery, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Xuequn Ren
- Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng 475000, China
| | - Zhenhua Feng
- Department of Urinary Surgery, Gaozhou People's Hospital, Maoming 525200, China
| | - Zhigang Pang
- Department of General Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Jin Wang
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Xiangliang Zhang
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Hongsheng Tang
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Jiahong Wang
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Qingjun He
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Ziying Lei
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Quanxing Liao
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Jiali Luo
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Shuzhong Cui
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
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109
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Marcq G, Kassouf W. Adjuvant Intravesical Therapy: Bacillus Calmette-Guerin. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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110
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Rossi SM, Murray T, McDonough L, Kelly H. Loco-regional drug delivery in oncology: current clinical applications and future translational opportunities. Expert Opin Drug Deliv 2020; 18:607-623. [PMID: 33253052 DOI: 10.1080/17425247.2021.1856074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Drug-based treatment regimens for cancer are often associated with off-target toxic side effects and low penetration of the drug at the tumor site leading to patient morbidity and limited efficacy. Loco-regional drug delivery has the potential to increase efficacy while concomitantly reducing toxicity.Areas covered: Clinical applications using loco-regional delivery include intra-arterial drug delivery in retinoblastoma, direct intra-tumoral (IT) injection of ethanol for ablation in hepatocellular carcinoma (HCC) and the use of HIPEC in peritoneal carcinomas. In recent years, there has been a significant increase in both approved products and clinical trials, with a particular emphasis on drug delivery platforms such as drug-eluting beads for HCC and hydrogel platforms for intravesical delivery in bladder cancer.Expert opinion: Development of loco-regional drug-delivery systems has been slow, limited by weak clinical data for early applications and challenges relating to dosing, delivery and retention of drugs at the site of action. However, there is increasing focus on the potential of loco-regional drug delivery when combined with bespoke drug-delivery platforms. With the growth in immunotherapies, the use of IT delivery to drive priming of the anti-tumor response has opened up a new field of opportunity for loco-regional drug delivery.
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Affiliation(s)
- Seona M Rossi
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Timothy Murray
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Liam McDonough
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Helena Kelly
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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111
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Koguchi D, Matsumoto K, Hirayama T, Moroo S, Kobayashi M, Katsumata H, Ikeda M, Iwamura M. Impact of maintenance therapy using a half dose of the bacillus Calmette-Guérin Tokyo strain on recurrence of intermediate and high-risk nonmuscle invasive bladder cancer: a retrospective single-center study. BMC Urol 2020; 20:194. [PMID: 33298034 PMCID: PMC7726881 DOI: 10.1186/s12894-020-00766-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Data are scarce regarding intravesical maintenance therapy (MT) with the low-dose bacillus Calmette–Guérin (BCG) Tokyo strain. We investigated the efficacy and safety of MT with a half dose of the Tokyo strain for patients following transurethral resection of nonmuscle invasive bladder cancer (NMIBC). Methods This study retrospectively reviewed clinical data on 78 patients diagnosed with intermediate or high-risk NMIBC followed by either MT (n = 38) or IT alone (n = 40) between January 2012 and March 2018. Statistical analysis was performed to compare recurrence-free survival (RFS) and adverse effects between the two groups. BCG was instilled once weekly for 6 weeks as IT, then once weekly in 2-week for a total of 20 instillations over 3 years. Results Kaplan–Meier analyses showed that patients undergoing MT had significantly better RFS than did those undergoing IT alone (hazard ratio (HR):0.32, 95% confidence interval (CI):0.12–0.89, P = 0.02). The 3-year RFS was 65.0% in the IT group and 89.5% in the MT group. Multivariate analysis showed that MT was associated with a reduced risk of recurrence (HR: 0.32, 95% CI:0.11–0.93, P = 0.03). One MT patient (2.6%) exhibited progression. Conclusions The BCG Tokyo strain showed acceptable efficacy and safety in patients undergoing MT; thus, it is a potential treatment for preventing bladder cancer recurrence.
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Affiliation(s)
- Dai Koguchi
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Takahiro Hirayama
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Shigetaka Moroo
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Momoko Kobayashi
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hiroki Katsumata
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masaomi Ikeda
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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Sharma V, Thakur APS, Ramasamy V, Shukla PK, Solanki FS, Choudhary A, Patel P. Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00099-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
Urothelial bladder carcinoma accounts for around 3.9% cases of all the male cancers in India. Non-muscle-invasive bladder carcinoma (NMIBC) is predominant group which constitute approximately three fourth of the urothelial bladder cancer. Intravesical BCG immunotherapy is the corner stone of today’s NMIBC management. However, as with any other therapy it has its own complications and its interruption due to these adverse effects is a major cause of suboptimal efficacy. The aim of this study was to assess the complications of intravesical BCG therapy and their management in NMIBC patients.
Methods
This was a retrospective descriptive study conducted between October 2016 and November 2019; a backward review of 149 patients with diagnosis of NMIBC that undergone intravesicle BCG therapy was performed. Patient’s demographical, clinical, diagnostic and procedural data regarding bladder tumour, BCG therapy, its complications and management were collected and analysed.
Results
Total 149 patients were analysed, comprising 116 males and 33 females. The mean age was of 57.2 ± 6.7 years. Total 85.23% were primary and 14.76% were recurrent tumours. Total 96 patients (64.42%) completed the planned course, while 53 (35.57%) interrupted. The reasons for BCG interruption includes adverse effects (15.4%), progression of disease (6.7%), disease refractory to BCG (4.6%) and disease recurrence during BCG (3.3%). Most of the adverse events occurred in first 6 months and most interruptions occurred after the induction period. Cystitis was the most common observed adverse effect seen in 39.6% patients. Frequency, urgency, haematuria were common presentation. Radical cystectomy was the most common (16.10%) further treatment with patients whose treatment was interrupted.
Conclusion
BCG is an indispensable therapy available for NMIBC, but it is associated with array of adverse effects and complications, which are the main reasons for poor compliance to BCG therapy. Although BCG-related complications can affect any organ in the body, potentially life-threatening systemic BCG-related infections are encountered in only < 5% of patients. There are some difficulties in diagnosis of the BCG complications because acid-fast staining, culture and PCR test are not always positive; tissue biopsies should be indicated sometimes to evaluate histopathology and presence of M. bovis. A persistently monitored multidisciplinary approach with high index of suspicion and prompt anti-TB therapy can help to derive the maximum benefits while keeping the complications at check.
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Lupon E, Martin-Blondel G, Pollon T, Berthier C, Lellouch A, Mansat P. BCGitis of the wrist after intravesical BCG therapy: A case report. HAND SURGERY & REHABILITATION 2020; 39:585-587. [DOI: 10.1016/j.hansur.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/04/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
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Lee LJ, Kwon CS, Forsythe A, Mamolo CM, Masters ET, Jacobs IA. Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:693-709. [PMID: 33262624 PMCID: PMC7695604 DOI: 10.2147/ceor.s274951] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/29/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Non-muscle invasive bladder cancer (NMIBC) is a malignancy restricted to the inner lining of the bladder. Intravesical Bacillus Calmette-Guerin (BCG) following transurethral resection of the bladder tumor is the mainstay first-line treatment for high-risk NMIBC patients. Two systematic literature reviews (SLRs) were conducted to further assess the current evidence on BCG use in NMIBC and the humanistic and economic burden of disease. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Embase® and MEDLINE® were searched using the Ovid platform to identify interventional or real-world evidence studies on the health-related quality of life (HRQoL) and economic burden in NMIBC. Limited evidence was found from initial economic SLR searches in NMIBC, so additional targeted searches for bladder cancer were conducted to expand findings. RESULTS Fifty-nine publications were included in the HRQoL SLR, of which 23 reported HRQoL and symptoms in NMIBC. At diagnosis, HRQoL was comparable with population norms but worsened considerably 2 years following diagnosis. Maintenance therapy with intravesical BCG was associated with reduced HRQoL, and treatment-related adverse events (AEs) resembled typical NMIBC symptoms. Twenty-two studies reported decreasing BCG compliance over time. Common AEs with BCG were frequent urination, lower urinary tract symptoms, pain, and hematuria. Forty-two publications were included in the economic SLR, of which nine assessed healthcare costs and resource use in NMIBC or bladder cancer. High-risk disease and high-intensity treatment were associated with increased healthcare costs. CONCLUSION NMIBC has a considerable symptomatic, HRQoL, and economic burden. Symptoms persisted and HRQoL worsened despite intravesical BCG treatment. NMIBC is a costly disease, with higher healthcare costs associated with increased risk of disease progression and recurrence. There is a high unmet need for safe and effective treatments that reduce the risk of disease progression and recurrence, provide symptomatic relief, and improve HRQoL for patients.
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Affiliation(s)
- Lauren J Lee
- Patient Health and Impact, Pfizer Inc, New York, NY, USA
| | - Christina S Kwon
- Evidence Generation, Purple Squirrel Economics, New York, NY, USA
| | - Anna Forsythe
- Evidence Generation, Purple Squirrel Economics, New York, NY, USA
| | | | | | - Ira A Jacobs
- Worldwide Research and Development, Pfizer Inc, New York, NY, USA
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Huang B, Huang G, Li W, Chen L, Mao X, Chen J. Intra-arterial chemotherapy combined with intravesical chemotherapy compared with intravesical BCG immunotherapy retrospectively in high-risk non-muscle-invasive bladder cancer after transurethral resection of the bladder tumor. J Cancer Res Clin Oncol 2020; 147:1781-1788. [PMID: 33222014 DOI: 10.1007/s00432-020-03453-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/04/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of intra-arterial chemotherapy (IAC) combined with intravesical chemotherapy (IVC) against intravesical BCG immunotherapy in high-risk non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of the bladder tumor (TURBT). MATERIALS AND METHODS 130 patients with high-risk NMIBC who had underwent TURBT were divided into two groups, of which IAC + IVC group received four courses of IAC (cisplatin and epirubicin) combined with IVC (epirubicin or pirarubicin) after surgery and BCG group received intravesical BCG immunotherapy. Recurrence rate and progression rate were assessed by Chi-square test, while recurrence-free survival and progression-free survival were calculated using the Kaplan-Meier method. RESULTS In this study, the recurrence rate was 27.9% (12/43) in IAC + IVC group and 26.4% (14/53) in BCG group, while progression rate was 9.3% (4/43) in IAC + IVC group and 9.4% (5/53) in BCG group. Both of the recurrence and progression rate did not show a significant difference. In the Kaplan-Meier plot, no difference was found with respect to recurrence-free survival and progression-free survival. Moreover, 46.5% (20/43) patients suffered from adverse events of IAC and 83.1% (49/59) patients suffered from adverse events associated with BCG, of which 6 patients discontinued treatment due to serious adverse events of BCG. Univariate analysis suggested that only recurrent tumor could be an independent risk factor related to recurrence. CONCLUSIONS IAC combined with IVC used in high-risk NMIBC could reduce the recurrence and progression as effective as BCG instillation with lower adverse events.
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Affiliation(s)
- Bin Huang
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China
| | - Gaowei Huang
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China
| | - Wenji Li
- Surgical Anesthesia Center, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China
| | - Lingwu Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.
| | - Xiaopeng Mao
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.
| | - Junxing Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.
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Abstract
IMPORTANCE Bladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality. OBSERVATIONS Advanced age, male sex, and cigarette smoking contribute to the development of bladder cancer. Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy. Non-muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification. Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence. Patients with high-risk non-muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage and many alternative therapies are being studied. For patients with muscle-invasive disease, more aggressive therapy with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation is warranted to curb the risk of metastasis and disease-specific mortality. Treatment of patients with advanced disease is undergoing rapid changes as immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease. CONCLUSIONS AND RELEVANCE Improved understanding of the molecular biology and genetics of bladder cancer has evolved the way localized and advanced disease is diagnosed and treated. While intravesical BCG has remained the mainstay of therapy for intermediate and high-risk non-muscle-invasive bladder cancer, the therapeutic options for muscle-invasive and advanced disease has expanded to include immunotherapy with checkpoint inhibition, targeted therapies, and antibody-drug conjugates.
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Affiliation(s)
- Andrew T Lenis
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | - Patrick M Lec
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | | | - M D Mshs
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
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Koch GE, Smelser WW, Chang SS. Side Effects of Intravesical BCG and Chemotherapy for Bladder Cancer: What They Are and How to Manage Them. Urology 2020; 149:11-20. [PMID: 33181123 DOI: 10.1016/j.urology.2020.10.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
Intravesical therapy for nonmuscle invasive bladder cancer decreases recurrence and progression but carries a high risk of side effects, which limit patient adherence. Appropriate management of the toxicities from intravesical therapy requires consideration of the agent used, the side effects experienced, and the timing of those side effects. Management strategies for intravesical toxicities ideally improve patient tolerance without sacrificing oncologic outcomes. This review aims to provide a comprehensive overview of the available evidence regarding the side effects of intravesical therapies for nonmuscle invasive bladder cancer and to propose practical strategies for toxicity management.
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Affiliation(s)
- George E Koch
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Woodson W Smelser
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
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Schmitz L, Berdien B, Huland E, Dase P, Beutel K, Fisch M, Engel O. The Impact of a New Interleukin-2-Based Immunotherapy Candidate on Urothelial Cells to Support Use for Intravesical Drug Delivery. Life (Basel) 2020; 10:life10100231. [PMID: 33027905 PMCID: PMC7601792 DOI: 10.3390/life10100231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/19/2020] [Accepted: 10/02/2020] [Indexed: 12/01/2022] Open
Abstract
(1) Background: The intravesical instillation of interleukin-2 (IL-2) has been shown to be very well tolerated and promising in patients with bladder malignancies. This study aims to confirm the use of a new IL-2 containing immunotherapy candidate as safe for intravesical application. IL-2, produced in mammalian cells, is glycosylated, because of its unique solubility and stability optimized for intravesical use. (2) Materials and Methods: Urothelial cells and fibroblasts were generated out of porcine bladder and cultured until they reached second passage. Afterwards, they were cultivated in renal epithelial medium (REM) and Dulbecco’s modified Eagles medium (DMEM) with the IL-2 candidate (IMS-Research) and three more types of human interleukin-2 immunotherapy products (IMS-Pure, Natural IL-2, Aldesleukin) in four different concentrations (100, 250, 500, 1000 IU/mL). Cell proliferation was analyzed by water soluble tetrazolium (WST) proliferation assay after 0, 3, and 6 days for single cell culture and co-culture. (3) Results: Proliferation assays showed that all IL-2 products induced very similar cultivation results and none of the IL-2 variants had a negative impact on the proliferation of urothelial cells and fibroblast in either concentration. (4) Conclusion: Human recombinant glycosylated IL-2 as well as human non-glycosylated IL-2 have no negative influence on the tissue cell proliferation of porcine urothelial cells and fibroblasts in vitro and represent a promising and innovative potential intravesical therapy candidate for patients in high need.
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Affiliation(s)
- Lisa Schmitz
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
- Correspondence:
| | | | - Edith Huland
- Immunservice GmbH, 20251 Hamburg, Germany; (B.B.); (E.H.)
| | - Petra Dase
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
| | - Karin Beutel
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
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Mohamed MB, Ali MH, Shamaa MA, Shaaban SM. Single course of intravesical Bacillus Calmette-Guerin versus single course with maintenance therapy in the management of nonmuscle invasive bladder cancer: A prospective randomized study. Urol Ann 2020; 12:360-365. [PMID: 33776333 PMCID: PMC7992517 DOI: 10.4103/ua.ua_137_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/26/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: The objective of the study was to compare maintenance versus single course of intravesical Bacillus Calmette–Guerin (BCG) in the management of high-risk nonmuscle invasive bladder cancer (NMIBC) regarding recurrence, progression, survival, and complications. Patients and Methods: After transurethral resection of bladder tumor (TURBT), Group I patients (33) received weekly doses of 90 mg of live attenuated Pasteur strain of BCG. The course was started 14 days after the second TURBT for 6 consecutive weeks. In Group II: 35 patients, the induction schedule was followed by 3 weekly instillations at months 3, 6, and 12 as a maintenance course. Recurrence, progression rates, survival, and toxicity were assessed in both the groups. Results: Patients with induction therapy alone had significantly higher recurrence rate than those received maintenance therapy (55.6% vs. 19.2%, P = 0.01). The 5-year recurrence-free survival rate was 41% and 78% in both the groups, respectively. There was no significant difference regarding the progression rate for both the groups. The mean 5-year progression-free time was comparable between the two groups. The 5-year progression-free survival was 69.8% for patients who underwent induction therapy alone compared to 70.7% for maintenance therapy. Overall local adverse events were significantly higher in patients who underwent maintenance treatment protocol. Statistical Analysis Used: SPSS package version 20 and Kaplan–Meier curves were used to evaluate the survival rate. Conclusions: Maintenance doses of BCG significantly decrease and delay the recurrence of high-risk NMIBC. However, there is no significant favor as regards tumor progression. Maintenance doses of BCG are significantly associated with a higher incidence of local adverse effects than induction doses alone.
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Affiliation(s)
- Mohamed Bakr Mohamed
- Department of Urology, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Mohamed Hassan Ali
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mostafa A Shamaa
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sami M Shaaban
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Bai L, Li W, Zheng W, Xu D, Chen N, Cui J. Promising targets based on pattern recognition receptors for cancer immunotherapy. Pharmacol Res 2020; 159:105017. [DOI: 10.1016/j.phrs.2020.105017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023]
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121
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Semeniuk-Wojtaś A, Lubas A, Cierniak S, Brzóskowska U, Syryło T, Zieliński H, Stec R. Selected protein expression in a new prognostic model for patients with non-muscle-invasive bladder cancer. J Cancer Res Clin Oncol 2020; 146:2099-2108. [PMID: 32239282 PMCID: PMC7324417 DOI: 10.1007/s00432-020-03202-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION After transurethral resection of a bladder tumor, patients frequently have a recurrence of the disease, thereby requiring adjuvant therapy. PURPOSE The study aimed to determine the prognostic value of expression levels of p53, Ki-67, and survivin, and to develop a new prognostic model for patients with non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of a bladder tumor. METHODS The study group consisted of 101 patients with primary NMIBC. Univariate followed by multivariate Cox proportional hazard regression analysis was performed to obtain a model including the smallest possible number of descriptive variables with the highest statistical significance and impact on risk. RESULTS The RECINT model (RECurrence In Not Treated) including factors independently associated with cancer recurrence (tumor size [HR 1.148; p = 0.034], intensity of the color reaction for p53 [HR 1.716; p = 0.008], Ki-67 [HR 3.001; p = 0.022], and survivin [HR 1.461; p = 0.021]) adequately stratified recurrence free-survival (R2 = 0.341, p < 0.001) in patients with primary NMIBC. Patients with the lowest RECINT score (0-6) had the lowest probability of cancer recurrence (1- and 5-year recurrence of 16%) in comparison with other groups (p < 0.001). CONCLUSIONS The RECINT model may be useful for stratifying the risk of recurrence in patients with non-muscle-invasive bladder cancer and may allow for identification of those who may benefit the most from adjuvant BCG immunotherapy.
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Affiliation(s)
| | - Arkadiusz Lubas
- Internal Diseases, Nephrology and Dialysis Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Szczepan Cierniak
- Patomorphology Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Urszula Brzóskowska
- Patomorphology Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Tomasz Syryło
- General, Functional and Oncological Urology Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Henryk Zieliński
- General, Functional and Oncological Urology Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Rafał Stec
- Oncology Department, Medical University of Warsaw, 19/25 Stępińska St., 00-739, Warsaw, Poland
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Sturgess G, Gill J. Urethral catheter trapped in the ureter removed using holmium laser: An unusual case and review of the literature. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820942713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Inadvertent placement of a urethral catheter into the ureter is a rare but documented complication of catheterisation. Management becomes more challenging when the catheter cannot be removed using conservative techniques. We present the case of an 85-year-old male with a history of bladder cancer treated with intravesical Bacillus Calmette–Guérin (BCG) therapy who was found to have a urethral catheter stuck in his left ureter on computerized tomography scan after a routine catheter change. The catheter balloon was punctured using ureteroscopy and Holmium laser. Our literature review identified five other cases where a misguided urethral catheter required surgical intervention for removal from the ureter and the different techniques used are discussed. Risk factors appear to be pregnancy and structural changes to the bladder resulting in widened ureteric orifices including BCG therapy. We suggest that laser puncture of an inflated catheter balloon is a safe and effective method for facilitating removal. Level of evidence: 4
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Affiliation(s)
- George Sturgess
- Department of Urology, Harrogate and District NHS Foundation Trust, UK
| | - Jonathan Gill
- Department of Urology, Harrogate and District NHS Foundation Trust, UK
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Bajramovic S, Alic J, Skopljak E, Chikha A, Vesnic S, Smajilbegovic V, Aganovic D. Renal Tuberculosis Following Intravesical Bacillus Calmette-Guérin (BCG) Immunotherapy for the Treatment of Bladder Cancer. Med Arch 2020; 74:146-150. [PMID: 32577059 PMCID: PMC7296402 DOI: 10.5455/medarh.2020.74.146-150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Non-muscle-invasive bladder cancer (NMIBC) is usually effectively treated with transurethral resection (TUR), most often followed by intravesical instillation of bacillus Calmette-Guérin (BCG) or intravesical chemotherapy. Although the precise mechanism of BCG immunotherapy is still unclear, a local immune response is presumed. However, a number of severe side effects and complications are related to intravesical immunotherapy. AIM: Aim of this report is to present rare case of the renal granulomatous disease in a patient previously treated with intravesical instillation of BCG immunotherapy, following TURBT. In addition, we performed review of previously reported cases of renal granulomas following intravesical BCG immunotherapy. Case report: A 79-year-old man was presented to Urology Clinic due to clinically verified tumor of the urinary bladder. After transurethral resection of bladder tumor, histopathological analysis revealed the diagnosis of papillary urothelial high-grade pT1 carcinoma. Intravesical BCG immunotherapy was initiated, according to protocol currently used in our institution. Upon completion of therapy with BCG, we re-examined the patient and, using ultrasound, found a change in the right kidney, resembling moth bites not seen on CT scan before TURBT. Additionally, CT-guided core-needle biopsy of the affected kidney was performed, and the specimen was sent for histopathological analysis, which revealed chronic necrotizing granulomatous inflammation. Antituberculotic therapy was initiated for 6 months. Upon completion of antituberculotic therapy, control CT-scan was performed at follow-up, indicating regression of changes on the right kidney. Conclusion: This case report emphasizes the importance of consistent implementation of follow-up protocol and the identification of lesions during the asymptomatic period and enables the proper treatment of the disease. To reduce the incidence of adverse effects of BCG treatment for bladder tumors, an individualized approach is needed.
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Affiliation(s)
- Senad Bajramovic
- Urology Clinic, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Medical Faculty, University Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Jasmin Alic
- Urology Clinic, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edna Skopljak
- Medical Faculty, University Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Adisa Chikha
- Institute of Pathology, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sanela Vesnic
- Insitute of Radiology, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Velda Smajilbegovic
- Oncology Clinic, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Damir Aganovic
- Urology Clinic, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Oladiran O, Nwosu I, Oladunjoye A, Oladunjoye O. Disseminated BCG sepsis following intravesical therapy for Bladder Carcinoma: A case report and review of literature. J Community Hosp Intern Med Perspect 2020; 10:168-170. [PMID: 32850058 PMCID: PMC7425612 DOI: 10.1080/20009666.2020.1742475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/27/2020] [Indexed: 01/24/2023] Open
Abstract
Intravesical instillation of Bacillus-Calmette-Guerin (BCG), a live-attenuated-strain of Mycobacterium bovis, is an established treatment for superficial bladder carcinoma. Although generally well tolerated, 1/15,000 patients can develop life-threatening disseminated-BCG-infection typically soon after the procedure, a condition colloquially termed BCG-osis. Side-effects of intravesical BCG instillation including fever, chills, fatigue are common but BCG-osis is rare and severe, oftentimes requiring intensive care unit admission and triple anti-TB-therapy as in this case. It is therefore important for clinicians to recognize this possibility as the absence of specific signs and symptoms, coupled with the fastidious nature of the Mycobacteria, pose a diagnostic dilemma in the acute setting. Our case highlights this potential rare iatrogenic side effect of intravesical BCG treatment and the risk associated with non-treatment of BCG-osis.
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Affiliation(s)
- Oreoluwa Oladiran
- Department of Internal Medicine, Reading Hospital, Tower Health System, Reading, PA, USA
| | - Ifeanyi Nwosu
- Department of Internal Medicine, Leighton Hospital NHS Trust, Crewe, UK
| | - Adeolu Oladunjoye
- Division of Medical Critical Care, Boston Children’s Hospital, Boston, MA, USA
| | - Olubunmi Oladunjoye
- Department of Internal Medicine, Reading Hospital, Tower Health System, Reading, PA, USA
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Waked R, Choucair J, Chehata N, Haddad E, Saliba G. Intravesical Bacillus Calmette-Guérin (BCG) treatment's severe complications: A single institution review of incidence, presentation and treatment outcome. J Clin Tuberc Other Mycobact Dis 2020; 19:100149. [PMID: 32099909 PMCID: PMC7016447 DOI: 10.1016/j.jctube.2020.100149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Intravesical Bacillus Calmette-Guérin (BCG) treatment for superficial bladder cancer is interrupted in approximatively 8% of cases as a result of complications. The objective is to report the severe related complications of Bacillus Calmette-Guérin (BCG) following an intravesical instillation for bladder tumor encountered at our institution for the past 5 years. METHODS Medical records of a tertiary teaching hospital, located in Beirut, Lebanon, were retrospectively analyzed from June 2014 to June 2019 searching for severe related complications of BCG. A comprehensive review of articles on this subject was conducted. RESULTS The incidence of severe systemic adverse events related to BCG instillation was 1.5% (5 out of 332 patients). A total of five patients were found to have a severe BCG related complication, with fever, chills, and irritative urinary signs being the most frequent symptoms. All patients received antituberculosis therapy (Isoniazid, Rifampin and Ethambutol). Two were put on add-on corticosteroids. Three patients had a computed tomography scan image in favor of an infection. Two patients had a favorable outcome, three patients died. CONCLUSION BCG severe adverse events were mostly seen in patients with a traumatic instillation. Treatment used at our institution was similar to most cases reported in the literature. A standardized diagnostic and treatment approach should be implemented to help physicians tackle these life-threatening complications.
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Affiliation(s)
- R. Waked
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
| | - J. Choucair
- Coordinator of the Infectious Diseases department, Saint Joseph University, Beirut, Lebanon
| | - N. Chehata
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
| | - E. Haddad
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
| | - G. Saliba
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
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126
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Krajewski W, Poletajew S, Zdrojowy R, Kołodziej A. Complications after BCG immunotherapy - neither a mountain nor a molehill. Scand J Urol 2020; 53:265-266. [PMID: 32053047 DOI: 10.1080/21681805.2019.1617775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Sławomir Poletajew
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołodziej
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
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127
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Guallar-Garrido S, Julián E. Bacillus Calmette-Guérin (BCG) Therapy for Bladder Cancer: An Update. Immunotargets Ther 2020; 9:1-11. [PMID: 32104666 PMCID: PMC7025668 DOI: 10.2147/itt.s202006] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/28/2020] [Indexed: 01/02/2023] Open
Abstract
Physicians treating patients affected by nonmuscle-invasive bladder cancer (NMIBC) have been in shock during the last six years since manufacturing restrictions on the production of the first-option medicine, Mycobacterium bovis Bacillus Calmette-Guérin (BCG), have resulted in worldwide shortages. This shortage of BCG has led to a rethinking of the established treatment guidelines for the rationing of the administration of BCG. Some possible schedule modifications consist of a decrease in the length of maintenance treatment, a reduction in the dose of BCG in intravesical instillations or the use of different BCG substrains. All these strategies have been considered valuable in times of BCG shortage. In addition, the lack of availability of BCG has also led to the general recognition of the need to find new treatment options for these patients so that they are not dependent on a single treatment. Few alternatives are committed to definitively replacing BCG intravesical instillations, but several options are being evaluated to improve its efficacy or to combine it with other chemotherapeutic or immunotherapeutic options that can also improve its effect. In this article, we review the current state of the treatment with BCG in terms of all of the aforementioned aspects.
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Affiliation(s)
- Sandra Guallar-Garrido
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
| | - Esther Julián
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
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128
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Larsen ES, Joensen UN, Poulsen AM, Goletti D, Johansen IS. Bacillus Calmette-Guérin immunotherapy for bladder cancer: a review of immunological aspects, clinical effects and BCG infections. APMIS 2020; 128:92-103. [PMID: 31755155 DOI: 10.1111/apm.13011] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/10/2019] [Indexed: 12/29/2022]
Abstract
Bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer has been used since 1976 when the first evidence of its ability to lower recurrence and progression rates was published. Today, BCG immunotherapy is the choice of care for high-grade non-muscle invasive bladder cancer (NMIBC) after transurethral resection. This article presents indications and procedure of BCG instillations, and outlines the effects on recurrence and progression of NMIBC. The BCG-induced immunity in NMIBC is not yet fully understood. Animal studies point towards BCG inducing specific tumour immunity. We describe the current knowledge of how this immunity is induced, from internalization of BCG bacilli in urothelial cells, to cytokine- and chemokine-mediated recruitment of neutrophils, monocytes, macrophages, T cells, B cells and natural killer cells. In addition, we describe the process of trained immunity, the non-specific protective effects of BCG. Recent studies also indicate that dysbiosis of the urinary microbiome may cause lower urinary tract dysfunction. Side effects of BCG bladder instillations range from common, mild and transient symptoms, such as dysuria and flu-like symptoms, to more severe and rarely occurring life-threatening complications. We review the literature and give an overview of reported incidences and management of BCG infections after intravesical instillation.
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Affiliation(s)
| | - Ulla Nordström Joensen
- Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alicia Martin Poulsen
- Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases IRCCS L. Spallanzani, Rome, Italy
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, Denmark
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129
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Narita K, Akita H, Kikuchi E, Nakahara T, Okuda S, Nakatsuka S, Oya M, Jinzaki M. Biopsy-diagnosed renal granuloma after intravesical bacillus Calmette-Guérin therapy for bladder carcinoma: a case series and review of the literature. BJR Case Rep 2020; 5. [PMID: 31938553 PMCID: PMC6945262 DOI: 10.1259/bjrcr.20190012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 12/02/2022] Open
Abstract
Renal granuloma is a rare complication affecting the kidneys after intravesical bacillus Calmette-Guérin (BCG) therapy for bladder carcinoma. Our case series review describes the imaging and histopathological findings of BCG-induced renal granulomas. All three renal granulomas, which were located in the upper pole, had a solitary mass-like appearance. The mean diameter was 31.3 mm. In the two cases, the lesion was homogeneously enhanced on post-contrast CT, and presented homogeneous low signal intensity on T2 weighted imaging (T2WI) and iso-signal intensity on diffusion-weighted imaging (DWI). Both lesions had increased fludeoxyglucose (FDG) uptake. Histological examinations revealed granulomatous inflammation with fibrosis. The third case showed a lesion having heterogeneous enhancement on CT, heterogeneous and slightly high signal intensity on T2WI, and high signal intensity on DWI. This case showed more severe inflammatory cell infiltration and less fibrosis than the former two cases did. It was suggested that the signal intensity on T2WI and DWI depends on the degree of inflammation and fibrosis in renal granuloma. It is currently challenging to distinguish renal granuloma from renal malignancy based on only imaging findings. Biopsies were helpful in confirming the diagnosis and avoiding unnecessary resection. Renal granuloma should be considered as a differential diagnosis when a renal mass is found in a patient with a history of intravesical BCG treatment.
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Affiliation(s)
- Keiichi Narita
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hirotaka Akita
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Seishi Nakatsuka
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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130
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Matsuoka Y, Taoka R, Xia Z, Sugimoto M, Kakehi Y. Hyperthermic therapy using warm sterile water enhances cytocidal effects on bladder cancer cells. Scand J Urol 2020; 54:65-69. [PMID: 31928301 DOI: 10.1080/21681805.2019.1708967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: To investigate whether warm sterile water enhances the cytocidal effect of hypotonic shock on bladder cancer cells that show resistance to sterile water.Methods: Four bladder cancer cell lines of varying grades (T24, RT4, J82, and RT112) were exposed to sterile water, and morphological changes were closely observed under microscopy. Changes in cell membrane integrity and cell viability after water exposure were measured to determine the effects of water-induced hypotonic shock. Additionally, the effects of warm sterile water were analyzed.Results: T24, RT4, and J82 cells started swelling immediately upon exposure to water, followed by rupture within five minutes. RT112 cells demonstrated limited hypotonic swelling with significantly less cell rupture after 10 min. The percentages of viable cells at 10 min were 1.6 ± 0.8%, 3.5 ± 3.5%, 5.0 ± 3.2%, and 22.0 ± 10.3% for T24, RT4, J82, and RT112, respectively. The percentage of viable cells with 48 °C sterile water at one minute was 0% for RT112 cells.Conclusions: These findings support the efficacy of sterile water against bladder cancer cells and reveal that warm sterile water enhances the cytocidal effects of hypotonic shock, potentially avoiding the need for radical surgery.
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Affiliation(s)
- Yuki Matsuoka
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
| | - Rikiya Taoka
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
| | - Zhang Xia
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
| | - Mikio Sugimoto
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
| | - Yoshiyuki Kakehi
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
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131
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Marques M, Vazquez D, Sousa S, Mesquita G, Duarte M, Ferreira R. Disseminated Bacillus Calmette-Guérin (BCG) infection with pulmonary and renal involvement: A rare complication of BCG immunotherapy. A case report and narrative review. Pulmonology 2019; 26:346-352. [PMID: 31711964 DOI: 10.1016/j.pulmoe.2019.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 11/29/2022] Open
Abstract
Intravesical Bacillus Calmette-Guérin (BCG) instillation is a mainstay of adjunctive therapy for superficial bladder cancer that increases length of disease progression-free survival. Although usually well tolerated, moderate to severe local and systemic infectious complications can occur with this immunotherapy. Diagnosis is difficult and often based on high clinical suspicion since in many cases Mycobacterium bovis is not isolated. Treatment is not fully standardized but the combination of anti-tuberculosis drugs and corticosteroids is advocated in severe cases. The authors present an unusual case of a severe infectious complication following intravesical BCG instillation with pulmonary and kidney involvement. Prompt anti-tuberculosis treatment associated to corticosteroid resulted in a marked clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection. Based on this, the authors aimed to review the literature on this exceptional complication of this immunotherapy.
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Affiliation(s)
- Marta Marques
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal.
| | - Dolores Vazquez
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
| | - Susana Sousa
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
| | - Gonçalo Mesquita
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
| | - Maria Duarte
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
| | - Rosa Ferreira
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
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132
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Hobbs C, Bass E, Crew J, Mostafid H. Intravesical BCG: where do we stand? Past, present and future. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818817120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
High and intermediate risk non-muscle invasive bladder cancer poses a real challenge for treatment. Approximately 70% of bladder cancer presents as non-muscle invasive and 20–25% will progress to muscle invasive disease. Recurrences occur in up to 70% but treatment options are limited. Intravesical bacillus Calmette–Guérin is still considered the bladder sparing treatment of choice despite its well documented pitfalls. This review considers how bacillus Calmette–Guérin has become the recommended treatment, its benefits and risks and the alternative options for treatment. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - Edward Bass
- Department of Urology, Royal Surrey County NHS Foundation Trust, UK
| | - Jeremy Crew
- Department of Urology, Churchill Hospital, UK
| | - Hugh Mostafid
- Department of Urology, Royal Surrey County NHS Foundation Trust, UK
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133
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Braunstein MJ, Kucharczyk J, Adams S. Targeting Toll-Like Receptors for Cancer Therapy. Target Oncol 2019; 13:583-598. [PMID: 30229471 DOI: 10.1007/s11523-018-0589-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The immune system encompasses a broad array of defense mechanisms against foreign threats, including invading pathogens and transformed neoplastic cells. Toll-like receptors (TLRs) are critically involved in innate immunity, serving as pattern recognition receptors whose stimulation leads to additional innate and adaptive immune responses. Malignant cells exploit the natural immunomodulatory functions of TLRs, expressed mainly by infiltrating immune cells but also aberrantly by tumor cells, to foster their survival, invasion, and evasion of anti-tumor immune responses. An extensive body of research has demonstrated context-specific roles for TLR activation in different malignancies, promoting disease progression in certain instances while limiting cancer growth in others. Despite these conflicting roles, TLR agonists have established therapeutic benefits as anti-cancer agents that activate immune cells in the tumor microenvironment and facilitate the expression of cytokines that allow for infiltration of anti-tumor lymphocytes and the suppression of oncogenic signaling pathways. This review focuses on the clinical application of TLR agonists for cancer treatment. We also highlight agents that are undergoing development in clinical trials, including investigations of TLR agonists in combination with other immunotherapies.
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Affiliation(s)
- Marc J Braunstein
- Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd. Suite 500, Mineola, 11501, NY, USA
| | - John Kucharczyk
- Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd. Suite 500, Mineola, 11501, NY, USA
| | - Sylvia Adams
- Department of Medicine, NYU Langone Medical Center, Laura and Isaac Perlmutter Cancer Center, 160 East 34th Street, 4th Floor, New York, 10016, NY, USA.
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134
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Abstract
BCG immunotherapy is the gold-standard treatment for non-muscle-invasive bladder cancer at high risk of recurrence or progression. Preclinical and clinical studies have revealed that a robust inflammatory response to BCG involves several steps: attachment of BCG; internalization of BCG into resident immune cells, normal cells, and tumour urothelial cells; BCG-mediated induction of innate immunity, which is orchestrated by a cellular and cytokine milieu; and BCG-mediated initiation of tumour-specific immunity. As an added layer of complexity, variation between clinical BCG strains might influence development of tumour immunity. However, more than 40 years after the first use of BCG for bladder cancer, many questions regarding its mechanism of action remain unanswered. Clearly, a better understanding of the mechanisms underlying BCG-mediated tumour immunity could lead to improved efficacy, increased tolerance of treatment, and identification of novel immune-based therapies. Indeed, enthusiasm for bladder cancer immunotherapy, and the possibility of combining BCG with other therapies, is increasing owing to the availability of targeted immunotherapies, including checkpoint inhibitors. Understanding of the mechanism of action of BCG immunotherapy has advanced greatly, but many questions remain, and further basic and clinical research efforts are needed to develop new treatment strategies for patients with bladder cancer.
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135
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Babjuk M, Burger M, Compérat EM, Gontero P, Mostafid AH, Palou J, van Rhijn BWG, Rouprêt M, Shariat SF, Sylvester R, Zigeuner R, Capoun O, Cohen D, Escrig JLD, Hernández V, Peyronnet B, Seisen T, Soukup V. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ) - 2019 Update. Eur Urol 2019; 76:639-657. [PMID: 31443960 DOI: 10.1016/j.eururo.2019.08.016] [Citation(s) in RCA: 836] [Impact Index Per Article: 167.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022]
Abstract
CONTEXT This overview presents the updated European Association of Urology (EAU) guidelines for non-muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ (CIS). OBJECTIVE To provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation and recommendations. EVIDENCE ACQUISITION A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines has been performed annually since the last published version in 2017. Databases covered by the search included Medline, EMBASE, and the Cochrane Libraries. Previous guidelines were updated, and the level of evidence and grade of recommendation were assigned. EVIDENCE SYNTHESIS Tumours staged as Ta, T1, and/or CIS are grouped under the heading of NMIBC. Diagnosis depends on cystoscopy and histological evaluation of the tissue obtained by transurethral resection (TURB) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TURB is essential for the patient's prognosis and correct diagnosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a T1 tumour is detected, a second TURB should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the European Organisation for Research and Treatment of Cancer (EORTC) scoring system. Stratification of patients into low-, intermediate-, and high-risk groups is pivotal to the recommendation of adjuvant treatment. In patients with tumours presumed to be at a low risk and in those presumed to be at an intermediate risk with a low previous recurrence rate and an expected EORTC recurrence score of <5, one immediate chemotherapy instillation is recommended. Patients with intermediate-risk tumours should receive 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at the highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-unresponsive tumours. The extended version of the guidelines is available at the EAU website: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/. CONCLUSIONS These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. PATIENT SUMMARY The European Association of Urology Non-muscle-invasive Bladder Cancer (NMIBC) Panel has released an updated version of their guidelines, which contains information on classification, risk factors, diagnosis, prognostic factors, and treatment of NMIBC. The recommendations are based on the current literature (until the end of 2018), with emphasis on high-level data from randomised clinical trials and meta-analyses. Stratification of patients into low-, intermediate-, and high-risk groups is essential for deciding appropriate use of adjuvant intravesical chemotherapy or bacillus Calmette-Guérin (BCG) instillations. Surgical removal of the bladder should be considered in case of BCG-unresponsive tumours or in NMIBCs with the highest risk of progression.
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Affiliation(s)
- Marko Babjuk
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria.
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Eva M Compérat
- Department of Pathology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UPMC Paris VI, Paris, France
| | - Paolo Gontero
- Division of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy
| | - A Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bas W G van Rhijn
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany; Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Morgan Rouprêt
- Urology Department, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Richard Sylvester
- European Association of Urology Guidelines Office, Brussels, Belgium
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Otakar Capoun
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Daniel Cohen
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | | | - Virginia Hernández
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Thomas Seisen
- Urology Department, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Viktor Soukup
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Riccardi N, Ferrarese M, Castellotti P, Mazzola E, Sozzi F, Rigatti P, Vanzulli A, Sotgiu G, Codecasa L. A rare case of multi-focal human TB after BCG instillation for non-muscle-invasive bladder cancer. Urologia 2019; 87:199-202. [PMID: 31271544 DOI: 10.1177/0391560319860396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe a left epididymitis and para-aortical involvement caused by Mycobacterium tuberculosis hominis reactivation after bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer. PATIENT AND METHODS A Caucasian male, aged 76 years, exposed to bacillus Calmette-Guérin for a high-grade non-muscle-invasive bladder cancer in 2015, reported painful and progressive left scrotal swelling with purulent discharge from a cutaneous fistulous track that yielded, on liquid culture, a pan-susceptible Mycobacterium tuberculosis hominis strain. Moreover, after 6 months of anti-tuberculosis treatment, an abdominal peri-aortic mass, sized 4 cm, was found and a surgical biopsy showed necrotizing granulomas; however, although smear microscopy and Xpert MTB/Rif™ performed on fresh biopsy sample were positive, liquid cultures resulted negative, indicating treatment efficacy. RESULTS Numerous peculiar and multi-organ involvement due to BCGitis after intravesical immunotherapy have been previously described, including 17 scientific articles about epididymitis, however, no reports so far showed reactivation of Mycobacterium tuberculosis hominis after bacillus Calmette-Guérin treatment. CONCLUSION Although BCGitis is more prevalent in patients undergoing bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer, tuberculosis by other species of Mycobacterium tuberculosis should be always ruled out by molecular and conventional microbiology in patients with a history of Mycobacterium tuberculosis hominis exposure.
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Affiliation(s)
- Niccolò Riccardi
- Clinic of Infectious Diseases, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy.,StopTB Italia Onlus, Milan, Italy
| | - Maurizio Ferrarese
- StopTB Italia Onlus, Milan, Italy.,Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
| | - Paola Castellotti
- StopTB Italia Onlus, Milan, Italy.,Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
| | - Ester Mazzola
- Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
| | - Francesco Sozzi
- U.O. Urology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Angelo Vanzulli
- Departments of Diagnostic and Interventional Radiology and Oncology and Hemato-oncology, Niguarda Ca' Granda Hospital, University of Milan, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luigi Codecasa
- StopTB Italia Onlus, Milan, Italy.,Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
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137
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A systematic review of preventive and therapeutic options for symptoms of cystitis in patients with bladder cancer receiving intravesical bacillus Calmette–Guérin immunotherapy. Anticancer Drugs 2019; 30:517-522. [DOI: 10.1097/cad.0000000000000775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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138
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Soria F, Mosca A, Gontero P. Drug strategies for bladder cancer in the elderly: is there promise for the future? Expert Opin Pharmacother 2019; 20:1387-1396. [PMID: 31081702 DOI: 10.1080/14656566.2019.1615055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Bladder cancer (BCa) is a disease that predominantly affects adult and elderly populations. As people live longer, it will become even more frequent and consequently represents a big health problem for health-care providers and is a challenging clinical dilemma. In the elderly, the treatment of BCa presents some peculiarities due to its more aggressive behavior and reduced patient reserves, impacting their response to medical and surgical therapies. AREAS COVERED The authors provide a non-systematic review of the literature using PubMed to obtain an overview of the therapeutic options for BCa in the elderly, from the low-risk non-muscle-invasive setting to muscle-invasive and advanced/metastatic disease. EXPERT OPINION The main challenge in the treatment of BCa in the elderly is represented by the need to find a compromise between the risk of under- and overtreatment. The wide spectrum of disease prognoses between low-risk non-muscle invasive BCa and invasive metastatic disease represents a perfect setting for a personalized approach. To pursue this aim, older patients need a multidisciplinary approach and clinical management, in order to optimize oncological outcomes as well as to face and support their frailty during cancer therapies.
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Affiliation(s)
- Francesco Soria
- a Department of Urology and Comprehensive Cancer Center , Medical University of Vienna , Vienna , Austria.,b Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital , University of Studies of Torino , Turin , Italy
| | - Alessandra Mosca
- c Medical Oncology , Maggiore della Carità University Hospital , Novara , Italy
| | - Paolo Gontero
- b Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital , University of Studies of Torino , Turin , Italy
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Nummi A, Järvinen R, Sairanen J, Huotari K. A retrospective study on tolerability and complications of bacillus Calmette-Guérin (BCG) instillations for non-muscle-invasive bladder cancer. Scand J Urol 2019; 53:116-122. [PMID: 31074322 DOI: 10.1080/21681805.2019.1609080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: The objective was to evaluate the tolerability of BCG treatment and to evaluate the effects of interruption on treatment outcomes. The incidence and characteristics of severe complications were observed. Methods: From hospital records, all bladder carcinoma patients treated with BCG instillations in the institution from 2009-2015 were retrospectively identified. The reasons for interruption, treatment outcome, number of instillations, and diagnosis of BCG infection were recorded. Results: Of the 418 patients who started BCG instillation therapy, 176 (42.1%) interrupted BCG treatment. Of those, 23 (5.5%) patients interrupted because of suspected BCG infection. Systemic BCG infection was found in seven (1.7%), and local infection in five (1.2%) patients. Interruption of treatment was due to other adverse effects in 71 patients (17.0%), BCG failure in 46 patients (11.0%), and other reasons in 36 patients (8.6%). Fifty percent of interruptions due to adverse effects occurred within the first 6 months. The probabilities of tumor recurrence (20.0% vs 10.7%, p = 0.014, OR = 2.077, CI95% = 1.149-3.753) and disease progression (5.4% vs 1.2%, p = 0.018, OR = 4.534, CI95% = 1.152-17.840) were higher among patients whose BCG treatment was interrupted. Conclusions: Severe complications were encountered in only <5% of patients. Adverse effects requiring treatment interruption were more likely to happen within the first year of treatment. Interrupting BCG treatment due to adverse effects increased the risk of disease progression and tumor recurrence.
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Affiliation(s)
- Antti Nummi
- a Department of Urology , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Riikka Järvinen
- a Department of Urology , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Jukka Sairanen
- a Department of Urology , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Kaisa Huotari
- b Department of Infectious Diseases , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
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140
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Alcorn J, Burton R, Topping A. Patterns of patient withdrawal from BCG treatment for bladder cancer: A retrospective time interval analysis. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2019. [DOI: 10.1111/ijun.12191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jason Alcorn
- Department of Urology, Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield West Yorkshire UK
| | - Rob Burton
- School of Nursing and MidwiferyGriffith University Brisbane Queensland Australia
| | - Annie Topping
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham & University Birmingham Hospitals NHS Foundation Trust Birmingham UK
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141
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Iatrogenic Disease of the Genitourinary Tract. Adv Anat Pathol 2019; 26:171-185. [PMID: 30720471 DOI: 10.1097/pap.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Iatrogenic disease is defined as illness caused by diagnostic procedures or treatment given by health care professionals. More recently described treatment complications involving the genitourinary tract include newly recognized variants of renal carcinoma in the setting of dialysis/end-stage renal disease, treatment effect in genitourinary carcinomas, and medical renal disease caused by drug therapies, including immunotherapy. The objective of this review is to cover iatrogenic inflammatory diseases, pseudotumors and tumors of the kidney, bladder, prostate, testis and paratestis of most interest to surgical pathologists. For this reason, disease caused by the following will not be covered: iatrogenic glomerulonephritis, self-inflicted injury including the introduction of foreign bodies, surgical error, drugs of abuse and herbal medications, and iatrogenic disease in the transplant setting including ischemia/reperfusion injury. Emphasis is placed upon commonly encountered diseases in order to ensure that the review is of utility to practicing pathologists. The clinical context, pathophysiology and histopathology of each disease entity are covered.
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142
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Prakash G, Pal M, Odaiyappan K, Shinde R, Mishra J, Jalde D, Rajkumar B, Prabhash K, Joshi A, Noronha V, Murthy V, Krishnatry R, Desai S, Menon S, Sable N, Popat P, Rangarajan V, Agrawal A, Bakshi G. Bladder cancer demographics and outcome data from 2013 at a tertiary cancer hospital in India. Indian J Cancer 2019; 56:54-58. [PMID: 30950446 DOI: 10.4103/ijc.ijc_351_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Bladder cancer (BCa) is the ninth most common cancer accounting for 3.9% of all cancer cases as per the Indian Cancer Registry data. There is a scarcity of data on urinary Bca from India. AIM The aim of this study was to know demographic background, stage distribution, utilization of various treatment modalities, and oncological outcome in Indian patients presenting with bladder cancer to a tertiary care cancer center in Mumbai. METHODOLOGY We performed a retrospective audit of all patients registered as urinary BCa in our hospital from January 1, 2013 to December 31, 2013. Electronic medical records of these patients were checked for most of the information gathered. RESULTS Median age of patients at presentation was 59 years with a range of 18-88 years. There were 84% male and 16% female patients. Forty seven percent of patients had nonmuscle invasive bladder cancer (NMIBC), 36% had muscle invasive bladder cancer and locally advanced disease, and 17% had metastatic disease. Eight patients were treated with trimodality bladder preservation protocol. Recurrence was seen in 38 (22.6%) patients with NMIBC. Out of them. 44.7% and 55.3% were in low- and high-grade tumors, respectively. Overall survival and disease-free survival estimated for 3 years were 63% and 57%, respectively. CONCLUSION Bladder cancer has a varied spectrum of presentation. Bladder cancer patients presenting to our hospital generally have a higher stage and grade of disease compared with that in the west.
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Affiliation(s)
- Gagan Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mahendra Pal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - K Odaiyappan
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajesh Shinde
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jeeban Mishra
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Devendra Jalde
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Barath Rajkumar
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sangeeta Desai
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Palak Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ganesh Bakshi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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143
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Concomitant primary ovarian paraganglioma neuroendocrinal differentiated urothelial tumor in a BOTOX-injected bladder: A case report. Int J Surg Case Rep 2019; 57:122-125. [PMID: 30952024 PMCID: PMC6447811 DOI: 10.1016/j.ijscr.2019.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/24/2019] [Accepted: 03/13/2019] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION There is no reported data for patients with malignant bladder Botox® injection related outcomes. Herein, we reported effect of Botox® injection in case of BCG cystitis. In addition, reporting of rare incidence of both primary neuroendocrine differentiation of bladder tumor and primary ovarian paraganglioma post cystectomy. PRESENTATION OF CASE A-64 years old female presented with sever irritative lower urinary tract symptoms (LUTS) post vesical BCG installation for carcinoma in situ. Patient's symptoms were relieved after Botox® bladder injection after anticholinergics failure. One year later, she came back with hematuria. Cystoscopy showed nodular bladder lesion. Hypertension episodes were noticed during cystoscopic resection. Pathological examination showed presence of muscle invasive transitional cell carcinoma (TCC) with neuroendocrine differentiation. Patient underwent radical cystectomy and pathology was associated with incidentally discovered primary ovarian paraganglioma. DISCUSSION Intravesical BCG is a standard adjuvant treatment for carcinoma in situ with 75% induced cystitis as a local side effect. The International Bladder Cancer Group's recommendation for BCG cystitis included many agents, these treatment options had very limited outcomes. The existence of paraganglioma in the female genital tract described rarely <1% in the vagina, uterus, vulva and ovary with only few reports. The same as paraganglioma small cell differentiation of vesical urothelial tumor is a rare entity with no reported cases of simultaneous occurrence and to differentiate each other as primary or metastatic. CONCLUSION Bladder Botox® injection could be offered as a treatment for overactive bladder-like symptoms in malignant cystitis. Neuroendocrine tumors are with a rare entity could be happened instantaneously in urogenital tract.
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144
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Lin JF, Tsai TF, Lin YC, Chen HE, Chou KY, Hwang TIS. Benzyl isothiocyanate suppresses IGF1R, FGFR3 and mTOR expression by upregulation of miR-99a-5p in human bladder cancer cells. Int J Oncol 2019; 54:2106-2116. [PMID: 30942430 DOI: 10.3892/ijo.2019.4763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/26/2018] [Indexed: 11/06/2022] Open
Abstract
Benzyl isothiocyanate (BITC) is known for its pharmacological properties against malignant neoplasm, including bladder cancer (BC). The current study investigated microRNAs (miRNA or miR) expression profiles with an emphasis on the role of miR‑99a‑5p in BITC‑treated BC cells. A quantitative polymerase chain reaction (qPCR) microarray containing 79 aberrantly expressed miRNAs in BC was used to detect miRNA expression in BITC‑treated cells. Several dysregulated miRNAs were identified and further confirmed using miRNA stem‑loop reverse transcription (RT)‑qPCR in 5637 cells. Insulin‑like growth factor 1 receptor (IGF1R), fibroblast growth factor receptor 3 (FGFR3) and mammalian target of rapamycin (mTOR) expression were determined by RT‑qPCR and western blotting. Cell viability was evaluated using WST‑1 reagent and apoptosis was monitored by determining the levels of cleaved‑poly ADP‑ribose polymerase and cleaved‑caspase‑3. BITC treatment significantly upregulated miR‑99a‑5p levels in a dose‑dependent manner. miR‑99a‑5p overexpression decreased IGF1R, mTOR and FGFR3 expression, predicted targets of miR‑99a‑5p. In addition, antisense miR‑99a‑5p sequences inhibited BITC‑induced miR‑99a‑5p overexpression, resulting in the restoration of protein expression and decreased cell viability. The current study identified multiple miRNAs responsive to BITC treatment, including miR‑99a‑5p. In addition, the induction of miR‑99a‑5p decreased IGF1R, mTOR and FGFR3 expression in BITC‑treated BC cells. The current study provided novel insight into the antitumor mechanism by which BITC restores miR‑99a‑5p expression and decreases cancer cell survival.
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Affiliation(s)
- Ji-Fan Lin
- Central Laboratory, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, R.O.C
| | - Te-Fu Tsai
- Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan, R.O.C
| | - Yi-Chia Lin
- Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan, R.O.C
| | - Hung-En Chen
- Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan, R.O.C
| | - Kuang-Yu Chou
- Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan, R.O.C
| | - Thomas I-Sheng Hwang
- Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan, R.O.C
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145
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Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer. JOURNAL OF ONCOLOGY 2019; 2019:6230409. [PMID: 30984262 PMCID: PMC6431507 DOI: 10.1155/2019/6230409] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/24/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
Abstract
Because of its proven efficacy, intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is an important treatment for nonmuscle invasive bladder cancer at high risk of recurrence or progression. However, approximately 8% of patients have to stop BCG instillation as a result of its complications. Complications induced by BCG therapy can have a variety of clinical manifestations. These adverse reactions may occur in conjunction with BCG instillation or may not develop until months or years after BCG cessation. An essential step in the management complications arising from BCG is early establishment of diagnosis, particularly for distant, disseminated, and obscure infections. Therefore we reviewed the literature on the potential complications after intravesical BCG immunotherapy for bladder cancer and provide an overview on the incidence, diagnosis, and treatment modality of genitourinary and systemic BCG-induced complications.
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146
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Moschini M, Zamboni S, Mattei A, Amparore D, Fiori C, De Dominicis C, Esperto F. Bacillus Calmette-Guérin unresponsiveness in non-muscle-invasive bladder cancer patients: what the urologists should know. MINERVA UROL NEFROL 2019; 71:17-30. [DOI: 10.23736/s0393-2249.18.03309-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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147
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Pang KH, Noon AP. Selection of patients and benefit of immediate radical cystectomy for non-muscle invasive bladder cancer. Transl Androl Urol 2019; 8:101-107. [PMID: 30976574 PMCID: PMC6414338 DOI: 10.21037/tau.2018.09.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/12/2018] [Indexed: 12/21/2022] Open
Abstract
Bladder cancer (BC) is a common disease in both sexes and majority of cases present as non-muscle invasive BC (NMIBC). The percentage of NMIBC progressing to muscle invasive BC (MIBC) varies between 25% and 75% and currently there are no reliable molecular markers that may predict the outcome of high-risk (HR) NMIBC. Transurethral resection of the bladder tumour (TURBT) with intravesical bacillus Calmette-Guérin (BCG) or immediate radical cystectomy (RC) are the current gold standard treatment options. The European Association of Urology (EAU) guidelines recommend immediate or delayed RC for HR- and a subgroup of "highest-risk" NMIBC. These cases include pT1, carcinoma in-situ (CIS), multifocal disease, histological variants such as micropapillary and sarcomatoid, and patients who have contraindications to, or have failed with BCG. The comparative risks between maintenance BCG (mBCG) and immediate RC are unclear. However, RC may give patients the best oncological outcome.
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Affiliation(s)
- Karl H. Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Aidan P. Noon
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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148
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Steinberg RL, Thomas LJ, Mott SL, O’Donnell MA. Multi-Perspective Tolerance Evaluation of Bacillus Calmette-Guerin with Interferon in the Treatment of Non-Muscle Invasive Bladder Cancer. Bladder Cancer 2019. [DOI: 10.3233/blc-180203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ryan L. Steinberg
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | | | - Sarah L. Mott
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Michael A. O’Donnell
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- Department of Urology, University of Iowa, Iowa City, IA, USA
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149
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Green DB, Kawashima A, Menias CO, Tanaka T, Redelman-Sidi G, Bhalla S, Shah R, King BF. Complications of Intravesical BCG Immunotherapy for Bladder Cancer. Radiographics 2019; 39:80-94. [DOI: 10.1148/rg.2019180014] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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150
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Wang Z, Xiao H, Wei G, Zhang N, Wei M, Chen Z, Peng Z, Peng S, Qiu S, Li H, Long J. Low-dose Bacillus Calmette-Guerin versus full-dose for intermediate and high-risk of non-muscle invasive bladder cancer: a Markov model. BMC Cancer 2018; 18:1108. [PMID: 30419836 PMCID: PMC6233591 DOI: 10.1186/s12885-018-4988-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the efficacy of low dose (27 mg) Bacillus Calmette-Guérin (BCG) and a full dose (81 mg) BCG immunotherapy for patients with intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) after a typical transurethral bladder resection. METHODS We constructed a Markov model for a 20-year simulation of the disease to compare the overall survival of patients with intermediate and high-risk of NMIBC between the full-dose therapy (FD group) and the low-dose therapy (LD group). Base case analysis, one-way and two-way sensitivity analysis and a second-order Monte Carlo analysis were performed based on data from 15 published articles. RESULTS The expected overall survivals were 9.56 (9.55-9.57) years for FD group and 9.63 (9.61-9.64) years for LD group(P < 0.001). The estimated mortality in the FD group at 5, 10, and 20 years were 34.23%, 57.51% and 83.14%, respectively. The corresponding values in the LD group were 34.11%, 57.17%, 82.16%, respectively. Age-specific mortality and metastatic rate after undergoing radical cystectomy (RC) were the most two sensitive parameters in both groups. The rate of disease recurrence with disease worsening is the determining factor when choosing the optimal dose of BCG treatment. CONCLUSIONS A low-dose BCG treatment may act slightly better than a full-dose BCG treatment for patients with intermediate and high-risk of NMIBC. This finding will require further high-quality studies to validate.
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Affiliation(s)
- Zongren Wang
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Han Xiao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guangyan Wei
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ning Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Mengchao Wei
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zebin Chen
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhenwei Peng
- Department of Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Sui Peng
- Department of Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shaopeng Qiu
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Heping Li
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Jianting Long
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
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