201
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The prognostic role of pre-cystectomy hemoglobin levels in patients with invasive bladder cancer. World J Urol 2015; 34:829-34. [DOI: 10.1007/s00345-015-1693-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022] Open
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202
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Buti S, Ciccarese C, Zanoni D, Santoni M, Modena A, Maines F, Gilli A, Bria E, Brunelli M, Rimanti A, Cascinu S, Ardizzoni A, Tortora G, Massari F. Prognostic and predictive factors in patients treated with chemotherapy for advanced urothelial cancer: where do we stand? Future Oncol 2015; 11:107-19. [PMID: 25572786 DOI: 10.2217/fon.14.172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The standard of care for patients with local advanced or metastatic urothelial carcinoma is chemotherapy. However, results with this are rather disappointing, and validated prognostic factors and biomarkers of tumor response, which are useful in the decision-making process, are still lacking. PubMed databases were searched for articles published until November 2013. Several promising clinical and biological candidate prognostic factors or markers of tumor response to first- or second-line therapy, such as hemoglobin, performance status, visceral metastasis and ERCC1, hENT1 and EMT markers, have been identified and described in this article. In summary, clinical parameters and molecular profiling could revolutionize the management of local advanced or metastatic urothelial cancer, but an improvement in individualized therapeutic approaches still seems distant.
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Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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203
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204
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Treatment of poor risk patients. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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205
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Iyer G, Calabró F, Bajorin DF. Treatment of metastatic bladder cancer. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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206
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Sonpavde G, Pond GR, Rosenberg JE, Bajorin DF, Choueiri TK, Necchi A, Di Lorenzo G, Bellmunt J. Improved 5-Factor Prognostic Classification of Patients Receiving Salvage Systemic Therapy for Advanced Urothelial Carcinoma. J Urol 2015; 195:277-82. [PMID: 26292040 DOI: 10.1016/j.juro.2015.07.111] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Prognostic factors in patients receiving salvage systemic therapy for advanced urothelial carcinoma include performance status, liver metastasis, hemoglobin and time since chemotherapy. We investigated the impact of albumin, and neutrophil, lymphocyte and platelet counts. MATERIALS AND METHODS Patient level data from 10 phase II trials were used. Cox proportional hazards regression was applied to evaluate associations with overall survival. An optimal regression model was constructed using forward stepwise selection and risk groups were defined using the number of adverse factors. Trial was a stratification factor. External validation was done in a separate data set of 5 salvage phase II trials. RESULTS Discovery data were obtained on 708 patients. After adjustment for the 4 known factors a platelet count of the upper limit of normal or greater and albumin less than the lower limit of normal were significant poor prognostic factors. Only the addition of albumin was externally validated. For 0 or 1, 2 and 3 or greater risk factors median overall survival was 8.9, 6.4 and 4.5 months in 207, 171 and 113 patients in the discovery data set of 491, and 10.6, 10.0 and 7.0 months in 73, 47 and 47 patients, respectively, in the validation data set of 167. By adding albumin the c-index improved from 0.610 to 0.639 in the discovery set and from 0.616 to 0.646 in the validation set. CONCLUSIONS Albumin was externally validated as a prognostic factor for overall survival after accounting for time from prior chemotherapy, hemoglobin, performance status and liver metastasis status in patients receiving salvage systemic therapy for advanced urothelial carcinoma. The discovery of molecular prognostic factors is a priority to further enhance this new preferred 5-factor clinical prognostic model.
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Affiliation(s)
- Guru Sonpavde
- University of Alabama-Birmingham Comprehensive Cancer Center, Birmingham, Alabama.
| | | | | | - Dean F Bajorin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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207
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Sonpavde G, Pond GR, Choueiri TK, Mullane S, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Buonerba C, Rozzi A, Matsumoto K, Lee JL, Kitamura H, Kume H, Bellmunt J. Single-agent Taxane Versus Taxane-containing Combination Chemotherapy as Salvage Therapy for Advanced Urothelial Carcinoma. Eur Urol 2015; 69:634-641. [PMID: 26264159 DOI: 10.1016/j.eururo.2015.07.042] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Single-agent taxanes are commonly used as salvage systemic therapy for patients with advanced urothelial carcinoma (UC). OBJECTIVE To study the impact of combination chemotherapy delivering a taxane plus other chemotherapeutic agents compared with single-agent taxane as salvage therapy. DESIGN, SETTING, AND PARTICIPANTS Individual patient-level data from phase 2 trials of salvage systemic therapy were used. INTERVENTIONS Trials evaluating either single agents (paclitaxel or docetaxel) or combination chemotherapy (taxane plus one other chemotherapeutic agent or more) following prior platinum-based therapy were used. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Information regarding the known major baseline prognostic factors was required: time from prior chemotherapy, hemoglobin, performance status, albumin, and liver metastasis status. Cox proportional hazards regression was used to evaluate the association of prognostic factors and combination versus single-agent chemotherapy with overall survival (OS). RESULTS AND LIMITATIONS Data were available from eight trials including 370 patients; two trials (n=109) evaluated single-agent chemotherapy with docetaxel (n=72) and cremophor-free paclitaxel (n=37), and six trials (n=261) evaluated combination chemotherapy with gemcitabine-paclitaxel (two trials, with n=99 and n=24), paclitaxel-cyclophosphamide (n=32), paclitaxel-ifosfamide-nedaplatin (n=45), docetaxel-ifosfamide-cisplatin (n=26), and paclitaxel-epirubicin (n=35). On multivariable analysis after adjustment for baseline prognostic factors, combination chemotherapy was independently and significantly associated with improved OS (hazard ratio: 0.60; 95% confidence interval, 0.45-0.82; p=0.001). The retrospective design of this analysis and the trial-eligible population were inherent limitations. CONCLUSIONS Patients enrolled in trials of combination chemotherapy exhibited improved OS compared with patients enrolled in trials of single-agent chemotherapy as salvage therapy for advanced UC. Prospective randomized trials are required to validate a potential role for rational and tolerable combination chemotherapeutic regimens for the salvage therapy of advanced UC. PATIENT SUMMARY This retrospective study suggests that a combination of chemotherapy agents may extend survival compared with single-agent chemotherapy in selected patients with metastatic urothelial cancer progressing after prior chemotherapy.
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Affiliation(s)
- Guru Sonpavde
- UAB Comprehensive Cancer Center, Birmingham, AL, USA.
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Stephanie Mullane
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Carlo Buonerba
- Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero In Vulture, Italy
| | - Antonio Rozzi
- Istituto Neurotraumatologico Italiano, Grottaferrata, Italy
| | | | | | | | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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208
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Prognostic Model for Predicting Survival in Patients with Disease Recurrence Following Radical Cystectomy. Eur Urol Focus 2015; 1:75-81. [DOI: 10.1016/j.euf.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 11/21/2022]
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209
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210
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Taguchi S, Nakagawa T, Uemura Y, Matsumoto A, Nagase Y, Kawai T, Tanaka Y, Yoshida K, Yamamoto S, Enomoto Y, Nose Y, Sato T, Ishikawa A, Fujimura T, Fukuhara H, Kume H, Homma Y. Validation of major prognostic models for metastatic urothelial carcinoma using a multi-institutional cohort of the real world. World J Urol 2015; 34:163-71. [PMID: 26135306 DOI: 10.1007/s00345-015-1631-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/23/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Several prognostic models predicting survival of patients with metastatic urothelial carcinoma (UC) have been developed; however, of them, the first model by Bajorin in 1999 is still the most representative and widely used, and validations of newer models are lacking. This study aimed to validate three major prognostic models for metastatic UC constructed based on clinical trials. METHODS We reviewed 200 patients with metastatic UC who received first-line chemotherapy at our five affiliate institutions between 2003 and 2011. Using this multi-institutional cohort, we validated the following models: the "Bajorin model," a model consisting of visceral metastasis and performance status; the "Apolo model," a nomogram including visceral metastasis, performance status, albumin and hemoglobin; and the "Galsky model," a nomogram including leukocyte count, number of sites of visceral metastases, site of primary tumor, performance status and lymph node metastasis. Harrell's c-index was calculated for each model. Cox proportional hazards regression model was used for multivariate analysis. RESULTS Among 200 patients, 171 (85.5%) died during the follow-up, with a median survival of 12.0 months. Multivariate analysis demonstrated ECOG performance status, visceral metastasis and leukocyte count to be independent predictors of overall survival. C-index results (95% confidence interval) were Bajorin: 0.86 (0.74-0.95); Apolo: 0.89 (0.78-0.98); and Galsky: 0.82 (0.69-0.93). CONCLUSIONS All models were demonstrated to have high external validities in real-world patients, and of them, the "Apolo model" achieved the highest c-index in the present population. Further studies with larger populations are needed for establishment of the next standard model.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yukari Uemura
- Central Coordinating Unit, Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiko Matsumoto
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yasushi Nagase
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yoshinori Tanaka
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kanae Yoshida
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Sachi Yamamoto
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yutaka Enomoto
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yorito Nose
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Toshikazu Sato
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Akira Ishikawa
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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211
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Mazzola CR, Chin J. Targeting the VEGF pathway in metastatic bladder cancer. Expert Opin Investig Drugs 2015; 24:913-27. [DOI: 10.1517/13543784.2015.1041588] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Clarisse R Mazzola
- Western University, Division of Urology and Division of Surgical Oncology, London, Ontario, Canada ;
| | - Joseph Chin
- Western University, Division of Urology and Division of Surgical Oncology, London, Ontario, Canada ;
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212
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Sonpavde G, Bellmunt J. Salvage systemic therapy for advanced urothelial carcinoma: on the cusp of a sea change? Oncologist 2015; 20:461-3. [PMID: 25845991 PMCID: PMC4425398 DOI: 10.1634/theoncologist.2015-0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/13/2015] [Indexed: 01/04/2023] Open
Abstract
This commentary addresses salvage therapy of advanced urothelial carcinoma and the importance of prognostic classification. Patients should be referred to one of the important clinical trials of salvage therapy rather than treatment with marginally active chemotherapeutic agents.
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Affiliation(s)
- Guru Sonpavde
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA; Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Joaquim Bellmunt
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA; Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
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213
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Carcinomes urothéliaux, formes métastatiques : traitements médicaux d’aujourd’hui et de demain. ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2505-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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214
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Sonpavde G, Pond GR, Rosenberg JE, Bajorin DF, Regazzi AM, Choueiri TK, Qu AQ, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Fougeray R, Dreicer R, Chen YH, Wong YN, Sridhar SS, Ko YJ, Milowsky MI, Galsky MD, Bellmunt J. Complete Response as an Intermediate End Point in Patients Receiving Salvage Systemic Therapy for Urothelial Carcinoma. Clin Genitourin Cancer 2015; 13:185-92. [DOI: 10.1016/j.clgc.2014.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/25/2014] [Indexed: 12/01/2022]
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215
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Controversies in the treatment of invasive urothelial carcinoma: a case report and review of the literature. BMC Urol 2015; 15:15. [PMID: 25887442 PMCID: PMC4361131 DOI: 10.1186/s12894-015-0008-7] [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: 05/14/2014] [Accepted: 02/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than 429,000 patients worldwide are diagnosed with bladder cancer each year and muscle-invasive bladder cancer has an especially poor outcome. The median age at diagnosis is over 70 years, and many patients also have a substantial number of age-associated impairments that need to be considered when planning therapeutic interventions. CASE PRESENTATION Here, we report the case of a 63-year-old man with a cT3b urothelial carcinoma which was surgically removed. No neoadjuvant or adjuvant chemotherapy was administered. After 18 months a lung metastasis was confirmed and resected but no chemotherapy was given after surgery. Twelve months later, the patient relapsed and was treated with a combination of gemcitabine and cisplatin and after a decline in renal function the treatment was changed to a combination of carboplatin and gemcitabine which resulted in a partial response which lasted 8 months. Following this vinflunine was administered as a second line treatment. Here we review the evidence available in the literature regarding the suitability of different treatment options for managing muscle-invasive bladder cancer at each step of the case presentation. CONCLUSION Bladder cancer treatment requires a multidisciplinary approach. Although, depending on the clinical characteristics of the patient, there are some controversial points in the management of this pathology we hope that the scientific data and the clinical trials reviewed in this case report, can help to guide physicians to make more rational decisions regarding the management of these patients.
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216
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Jordan EJ, Iyer G. Targeted therapy in advanced bladder cancer: what have we learned? Urol Clin North Am 2015; 42:253-62, ix. [PMID: 25882566 DOI: 10.1016/j.ucl.2015.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite advances in the treatment of other genitourinary malignancies, no novel therapies have been approved by the US Food and Drug Administration for urothelial carcinoma (UC) in the last 20 years. To date, no clinical trials of targeted agents in UC have led to improvements in survival compared with cytotoxic therapy. This article outlines representative trials of targeted therapies in UC and discusses the significance of genetic preselection in trial design as a method to optimize responses to these agents, thus, hopefully expanding the armamentarium of treatment options against this lethal disease.
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Affiliation(s)
- Emmet J Jordan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Gopa Iyer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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217
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Niegisch G, Retz M, Thalgott M, Balabanov S, Honecker F, Ohlmann CH, Stöckle M, Bögemann M, Vom Dorp F, Gschwend J, Hartmann A, Ohmann C, Albers P. Second-Line Treatment of Advanced Urothelial Cancer with Paclitaxel and Everolimus in a German Phase II Trial (AUO Trial AB 35/09). Oncology 2015; 89:70-8. [PMID: 25765871 DOI: 10.1159/000376551] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/27/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The efficacy of second-line treatment after failure of platinum-based chemotherapy in patients with advanced urothelial cancer is limited. Based on encouraging preclinical and clinical phase I data, we evaluated the safety and efficacy of the combination of paclitaxel and everolimus in these patients. METHODS In this trial, patients having failed to respond to prior platinum-based combination treatment of urothelial cancer were treated with paclitaxel (175 mg/m(2) i.v., 3-weekly) and the mTOR-inhibitor everolimus (10 mg p.o., once daily). The patients were treated until tumor progression or until a maximum of 6 cycles was completed. A one-stage design was used to evaluate the objective response rate (ORR) as the primary endpoint. RESULTS A total of 27 patients (67% male; median age 63 years) were enrolled. The most frequent grade III/IV toxicities were anemia (28%), peripheral neuropathy (28%), and fatigue (24%). No treatment-related deaths were reported. Complete and partial remissions were observed in 0/24 and 3/24 patients eligible for efficacy analysis, respectively (ORR 13%). Progression-free survival was 2.9 months [95% confidence interval (95% CI) 1.9-4.2], and the median overall survival was 5.6 months (95% CI 4.8-10.2). CONCLUSION The combination of paclitaxel and everolimus has not achieved the expected efficacy in second-line treatment of urothelial cancer and should not be further explored.
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Affiliation(s)
- Günter Niegisch
- Department of Urology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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218
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Kluth LA, Black PC, Bochner BH, Catto J, Lerner SP, Stenzl A, Sylvester R, Vickers AJ, Xylinas E, Shariat SF. Prognostic and Prediction Tools in Bladder Cancer: A Comprehensive Review of the Literature. Eur Urol 2015; 68:238-53. [PMID: 25709027 DOI: 10.1016/j.eururo.2015.01.032] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
Abstract
CONTEXT This review focuses on risk assessment and prediction tools for bladder cancer (BCa). OBJECTIVE To review the current knowledge on risk assessment and prediction tools to enhance clinical decision making and counseling of patients with BCa. EVIDENCE ACQUISITION A literature search in English was performed using PubMed in July 2013. Relevant risk assessment and prediction tools for BCa were selected. More than 1600 publications were retrieved. Special attention was given to studies that investigated the clinical benefit of a prediction tool. EVIDENCE SYNTHESIS Most prediction tools for BCa focus on the prediction of disease recurrence and progression in non-muscle-invasive bladder cancer or disease recurrence and survival after radical cystectomy. Although these tools are helpful, recent prediction tools aim to address a specific clinical problem, such as the prediction of organ-confined disease and lymph node metastasis to help identify patients who might benefit from neoadjuvant chemotherapy. Although a large number of prediction tools have been reported in recent years, many of them lack external validation. Few studies have investigated the clinical utility of any given model as measured by its ability to improve clinical decision making. There is a need for novel biomarkers to improve the accuracy and utility of prediction tools for BCa. CONCLUSIONS Decision tools hold the promise of facilitating the shared decision process, potentially improving clinical outcomes for BCa patients. Prediction models need external validation and assessment of clinical utility before they can be incorporated into routine clinical care. PATIENT SUMMARY We looked at models that aim to predict outcomes for patients with bladder cancer (BCa). We found a large number of prediction models that hold the promise of facilitating treatment decisions for patients with BCa. However, many models are missing confirmation in a different patient cohort, and only a few studies have tested the clinical utility of any given model as measured by its ability to improve clinical decision making.
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Affiliation(s)
- Luis A Kluth
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bernard H Bochner
- Department of Urology, Memorial Sloan-Kettering Cancer Center, Kimmel Center for Prostate and Urologic Tumors, New York, NY, USA
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
| | | | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, UT Southwestern, Dallas, TX, USA; Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
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219
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Powles T, Eder JP, Fine GD, Braiteh FS, Loriot Y, Cruz C, Bellmunt J, Burris HA, Petrylak DP, Teng SL, Shen X, Boyd Z, Hegde PS, Chen DS, Vogelzang NJ. MPDL3280A (anti-PD-L1) treatment leads to clinical activity in metastatic bladder cancer. Nature 2015; 515:558-62. [PMID: 25428503 DOI: 10.1038/nature13904] [Citation(s) in RCA: 1847] [Impact Index Per Article: 205.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/30/2014] [Indexed: 02/07/2023]
Abstract
There have been no major advances for the treatment of metastatic urothelial bladder cancer (UBC) in the last 30 years. Chemotherapy is still the standard of care. Patient outcomes, especially for those in whom chemotherapy is not effective or is poorly tolerated, remain poor. One hallmark of UBC is the presence of high rates of somatic mutations. These alterations may enhance the ability of the host immune system to recognize tumour cells as foreign owing to an increased number of antigens. However, these cancers may also elude immune surveillance and eradication through the expression of programmed death-ligand 1 (PD-L1; also called CD274 or B7-H1) in the tumour microenvironment. Therefore, we examined the anti-PD-L1 antibody MPDL3280A, a systemic cancer immunotherapy, for the treatment of metastatic UBC. MPDL3280A is a high-affinity engineered human anti-PD-L1 monoclonal immunoglobulin-G1 antibody that inhibits the interaction of PD-L1 with PD-1 (PDCD1) and B7.1 (CD80). Because PD-L1 is expressed on activated T cells, MPDL3280A was engineered with a modification in the Fc domain that eliminates antibody-dependent cellular cytotoxicity at clinically relevant doses to prevent the depletion of T cells expressing PD-L1. Here we show that MPDL3280A has noteworthy activity in metastatic UBC. Responses were often rapid, with many occurring at the time of the first response assessment (6 weeks) and nearly all were ongoing at the data cutoff. This phase I expansion study, with an adaptive design that allowed for biomarker-positive enriched cohorts, demonstrated that tumours expressing PD-L1-positive tumour-infiltrating immune cells had particularly high response rates. Moreover, owing to the favourable toxicity profile, including a lack of renal toxicity, patients with UBC, who are often older and have a higher incidence of renal impairment, may be better able to tolerate MPDL3280A versus chemotherapy. These results suggest that MPDL3280A may have an important role in treating UBC-the drug received breakthrough designation status by the US Food and Drug Administration (FDA) in June 2014.
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Affiliation(s)
- Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, Barts Experimental Cancer Medicine Centre, London EC1M 6BQ, UK
| | - Joseph Paul Eder
- Yale Cancer Center, 333 Cedar Street, WWW211, New Haven, Connecticut 06520, USA
| | - Gregg D Fine
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, USA
| | - Fadi S Braiteh
- Comprehensive Cancer Centers of Nevada, 3730 S. Eastern Avenue, Las Vegas, Nevada 89169, USA
| | - Yohann Loriot
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805 Villejuif, France
| | - Cristina Cruz
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital. Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Howard A Burris
- Sarah Cannon Research Institute, 3322 West End Avenue, Suite 900, Nashville, Tennessee 37203, USA
| | - Daniel P Petrylak
- Yale Cancer Center, 333 Cedar Street, WWW211, New Haven, Connecticut 06520, USA
| | - Siew-leng Teng
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, USA
| | - Xiaodong Shen
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, USA
| | - Zachary Boyd
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, USA
| | - Priti S Hegde
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, USA
| | - Daniel S Chen
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, USA
| | - Nicholas J Vogelzang
- University of Nevada School of Medicine and US Oncology/Comprehensive Cancer Centers of Nevada, 3730 S. Eastern Avenue, Las Vegas, Nevada 89169, USA
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220
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Pond G, Bellmunt J, Rosenberg J, Bajorin D, Regazzi A, Choueiri T, Qu A, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Fougeray R, Wong YN, Sridhar S, Ko YJ, Milowsky M, Galsky M, Sonpavde G. Impact of the Number of Prior Lines of Therapy and Prior Perioperative Chemotherapy in Patients Receiving Salvage Therapy for Advanced Urothelial Carcinoma: Implications for Trial Design. Clin Genitourin Cancer 2015; 13:71-9. [DOI: 10.1016/j.clgc.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/29/2014] [Accepted: 06/03/2014] [Indexed: 11/16/2022]
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221
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Narayanan S, Harshman LC, Srinivas S. Second-line therapies in metastatic urothelial carcinoma. Hematol Oncol Clin North Am 2015; 29:341-59, x. [PMID: 25836939 DOI: 10.1016/j.hoc.2014.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with relapsed or refractory urothelial carcinoma (UC) face a poor prognosis and a dearth of available treatment options that improve their survival. End-organ function and performance status play a vital role in the choice of second-line therapies. Evidence supporting the use of cytotoxic chemotherapy, as single agents or in combination, arises from small phase 2 studies with modest responses. With the evolution of genomic testing in UC, several pathways amenable to available targeted therapies have emerged. Encouraging patient participation in clinical trials is critical to improve patient outcomes and to advance the current modest treatment armamentarium.
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Affiliation(s)
- Sujata Narayanan
- Department of Medicine, Stanford University School of Medicine, Blake Wilbur Drive, Stanford, CA 94305, USA
| | - Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, DANA 1230, Boston, MA 02215, USA
| | - Sandy Srinivas
- Department of Medicine, Stanford University School of Medicine, Blake Wilbur Drive, Stanford, CA 94305, USA.
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222
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Fukushima H, Yokoyama M, Nakanishi Y, Tobisu KI, Koga F. Sarcopenia as a prognostic biomarker of advanced urothelial carcinoma. PLoS One 2015; 10:e0115895. [PMID: 25612215 PMCID: PMC4303429 DOI: 10.1371/journal.pone.0115895] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/28/2014] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Sarcopenia, a novel concept reflecting the degenerative loss of skeletal muscle mass, is an objective indicator of cancer cachexia. We investigated its role as a prognostic biomarker in advanced urothelial carcinoma (UC) patients. METHODS This retrospective study consisted of 88 UC patients with cT4 and/or metastases to lymph nodes/distant organs. Skeletal muscle index (SMI), an indicator of whole-body muscle mass, was measured from computed tomography (CT) images at the diagnosis. Sarcopenia was defined as SMIs of <43 cm(2)/m(2) for males with body mass index (BMI) <25 cm(2)/m(2), <53 cm(2)/m(2) for males with BMI ≥ 25 cm(2)/m(2), and <41 cm(2)/m(2) for females. Predictors of overall survival (OS) were examined using Cox proportional hazard models. RESULTS Sixty-seven patients (76%) died during the median follow-up of 13 months. The median OS rate was 13 months. Multivariate analysis revealed that SMI was a significant and independent predictor of shorter OS (hazard ratio (HR) 0.90, P <0.001). In the present cohort, 53 (60%) were diagnosed with sarcopenia. The median OS rates were 11 and 31 months for sarcopenic and non-sarcopenic patients, respectively (P <0.001). On multivariate analysis, sarcopenia was a significant and independent predictor of shorter OS (HR 3.36, P <0.001), along with higher C-reactive protein (CRP) (P = 0.001), upper urinary tract cancer (P = 0.007), higher lactate dehydrogenase (LDH) (P = 0.047), and higher alkaline phosphatase (ALP) (P = 0.048). CONCLUSION Sarcopenia, which is readily evaluated on routine CT scans, is a useful prognostic biomarker of advanced UC. Non-sarcopenic patients can expect long-term survival. Evaluating sarcopenia can be helpful for decision-making processes in the management of advanced UC patients.
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Affiliation(s)
- Hiroshi Fukushima
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yasukazu Nakanishi
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Ken-ichi Tobisu
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
- * E-mail:
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223
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Sonpavde G, Pond GR, Fougeray R, Bellmunt J. Nomogram to predict the benefit from salvage systemic therapy for advanced urothelial carcinoma. BJU Int 2015; 115:854-5. [PMID: 25195625 DOI: 10.1111/bju.12922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Guru Sonpavde
- UAB Comprehensive Cancer Center, Birmingham, AL, USA.,McMaster University, Hamilton, Ontario, Canada
| | | | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,University Hospital del Mar-IMIM, Barcelona, Spain
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224
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Bellmunt J, Mullane SA, Werner L, Fay AP, Callea M, Leow JJ, Taplin ME, Choueiri TK, Hodi FS, Freeman GJ, Signoretti S. Association of PD-L1 expression on tumor-infiltrating mononuclear cells and overall survival in patients with urothelial carcinoma. Ann Oncol 2015; 26:812-817. [PMID: 25600565 DOI: 10.1093/annonc/mdv009] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Programmed death-1 (PD-1) receptor/PD-1 ligand (PD-L1) pathway negatively regulates T-cell-mediated responses. The prognostic impact of PD-L1 expression needs to be defined in urothelial carcinoma (UC). PATIENTS AND METHODS Formalin-fixed paraffin-embedded tumor samples from 160 patients with UC were retrieved. PD-L1 expression was evaluated by immunohistochemistry using a mouse monoclonal anti-PD-L1 antibody (405.9A11). PD-L1 positivity on tumor cell membrane was defined as ≥5% of tumor cell membrane staining. The extent of tumor-infiltrating mononuclear cells (TIMCs) as well as PD-L1 expression on TIMCs was scored from 0 to 4. A score of 2, 3, or 4 was considered PD-L1-positive. Clinico-pathological variables were documented. The Cox regression model was used to assess the association of PD-L1 expression with overall survival (OS) in patients who developed metastases. RESULTS TIMCs were present in 143 of the 160 patient samples. Out of 160 samples, 32 (20%) had positive PD-L1 expression in tumor cell membrane. Out of 143 samples with TIMCs, 58 (40%) had positive PD-L1 expression in TIMCs. Smoking history, prior BCG use and chromosome 9 loss did not correlate with PD-L1 expression in either tumor cell membrane or TIMCs. PD-L1 positivity was not different between non-invasive or invasive UC. In patients who developed metastases (M1) and were treated with systemic therapy (n = 100), PD-L1 positivity on tumor cell membrane was seen in 14% of patients and did not correlate with OS (P = 0.45). Out of 89 M1 patients who had evaluable PD-L1 on TIMCs, PD-L1 expression was seen in 33% of patients and was significantly associated with longer OS on multivariate analysis (P = 0.0007). CONCLUSION PD-L1 is widely expressed in tumor cell membrane and TIMCs in UC. PD-L1 in tumor cells was not predictive of OS. However, positive PD-L1 expression in TIMCs was significantly associated with longer survival in those patients who developed metastases.
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Affiliation(s)
- J Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston.
| | - S A Mullane
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - L Werner
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston
| | - A P Fay
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - M Callea
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - J J Leow
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston
| | - M E Taplin
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - T K Choueiri
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - F S Hodi
- Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston; Center for Immuno-oncology, Dana-Farber Cancer Institute, Boston, USA
| | - G J Freeman
- Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - S Signoretti
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
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225
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Ergani B, Türk H, Ün S, Karabıçak M, Tarhan H, Zorlu F. Prognostic effect of preoperative anemia in patients who have undergone radical cystectomy for bladder cancer. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ctrc.2015.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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226
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Sonpavde G, Jones BS, Bellmunt J, Choueiri TK, Sternberg CN. Future directions and targeted therapies in bladder cancer. Hematol Oncol Clin North Am 2014; 29:361-76, x. [PMID: 25836940 DOI: 10.1016/j.hoc.2014.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There are substantial unmet needs for patients with metastatic urothelial carcinoma (UC). First-line cisplatin-based chemotherapy regimens yield a median survival of 12 to 15 months and long-term survival in 5% to 15%. Salvage systemic therapy yields a median survival of 6 to 8 months. Hence, the discovery of novel therapeutic targets is of paramount importance. Recent molecular analyses have provided insights regarding molecular tumor tissue alterations on multiple platforms. A multidisciplinary effort using innovative clinical trial designs and exploiting preclinical signals of robust activity guided by predictive biomarkers may provide much needed clinical advances in therapy for advanced UC.
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Affiliation(s)
- Guru Sonpavde
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, 1720 2nd Ave. S., Birmingham, AL 35294, USA
| | - Benjamin S Jones
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, 1720 2nd Ave. S., Birmingham, AL 35294, USA
| | - Joaquim Bellmunt
- Bladder Cancer Institute, Dana Farber Cancer Institute, Dana-Farber/Brigham and Women's Cancer Center, Boston, 450, Brookline Ave, MA 02215, USA
| | - Toni K Choueiri
- Bladder Cancer Institute, Dana Farber Cancer Institute, Dana-Farber/Brigham and Women's Cancer Center, Boston, 450, Brookline Ave, MA 02215, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglioni Flajani, 1st Floor, Circonvallazione Gianicolense 87, Rome 00152, Italy.
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227
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Intravenous 3-weekly paclitaxel and metronomic oral cyclophosphamide in patients with advanced urothelial cancer previously treated with gemcitabine and platinum. Cancer Chemother Pharmacol 2014; 75:247-54. [DOI: 10.1007/s00280-014-2640-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
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228
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Kramer MW, Heinisch A, Wegener G, Abbas M, von Klot C, Peters I, Tezval H, Herrmann TR, Kuczyk MA, Merseburger AS. [C-reactive protein prior to radical cystectomy: preoperative determination of CRP]. Urologe A 2014; 53:222-7. [PMID: 23955283 DOI: 10.1007/s00120-013-3299-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Numerous studies have shown a positive correlation between elevated C-reactive protein (CRP) and systemic spread of malignancies. The goal of the current study was to assess the predictive significance of preoperative CRP in patients undergoing radical cystectomy (RC). MATERIAL AND METHODS Preoperative CRP values were measured in 194 patients undergoing RC because of urothelial carcinoma between 1996 and 2005. Elevated CRP level was defined as ≥ 5 mg/l. RESULTS Preoperative increased CRP values were detected in 89 (45.9%) patients and these patients were more likely to have advanced tumor stages (pT3-4), positive resection margins and positive lymph nodes. Advanced urinary diversions were more common in patients with normal CRP values. In multivariate analysis, CRP was identified as an independent prognostic indicator for poor cancer-specific survival. CONCLUSION The results confirm previous reports that showed a prognostic significance of preoperative CRP elevation.
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Affiliation(s)
- M W Kramer
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
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229
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Milowsky MI, Dittrich C, Durán I, Jagdev S, Millard FE, Sweeney CJ, Bajorin D, Cerbone L, Quinn DI, Stadler WM, Rosenberg JE, Lochheed M, Sen P, Squires M, Shi M, Sternberg CN. Phase 2 trial of dovitinib in patients with progressive FGFR3-mutated or FGFR3 wild-type advanced urothelial carcinoma. Eur J Cancer 2014; 50:3145-52. [PMID: 25457633 DOI: 10.1016/j.ejca.2014.10.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/25/2014] [Accepted: 10/10/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Second-line treatment options for patients with advanced urothelial carcinoma (UC) are limited. Fibroblast growth factor receptor 3 (FGFR3) is dysregulated in UC by activating mutations or protein overexpression in non-mutant tumours. In this study, the efficacy, pharmacodynamics and safety of dovitinib-a broad-targeted inhibitor of tyrosine kinases, including FGFR3-were evaluated in patients with previously treated advanced UC with and without FGFR3 mutations. METHODS Forty-four adults with advanced UC who had progressed after one to three platinum-based and/or combination chemotherapy regimens were classified as having mutant (FGFR3(MUT); n=12), wild-type (FGFR3(WT); n=31), or unknown (n=1) FGFR3 status. Patients received 500 mg dovitinib once daily on a 5-days-on/2-days-off schedule. The primary end-point of this two-stage study was the investigator-assessed overall response rate (ORR). RESULTS Most of the patients were men (75%) and over half of the patients were aged ⩾65 years (61%). All patients had received ⩾1 prior antineoplastic therapy for UC. The study was terminated at the end of stage 1, when it was determined by investigator review that the ORR of both the FGFR3(MUT) (0%; 95% confidence interval [CI], 0.0-26.5) and FGFR3(WT) (3.2%; 95% CI, 0.1-16.7) groups did not meet the criteria to continue to stage 2. The most common grade 3/4 adverse events, suspected to be study-drug related, included thrombocytopenia (9%), fatigue (9%), and asthenia (9%). CONCLUSION Although generally well tolerated, dovitinib has very limited single-agent activity in patients with previously treated advanced UC, regardless of FGFR3 mutation status. clinicaltrials.gov NCT00790426.
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Affiliation(s)
- Matthew I Milowsky
- Department of Medicine, Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Christian Dittrich
- LBI-ACR VIEnna & ACR-ITR VIEnna, Center for Oncology and Haematology, Kaiser Franz Josef-Spital, Vienna, Austria
| | - Ignacio Durán
- Centro Integral Oncologico Clara Campal, Universidad CEU San Pablo, Madrid, Spain
| | | | - Frederick E Millard
- Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, San Diego, CA, USA
| | | | - Dean Bajorin
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Linda Cerbone
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - David I Quinn
- Division of Medical Oncology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | - Jonathan E Rosenberg
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Paramita Sen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Michael Shi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
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230
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Castellano D, Puente J, de Velasco G, Chirivella I, López-Criado P, Mohedano N, Fernández O, García-Carbonero I, González MB, Grande E. Safety and effectiveness of vinflunine in patients with metastatic transitional cell carcinoma of the urothelial tract after failure of one platinum-based systemic therapy in clinical practice. BMC Cancer 2014; 14:779. [PMID: 25342282 PMCID: PMC4216839 DOI: 10.1186/1471-2407-14-779] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 10/02/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with transitional cell carcinoma of the urothelial tract (TCCU) who fail initial platinum-based chemotherapy for advanced disease represent a challenge in daily clinical practice. Vinflunine is approved by the European Medicine Agency (EMA) but, up to now, limited experience has been reported outside clinical trials. METHODS We assessed the efficacy and safety of vinflunine in an unselected group of 102 consecutive patients with metastatic TCCU. RESULTS The median age was 67 years (range 45-83). Among the most common comorbidities that patients presented at baseline were hypertension (50.5%) and diabetes (20.7%).Distant metastases were present in retroperitoneal nodes (58%), lung (29.3%), and bone (20.2%). The ECOG 0, 1 and 2 performance status at the start of vinflunine were 31.3%, 60.6% and 8.1%, respectively. The most commonly reported adverse events of any grade were constipation 70.6% (5.9% grade 3-4), vomiting 49.1% (2% grade 3-4), neutropenia 48.1% (12.8% grade 3-4) and abdominal pain 34.3% (4.9% grade 3-4). A median of 4 cycles of vinflunine was administered per patient (range 1-18). Median progression free and overall survival for all patients (N = 102) were 3.9 months (2.3-5.5) and 10 months (7.3-12.8), respectively. Time to tumor progression was 4.3 months (2.6-5.9). Two patients (2%) achieved CR, 23 (22.5%) patients had PR, and 42 (41.2%) presented SD as best response. The clinical benefit rate with vinflunine was 65.7%. CONCLUSIONS Our results show that the behavior of vinflunine in routine clinical practice resembles that of the pivotal phase III randomized study.
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Affiliation(s)
- Daniel Castellano
- />Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Javier Puente
- />Medical Oncology Department, Clínico San Carlos University Hospital, Madrid, Spain
| | - Guillermo de Velasco
- />Research Fellow in Uro-Oncology, Cambridge University Health Partners, Cambridge, UK
| | - Isabel Chirivella
- />Medical Oncology Department, Clínico de Valencia University Hospital, Valencia, Spain
| | | | - Nicolás Mohedano
- />Medical Oncology Department, Guadalajara University Hospital, Guadalajara, Spain
| | - Ovidio Fernández
- />Medical Oncology Department, Orense Hospital Complex, Orense, Spain
| | | | | | - Enrique Grande
- />Medical Oncology Department, Ramón y Cajal University Hospital, Ctra. de Colmenar Viejo km. 9,100, 28034 Madrid, Spain
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231
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Necchi A, Pond GR, Giannatempo P, Di Lorenzo G, Eigl BJ, Locke J, Pal SK, Agarwal N, Poole A, Vaishampayan UN, Niegisch G, Hussain SA, Singh P, Bellmunt J, Sonpavde G. Cisplatin-based first-line therapy for advanced urothelial carcinoma after previous perioperative cisplatin-based therapy. Clin Genitourin Cancer 2014; 13:178-84. [PMID: 25450035 DOI: 10.1016/j.clgc.2014.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/08/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Outcomes with cisplatin-based first-line therapy for advanced UC after previous perioperative cisplatin-based chemotherapy are unclear. In this study we evaluated outcomes with a focus on the effect of time from previous cisplatin-based perioperative chemotherapy. PATIENTS AND METHODS Data were collected for patients who received cisplatin-based first-line therapy for advanced UC after previous perioperative cisplatin-based therapy. Cox proportional hazards models were used to investigate the prognostic ability of visceral metastasis, ECOG PS, TFPC, anemia, leukocytosis, and albumin on overall survival (OS). RESULTS Data were available for 41 patients from 8 institutions including 31 men (75.6%). The median age was 61 (range, 41-77) years, most received gemcitabine plus cisplatin (n = 26; 63.4%), and the median number of cycles was 4 (range, 1-8). The median OS was 68 weeks (95% confidence interval [CI], 48.0-81.0). Multivariable Cox regression analysis results showed an independent prognostic effect on OS for PS > 0 versus 0 (hazard ratio [HR], 4.56 [95% CI, 1.66-12.52]; P = .003) and TFPC ≥ 78 weeks versus < 78 weeks (HR, 0.48 [95% CI, 0.21-1.07]; P = .072). The prognostic model for OS was internally validated with c-index = 0.68. Patients with TFPC < 52 weeks, 52 to 104 weeks, and ≥ 104 weeks had median survival of 42, 70, and 162 weeks, respectively. CONCLUSION Longer TFPC ≥ 78 weeks and ECOG PS = 0 were independently prognostic for better survival with cisplatin-based first-line chemotherapy for advanced UC after previous perioperative cisplatin-based chemotherapy. The data support using TFPC ≥ 52 weeks to rechallenge with cisplatin-based first-line chemotherapy for metastatic disease.
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Affiliation(s)
- Andrea Necchi
- Department of Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gregory R Pond
- Department of Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Patrizia Giannatempo
- Department of Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Bernhard J Eigl
- Department of Medicine, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Jenn Locke
- Department of Medicine, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Sumanta K Pal
- Department of Medicine, City of Hope Cancer Center, Duarte, CA
| | - Neeraj Agarwal
- Department of Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Austin Poole
- Department of Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Guenter Niegisch
- Department of Urology, Heinrich Heine University, Dusseldorf, Germany
| | - Syed A Hussain
- Department of Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | - Joaquim Bellmunt
- Department of Medicine, Dana Farber Cancer Institute, Boston, MA
| | - Guru Sonpavde
- Department of Medicine, UAB Comprehensive Cancer Center, Birmingham, AL.
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232
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Choueiri TK, Fay AP, Gray KP, Callea M, Ho TH, Albiges L, Bellmunt J, Song J, Carvo I, Lampron M, Stanton ML, Hodi FS, McDermott DF, Atkins MB, Freeman GJ, Hirsch MS, Signoretti S. PD-L1 expression in nonclear-cell renal cell carcinoma. Ann Oncol 2014; 25:2178-2184. [PMID: 25193987 DOI: 10.1093/annonc/mdu445] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Programmed death ligand-1 (PD-L1) expression in nonclear-cell RCC (non-ccRCC) and its association with clinical outcomes are unknown. METHODS Formalin-fixed paraffin-embedded (FFPE) specimens were obtained from 101 patients with non-ccRCC. PD-L1 expression was evaluated by immunohistochemistry in both tumor cell membrane and tumor-infiltrating mononuclear cells (TIMC). PD-L1 tumor positivity was defined as ≥5% tumor cell membrane staining. For PD-L1 expression in TIMC, a combined score based on the extent of infiltrate and percentage of positive cells was used. Baseline clinico-pathological characteristics and outcome data [time to recurrence (TTR) and overall survival (OS)] were correlated with PD-L1 staining. RESULTS Among 101 patients, 11 (10.9%) were considered PD-L1+ in tumor cells: 2/36 (5.6%) of chromophobe RCC, 5/50 (10%) of papillary RCC, 3/10 (30%) of Xp11.2 translocation RCC and 1/5 (20%) of collecting duct carcinoma. PD-L1 positivity (PD-L1+) in tumor cells was significantly associated with higher stage (P = 0.01) and grade (P = 0.03), as well as shorter OS (P < 0.001). On the other hand, PD-L1 positivity by TIMC was observed in 57 (56.4%) patients: 13/36 (36.1%) of chromophobe RCC, 30/50 (60%) of papillary RCC, 9/10 (90%) of Xp11.2 translocation RCC and 5/5 (100%) of collecting duct carcinoma. A trend toward shorter OS was observed in patients with PD-L1+ in TIMC (P = 0.08). PD-L1+ in both tumor cell membrane and TIMC cells were associated with shorter TTR (P = 0.02 and P = 0.03, respectively). CONCLUSION In non-ccRCC, patients with PD-L1+ tumors appear to have worse clinical outcomes, although only PD-L1 positivity in tumor cells is associated with higher tumor stage and grade.
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Affiliation(s)
- T K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Medical Oncology, Brigham and Women's Hospital, Boston; Harvard Medical School, Boston.
| | - A P Fay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - K P Gray
- Biostatistics and Computational Biology, Harvard School of Public Health, Boston
| | - M Callea
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - T H Ho
- Department of Medical Oncology, Mayo Clinic, Scottsdale
| | - L Albiges
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Bellmunt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Medical Oncology, Brigham and Women's Hospital, Boston; Harvard Medical School, Boston
| | - J Song
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - I Carvo
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - M Lampron
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - M L Stanton
- Department of Medical Oncology, Mayo Clinic, Scottsdale
| | - F S Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston; Center for Immuno-oncology, Dana-Farber Cancer Institute, Boston
| | - D F McDermott
- Harvard Medical School, Boston; Department of Medical Oncology, Beth-Israel Deaconess Medical Center, Boston
| | - M B Atkins
- Department of Medical Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, USA
| | - G J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston
| | - M S Hirsch
- Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
| | - S Signoretti
- Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
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Mise au point du FRancilian Oncogeriatric Group (FROG) pour la prise en charge du cancer de vessie du sujet âgé. Bull Cancer 2014; 101:841-55. [DOI: 10.1684/bdc.2014.1939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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234
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Ramos JD, Cheng HH, Yu EY. Long-term survival in bone-predominant metastatic urothelial carcinoma. Clin Genitourin Cancer 2014; 12:e241-4. [PMID: 25160520 DOI: 10.1016/j.clgc.2014.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/13/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Jorge D Ramos
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle, WA
| | - Heather H Cheng
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle, WA
| | - Evan Y Yu
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle, WA.
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235
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Bellmunt J, Orsola A, Leow JJ, Wiegel T, De Santis M, Horwich A. Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3:iii40-8. [PMID: 25096609 DOI: 10.1093/annonc/mdu223] [Citation(s) in RCA: 230] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- J Bellmunt
- Department of Medical Oncology, University Hospital del Mar-IMIM, Barcelona, Spain Bladder Cancer Center, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, USA
| | - A Orsola
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J J Leow
- Department of Medical Oncology, University Hospital del Mar-IMIM, Barcelona, Spain Bladder Cancer Center, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, USA
| | - T Wiegel
- Department of Radio Oncology, University Hospital Ulm, Ulm, Germany
| | - M De Santis
- Ludwig Boltzmann Institute for Applied Cancer Research, Kaiser Franz Josef- Spital, Vienna, Austria
| | - A Horwich
- Institute of Cancer Research and Royal Marsden Hospital, Sutton, UK
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236
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Sonpavde G, Bellmunt J, Rosenberg JE, Regazzi AM, Bajorin DF, Choueiri TK, Qu AQ, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Fougeray R, Wong YN, Sridhar SS, Ko YJ, Milowsky MI, Galsky MD, Pond GR. Patient eligibility and trial design for the salvage therapy of advanced urothelial carcinoma. Clin Genitourin Cancer 2014; 12:395-8. [PMID: 25035282 DOI: 10.1016/j.clgc.2014.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/28/2014] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Angela Q Qu
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | - Yoo-Joung Ko
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | | | - Matthew D Galsky
- Tisch Cancer Center Institute, Mount Sinai School of Medicine, New York, NY
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237
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Shah CH, Viktorsson K, Kanter L, Sherif A, Asmundsson J, Rosenblatt R, Lewensohn R, Ullén A. Vascular endothelial growth factor receptor 2, but not S100A4 or S100A6, correlates with prolonged survival in advanced urothelial carcinoma. Urol Oncol 2014; 32:1215-24. [PMID: 24880461 DOI: 10.1016/j.urolonc.2014.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE A major challenge in muscle-invasive urothelial carcinoma (UC) is to identify biomarkers that can predict disease prognosis and treatment response after cystectomy. Therefore, we analyzed the potential prognostic value of the proteins vascular endothelial growth factor receptor 2 (VEGFR2), S100A4, and S100A6 in UC. METHODS Retrospective outcome data and tumor specimens from 83 cystectomy patients with histologically confirmed invasive UC were included. Expression levels of VEGFR2 (also called flk-1 and KDR), S100A4, and S100A6 were analyzed in primary tumor tissue by immunohistochemistry. RESULTS Immunohistochemical staining and analysis of VEGFR2, S100A4, and S100A6 showed localization mainly in tumor cell cytoplasm. High VEGFR2 expression and low tumor category were independent variables associated with longer overall survival (OS) and disease-free survival, revealed by a bivariate Cox proportional hazards regression model (both P<0.001). In addition, the univariate log-rank test and the Cox model demonstrated that OS beyond 2 years was significantly greater among patients with low S100A6 expression than in those with high S100A6 expression (P = 0.017 and 0.022, respectively). Differences in tumor expression of S100A4 were not significantly associated with outcome. CONCLUSION In this study, VEGFR2 expression was significantly correlated with risk of disease relapse and OS in a defined cohort of patients with UC of the bladder treated by cystectomy.
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Affiliation(s)
- Carl-Henrik Shah
- Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Kristina Viktorsson
- Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, Sweden
| | - Lena Kanter
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Amir Sherif
- Urology and Andrology, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Jurate Asmundsson
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Rolf Lewensohn
- Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ullén
- Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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238
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Ortmann CA, Mazhar D. Second-line systemic therapy for metastatic urothelial carcinoma of the bladder. Future Oncol 2014; 9:1637-51. [PMID: 24156324 DOI: 10.2217/fon.13.139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
While platinum-based combination chemotherapy leads to high response rates in patients with advanced urothelial cancer of the bladder, most patients will ultimately progress and optimal treatment in the second-line setting still needs to be determined. Advanced age, poor performance status, comorbidities and rapidly progressive disease have rendered accrual into trials difficult. Vinflunine is the only cytotoxic agent to demonstrate survival benefit in a randomized Phase III setting, but its response rate is disappointing and it has not been compared with other currently used agents such as taxanes. Recent years have seen a better definition of prognostic and predictive factors in patients with relapsed urothelial cancer. In addition, several trials have investigated novel biological agents to target chemoresistant disease. This review provides an update on the current systemic management of advanced urothelial cancer on progression following first-line chemotherapy, and discusses emerging data from recent Phase II/III trials.
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239
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Pond GR, Agarwal N, Bellmunt J, Choueiri TK, Qu A, Fougeray R, Vaughn D, James ND, Salhi Y, Albers P, Niegisch G, Galsky MD, Wong YN, Ko YJ, Stadler WM, O'Donnell PH, Sridhar SS, Vogelzang NJ, Necchi A, Di Lorenzo G, Sternberg CN, Mehta A, Sonpavde G. A nomogram including baseline prognostic factors to estimate the activity of second-line therapy for advanced urothelial carcinoma. BJU Int 2014; 113:E137-43. [DOI: 10.1111/bju.12564] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gregory R. Pond
- Ontario Clinical Oncology Group; McMaster University; Hamilton ON Canada
| | - Neeraj Agarwal
- Department of Medicine; Section of Hematology-Oncology Huntsman Cancer Institute; University of Utah; Salt Lake City UT USA
| | | | - Toni K. Choueiri
- Department of Medicine; Section of Hematology-Oncology Dana-Farber Cancer Institute and Harvard Medical School; Boston MA USA
| | - Angela Qu
- Institut de Recherche Pierre Fabre; Boulogne France
| | | | - David Vaughn
- Department of Medicine; Section of Hematology-Oncology University of Pennsylvania; Philadelphia PA USA
| | | | - Yacine Salhi
- Institut de Recherche Pierre Fabre; Boulogne France
| | | | | | - Matthew D. Galsky
- Department of Medicine; Section of Hematology-Oncology Tisch Cancer Center Institute; Mount Sinai School of Medicine; New York NY
| | - Yu-Ning Wong
- Department of Medicine; Section of Hematology-Oncology Fox Chase Cancer Center; Philadelphia PA USA
| | - Yoo-Joung Ko
- Sunnybrook Odette Cancer Centre; Toronto ON Canada
| | - Walter M. Stadler
- Department of Medicine; Section of Hematology-Oncology University of Chicago; Chicago IL USA
| | - Peter H. O'Donnell
- Department of Medicine; Section of Hematology-Oncology University of Chicago; Chicago IL USA
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori; Milan
| | | | | | - Amitkumar Mehta
- Department of Medicine; Section of Hematology-Oncology UAB (University of Alabama at Birmingham) Comprehensive Cancer Center; Birmingham AL USA
| | - Guru Sonpavde
- Department of Medicine; Section of Hematology-Oncology UAB (University of Alabama at Birmingham) Comprehensive Cancer Center; Birmingham AL USA
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240
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Vinflunine for the treatment of metastatic transitional cell carcinoma: recent evidence from clinical trials and observational studies. ACTA ACUST UNITED AC 2014. [DOI: 10.4155/cli.14.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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241
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Giannatempo P, Alessi A, Miceli R, Raggi D, Farè E, Nicolai N, Serafini G, Padovano B, Piva L, Biasoni D, Torelli T, Catanzaro M, Stagni S, Maffezzini M, Mariani L, Gianni AM, Sonpavde G, Salvioni R, Necchi A, Crippa F. Interim fluorine-18 fluorodeoxyglucose positron emission tomography for early metabolic assessment of therapeutic response to chemotherapy for metastatic transitional cell carcinoma. Clin Genitourin Cancer 2014; 12:433-9. [PMID: 24787972 DOI: 10.1016/j.clgc.2014.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/03/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prognostic impact of early metabolic response by fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) after 2 cycles of first-line chemotherapy is still unrecognized in metastatic transitional cell carcinoma (TCC). PATIENTS AND METHODS Patients with metastatic TCC receiving the modified combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), according to institutional protocol, underwent computed tomography (CT) and FDG-PET imaging at baseline, a restaging with PET imaging after 2 cycles only (PET2), and a CT (± FDG-PET) scan at the end of treatment and during follow-up. Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method; univariate (UVA) and multivariate (MVA) Cox models were fitted. Prespecified variables were the presence of visceral metastases, nodal or soft tissue disease, and early PET response. RESULTS In the period from May 2010 to October 2012, 31 patients with Eastern Cooperative Oncology Group performance status 0 received the modified MVAC regimen every 3 weeks. In all, 6 patients (19.3%) had a complete response (CR) and 17 (54.8%) a partial metabolic response (PR), 4 had stable disease (SD), and 4 progressed. PET2 responders had a median PFS of 8 months (95 % CI, 7-11 mo) compared with 3 months (95 % CI, 2-5 mo) of patients without response (P = .024). They also had a significant benefit in 8-month PFS (P < .001 via Klein test) and 15-month OS (P = .016). PET2 response was significant for PFS in both UVA and MVA Cox models (P = .027 and P = .023, respectively). CONCLUSION PET response after 2 cycles of first-line chemotherapy, compared with detection by early CT, was associated with longer PFS and OS in advanced TCC and warrants further investigation in the field.
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Affiliation(s)
- Patrizia Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Alessi
- Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Clinical Epidemiology and Trials Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Raggi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Farè
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gianluca Serafini
- Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Padovano
- Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Piva
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Biasoni
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tullio Torelli
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Catanzaro
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stagni
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Maffezzini
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Clinical Epidemiology and Trials Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro M Gianni
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; University of Milan School of Medicine, Milan, Italy
| | - Guru Sonpavde
- University of Alabama (UAB) Comprehensive Cancer Center, Birmingham, AL
| | - Roberto Salvioni
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Flavio Crippa
- Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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242
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Castellano DE, Bellmunt J, Maroto JP, Font-Pous A, Morales-Barrera R, Ghanem I, Suarez C, Martín Lorente C, Etxaniz O, Capdevila L, Coronado C, Alfaro V, Siguero M, Fernández-Teruel C, Carles J. Phase II clinical trial of PM00104 (Zalypsis®) in urothelial carcinoma patients progressing after first-line platinum-based regimen. Cancer Chemother Pharmacol 2014; 73:857-67. [DOI: 10.1007/s00280-014-2419-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/16/2014] [Indexed: 11/29/2022]
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243
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Necchi A, Giannatempo P, Mariani L, Farè E, Raggi D, Pennati M, Zaffaroni N, Crippa F, Marchianò A, Nicolai N, Maffezzini M, Togliardi E, Daidone MG, Gianni AM, Salvioni R, De Braud F. PF-03446962, a fully-human monoclonal antibody against transforming growth-factor β (TGFβ) receptor ALK1, in pre-treated patients with urothelial cancer: an open label, single-group, phase 2 trial. Invest New Drugs 2014; 32:555-60. [PMID: 24566706 DOI: 10.1007/s10637-014-0074-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 02/07/2014] [Indexed: 01/23/2023]
Abstract
Despite a compelling preclinical rationale for the use of anti-angiogenic drugs in urothelial cancer (UC), short-living responses have been observed in clinical trials. PF-03446962 is a novel monoclonal antibody against Activin Receptor-Like Kinase-1 (ALK1), a type I subclass of the TGFβ receptor, with dose-dependent anti-angiogenic activity. An open label, single-group, phase 2 trial of PF-03446962 was conducted in salvage setting. Patients failing at least one chemotherapy regimen were eligible. Design provided PF-03446962 10 mg/Kg intravenously fortnightly until disease progression (PD) or unacceptable toxicity. Two-month progression-free survival (PFS) was the primary endpoint. The trial was registered with ClinicalTrials.gov, number NCT01620970. Fourteen patients were enrolled from October 2012 to July 2013. Median age was 64 years (interquartile range [IQR]: 58.2-69.5), 9 patients had a Bellmunt score of 1-2, median number of prior drugs was 3. One stable disease and 13 PD were recorded and the study met the futility stopping rule of interim analysis. Median PFS was 1.8 months (95 %CI, 1.4-2.0). After a median follow up of 7.4 months (IQR 4.5-10.9), 8 patients are alive. Median overall survival (OS) was 8 months (95 %CI, 2.9-not estimable). Most common toxicities were thrombocytopenia (G1-2 in 5 cases, persistent G3 in one, with 3 dose delays and 1 dose interruption), fatigue and abdominal pain (G1-2 in 4 cases each). Impairment of quality of life (ESAS score) was observed as well as an increase from baseline to +2 month median levels of vascular endothelial growth factor (VEGF) and interleukin-8. PF-03446962 had no activity as single drug in refractory UC and we do not recommend further investigation outside of the combination with agents targeting the VEGF receptor axis.
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Affiliation(s)
- A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy,
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Riester M, Werner L, Bellmunt J, Selvarajah S, Guancial EA, Weir BA, Stack EC, Park RS, O'Brien R, Schutz FAB, Choueiri TK, Signoretti S, Lloreta J, Marchionni L, Gallardo E, Rojo F, Garcia DI, Chekaluk Y, Kwiatkowski DJ, Bochner BH, Hahn WC, Ligon AH, Barletta JA, Loda M, Berman DM, Kantoff PW, Michor F, Rosenberg JE. Integrative analysis of 1q23.3 copy-number gain in metastatic urothelial carcinoma. Clin Cancer Res 2014; 20:1873-83. [PMID: 24486590 DOI: 10.1158/1078-0432.ccr-13-0759] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Metastatic urothelial carcinoma of the bladder is associated with multiple somatic copy-number alterations (SCNAs). We evaluated SCNAs to identify predictors of poor survival in patients with metastatic urothelial carcinoma treated with platinum-based chemotherapy. EXPERIMENTAL DESIGN We obtained overall survival (OS) and array DNA copy-number data from patients with metastatic urothelial carcinoma in two cohorts. Associations between recurrent SCNAs and OS were determined by a Cox proportional hazard model adjusting for performance status and visceral disease. mRNA expression was evaluated for potential candidate genes by NanoString nCounter to identify transcripts from the region that are associated with copy-number gain. In addition, expression data from an independent cohort were used to identify candidate genes. RESULTS Multiple areas of recurrent significant gains and losses were identified. Gain of 1q23.3 was independently associated with a shortened OS in both cohorts [adjusted HR, 2.96; 95% confidence interval (CI), 1.35-6.48; P = 0.01 and adjusted HR, 5.03; 95% CI, 1.43-17.73; P < 0.001]. The F11R, PFDN2, PPOX, USP21, and DEDD genes, all located on 1q23.3, were closely associated with poor outcome. CONCLUSIONS 1q23.3 copy-number gain displayed association with poor survival in two cohorts of metastatic urothelial carcinoma. The identification of the target of this copy-number gain is ongoing, and exploration of this finding in other disease states may be useful for the early identification of patients with poor-risk urothelial carcinoma. Prospective validation of the survival association is necessary to demonstrate clinical relevance.
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Affiliation(s)
- Markus Riester
- Authors' Affiliations: Departments of Biostatistics and Computational Biology, and Medical Oncology; Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute; Department of Biostatistics, Harvard School of Public Health; Department of Pathology; Translational Medicine Division, Brigham and Women's Hospital, Boston; Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Sidney Kimmel Cancer Center; Department of Pathology, Johns Hopkins University, Baltimore, Maryland; Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York; and Hospital del Mar Research Institute-IMIM, Barcelona; and Hospital Parc Tauli, Sabadell, Spain
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245
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Nadal R, Bellmunt J. New Treatments for Bladder Cancer: When Will We Make Progress? Curr Treat Options Oncol 2014; 15:99-114. [DOI: 10.1007/s11864-013-0271-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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246
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Han JJ, Kim YJ, Kim JW, Chang H, Lee JO, Lee KW, Jeong CW, Kim JH, Hong SK, Bang SM, Byun SS, Lee SE, Lee JS. Salvage Treatment with Low-Dose Weekly Paclitaxel in Elderly or Poor Performance Status Patients with Metastatic Urothelial Carcinoma. TUMORI JOURNAL 2014. [DOI: 10.1177/1636.17906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jae Joon Han
- Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yu Jung Kim
- Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jin Won Kim
- Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyun Chang
- Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jeong-Ok Lee
- Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Keun-Wook Lee
- Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Chang Wook Jeong
- Departments of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jee Hyun Kim
- Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sung Kyu Hong
- Departments of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Soo-Mee Bang
- Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Seok-Soo Byun
- Departments of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sang Eun Lee
- Departments of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jong Seok Lee
- Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Stadler WM, Vaughn DJ, Sonpavde G, Vogelzang NJ, Tagawa ST, Petrylak DP, Rosen P, Lin CC, Mahoney J, Modi S, Lee P, Ernstoff MS, Su WC, Spira A, Pilz K, Vinisko R, Schloss C, Fritsch H, Zhao C, Carducci MA. An open-label, single-arm, phase 2 trial of the Polo-like kinase inhibitor volasertib (BI 6727) in patients with locally advanced or metastatic urothelial cancer. Cancer 2013; 120:976-82. [PMID: 24339028 DOI: 10.1002/cncr.28519] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/31/2013] [Accepted: 11/04/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Polo-like kinases (Plks) control multiple steps during the cell cycle, and Plk1 is overexpressed in urothelial cancer (UC). Volasertib (BI 6727), a Plk inhibitor, has demonstrated antitumor activity in several malignancies, including UC. In this phase 2 trial, the authors investigated volasertib as a second-line treatment in advanced/metastatic UC. METHODS Patients who progressed within 2 years of 1 prior chemotherapy regimen received 300 mg volasertib on day 1 every 3 weeks. The dose was escalated to 350 mg in cycle 2 if volasertib was tolerated in cycle 1. The primary endpoint was tumor response, which was assessed every 6 weeks; secondary endpoints were progression-free survival, overall survival, duration of response, safety, and pharmacokinetics. RESULTS Fifty patients were enrolled, and the median patient age was 68.5 years (range, 52-83 years). All patients had received prior platinum, 94% of patients had relapsed ≤2 years after prior therapy, 36% had liver metastases, and 54% had lung metastases. The median number of treatment cycles was 2 (range, 1-27 treatment cycles), and 23 patients were dose escalated at cycle 2. Seven patients (14%) had a partial response, 13 (26%) had stable disease, and 30 (60%) progressed within 6 weeks. The median response duration was 41 weeks (range, 29.1-77.3 weeks). The median progression-free survival was 1.4 months, and the median overall survival was 8.5 months. The most frequent grade 3 and 4 adverse events were neutropenia (28%), thrombocytopenia (20%), and anemia (16%). No cumulative toxicity was observed. CONCLUSIONS Volasertib as second-line treatment for advanced/metastatic UC had an acceptable safety profile but demonstrated insufficient antitumor activity for further evaluation as a monotherapy.
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Affiliation(s)
- Walter M Stadler
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
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Hegele A, Goebell P, Matz U, Neuhaus T. Monotherapy with intravenous vinflunine in patients with advanced or metastatic urothelial cancer after failure of a platinum-containing regimen: a retrospective analysis of German routine data. Urol Int 2013; 92:174-9. [PMID: 24334998 DOI: 10.1159/000354751] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/30/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this retrospective study was to investigate the efficacy and safety of vinflunine monotherapy and the utility of second-line prognostic factors in patients with advanced or metastatic urothelial cancer relapsing/progressing during or after a prior platinum-containing regimen under daily routine clinical conditions in Germany. METHODS The selection was based on the marketing authorization indication and recommendations as well as on the evaluation of second-line prognostic factors issued from prior pivotal trials. RESULTS Eight centers across Germany provided a total of 21 patient records. Demographic and clinical characteristics were similar to the data previously reported in pivotal trials. Complete and partial response to vinflunine treatment was observed in 1 (4.8%) and 3 (14.3%) patients, respectively, resulting in an overall response rate of 19.1%. The disease control rate reached 47.7%. The median progression-free survival amounted to 4.4 months (95% CI 2.6-6.6), with a median overall survival of 6.2 months (95% CI 3.9-10.7). The observed toxicity profile was manageable and consistent with prior clinical trials: leukopenia (33.3%), neutropenia (9.5%), anemia (9.5%) and hyperglycemia (4.8%). The reported satisfaction rate with the treatment was 90.5 and 61.9% among patients and physicians, respectively. CONCLUSIONS This retrospective study confirms that the clinical outcomes obtained from routine medical practice in Germany with vinflunine in the treatment of advanced/metastatic urothelial cancer are in line with the data observed in prior clinical trials.
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Affiliation(s)
- Axel Hegele
- Department of Urology and Pediatric Urology, University Hospital, Marburg, Germany
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Terakawa T, Miyake H, Yokoyama N, Miyazaki A, Tanaka H, Inoue T, Fujisawa M. Clinical outcome of paclitaxel and carboplatin as second-line chemotherapy for advanced urothelial carcinoma resistant to first-line therapy with gemcitabine and cisplatin. Urol Int 2013; 92:180-5. [PMID: 24246751 DOI: 10.1159/000354149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective was to investigate the efficacy and tolerability of combined therapy with paclitaxel and carboplatin (TC) in patients with advanced urothelial carcinoma after the failure of first-line chemotherapy with gemcitabine and cisplatin (GC). PATIENTS AND METHODS This was a retrospective study including a total of 16 patients with advanced urothelial carcinoma who showed evidence of progressive and/or recurrent disease after first-line therapy with GC and subsequently received second-line chemotherapy consisting of paclitaxel (175 mg/m(2)) and carboplatin (area under the curve 5). TC therapy was repeated every 3 weeks and was continued until disease progression or intolerable toxicity was observed. RESULTS The baseline patient characteristics were rather favorable; only 3 of 16 patients had liver metastases and 7 patients had an Eastern Cooperative Oncology Group performance status of 0. Of these, response to TC therapy was achieved in 5 (31.3%), including 2 with complete and 3 with partial response. The median progression-free and overall survival times in the 16 patients were 7.9 and 17.3 months, respectively. CONCLUSIONS TC therapy appeared to show modest activity with acceptable tolerability in patients refractory to GC therapy; therefore, TC chemotherapy might be considered as an alternative option as a second-line regimen for advanced urothelial carcinoma following GC therapy.
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Abstract
INTRODUCTION Advanced urothelial carcinoma is associated with a poor prognosis. In the metastatic setting, the response rate to first-line, cisplatin-containing chemotherapy is high, but survival is poor. Second-line treatment options are limited. Advanced age at diagnosis and the presence of comorbidities often preclude treatment with cisplatin-containing regimens. AREAS COVERED This review addresses the current therapy of urothelial carcinoma, the unmet needs in treatment and the status of drug development in this disease. The molecular targets identified and efforts to incorporate targeted agents into therapy will be addressed. EXPERT OPINION There have been no major advances in the treatment of urothelial carcinoma in three decades. Despite high response rates in the first-line setting, survival is limited. Major impediments to improved outcomes include poor durability of response to first-line chemotherapy and lack of second-line treatments. Better understanding in tumor biology has identified multiple targets in urothelial carcinoma; however, such discoveries have yet to lead to the incorporation of targeted agents into the routine treatment of urothelial carcinoma. Multiple ongoing clinical trials are investigating the use of targeted agents in urothelial carcinoma. Continued efforts are underway to better understand the molecular drivers of disease and such efforts are likely to identify additional therapeutic targets.
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Affiliation(s)
- Benjamin A Gartrell
- Albert Einstein College of Medicine, Montefiore Medical Center, Department of Medical Oncology , 111 E 210th St, Bronx, NY, 10467 , USA +1 718 920 4826 ; +1 718 798 7474 ;
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