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Hattori Y, Fujiwara T, Hagimoto H, Kokubun H, Murata S, Makita N, Abe Y, Kubota M, Tohi Y, Tsutsumi N, Shibasaki N, Inoue K, Kawakita M, Yamasaki T. Efficacy and safety of dose-dense gemcitabine plus cisplatin as neoadjuvant chemotherapy for muscle-invasive bladder cancer. Int J Urol 2024. [PMID: 38961545 DOI: 10.1111/iju.15524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy and safety of dose-dense gemcitabine and cisplatin (ddGC) as neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC). METHODS Patients with locally advanced MIBC (cT2aN0M0-cT4N1M0) who received ddGC between December 2017 and December 2023 were included. Regimens of ddGC with pegfilgrastim were administered every 2 weeks for 4 cycles, followed by radical cystectomy. The pathological complete response (CR) (pT0N0) and objective response (OR) ( RESULTS A total of 45 patients (cT2N0, 60%; cT3N0, 22%; cT4N0, 9%; and cTanyN1, 9%) were included. Of the 41 who underwent cystectomy, 38 (92.7%) completed all planned cycles, with a median RDI of 0.96 (interquartile range [IQR], 0.89-1.00). Overall, CR and OR were achieved in 12 (29.3%) and 17 (41.5%) patients, respectively, increasing to 32.4% and 45.9%, respectively, in cN0 patients. Severe AEs (grade ≥ 3) were observed in eight patients (17.8%), including four hematological toxicities. At a median follow-up of 31 months, 2-year DFS and OS were 70.8% and 89.2%, respectively. CONCLUSION Neoadjuvant ddGC demonstrated good tolerability, efficacy, and safety, suggesting its potential as a treatment option for MIBC.
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Affiliation(s)
- Yuto Hattori
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Tasuku Fujiwara
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Hiroki Hagimoto
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Hidetoshi Kokubun
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Shiori Murata
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Noriyuki Makita
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Yohei Abe
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Masashi Kubota
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Yoichiro Tohi
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Naofumi Tsutsumi
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Noboru Shibasaki
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Koji Inoue
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Toshinari Yamasaki
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
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Skelton WP, Masur J, Thomas J, Fallah P, Jain RK, Ravi P, Mantia C, McGregor BA, Nuzzo PV, Adib E, Zarif TE, Preston MA, Clinton TN, Li R, Steele GS, Kassouf W, Freeman D, Pond GR, Jain RK, Sonpavde GP. Impact of Angiotensin Converting Enzyme Inhibitors on Pathologic Complete Response With Neoadjuvant Chemotherapy for Muscle Invasive Bladder Cancer. Clin Genitourin Cancer 2024; 22:102143. [PMID: 39032202 DOI: 10.1016/j.clgc.2024.102143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION The renin-angiotensin system (RAS) has been demonstrated to modulate cell proliferation, desmoplasia, angiogenesis and immunosuppression. We examined the association of RAS inhibitors (RASi)-namely angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB)-with neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) preceding radical cystectomy (RC). PATIENTS AND METHODS We retrospectively investigated concurrent RASi use with NAC prior to RC in 302 patients with MIBC from 3 academic institutions. Outcomes included pathologic complete response (pCR) and overall survival (OS). Pathologic features, performance status (PS), clinical stage, type/number of cycles of NAC, and toxicities were collected. RESULTS Overall pCR rate was 26.2% and 5-year OS was 62%. Concurrent ACEi intake with NAC approached significance for association with pCR (odds ratio [OR] = 1.71; 95% CI, 0.94-3.11; P = .077). Patients with cT3/4N0-N1 disease receiving ACEi had higher pCR rates (30.8% vs. 17.7%, P = .056) than those not on ACEi. Female sex had a statistically significant favorable interaction for pCR with ACEi intake (P = .044). ACEi intake was not associated with OS, while pCR, PS and lower clinical stage were significantly associated with improved OS. CONCLUSION ACEi intake is potentially associated with increased pCR in patients with MIBC receiving NAC prior to RC, and this association is more pronounced in patients with higher clinical stage of disease at the initiation of therapy and female sex. Our data suggest the potential relevance of the RAS as a therapeutic target in aggressive MIBC.
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Affiliation(s)
- William Paul Skelton
- University of Virginia Comprehensive Cancer Center, Department of Oncology, Charlottesville, VA; H. Lee Moffitt Cancer Center and Research Institute, Department of Oncology, Tampa, FL
| | - Jack Masur
- University of Virginia Comprehensive Cancer Center, Department of Oncology, Charlottesville, VA
| | - Jonathan Thomas
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Parvaneh Fallah
- McGill University, Department of Oncology, Montreal, Quebec, Canada
| | - Rohit K Jain
- H. Lee Moffitt Cancer Center and Research Institute, Department of Oncology, Tampa, FL
| | - Praful Ravi
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Charlene Mantia
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | | | | | - Elio Adib
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Talal El Zarif
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Mark A Preston
- Brigham and Women's Hospital, Department of Oncology, Boston, MA
| | | | - Roger Li
- H. Lee Moffitt Cancer Center and Research Institute, Department of Oncology, Tampa, FL
| | - Graeme S Steele
- Brigham and Women's Hospital, Department of Oncology, Boston, MA
| | - Wassim Kassouf
- McGill University, Department of Oncology, Montreal, Quebec, Canada
| | - Dory Freeman
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | | | - Rakesh K Jain
- Massachusetts General Hospital, Department of Oncology, Boston, MA
| | - Guru P Sonpavde
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA; AdventHealth Cancer Institute and the University of Central Florida, Department of Oncology, Orlando, FL.
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Eule CJ, Warren A, Molina Kuna E, Callihan EB, Kim SP, Flaig TW. Neoadjuvant Cisplatin-based Chemotherapy in Nonmetastatic Muscle-invasive Bladder Cancer: A Systematic Review and Pooled Meta-analysis to Determine the Preferred Regimen. Urology 2024; 188:118-124. [PMID: 38685388 DOI: 10.1016/j.urology.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/01/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To determine whether neoadjuvant gemcitabine and cisplatin (GC) vs dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) before radical cystectomy improves overall survival (OS), progression-free survival (PFS), and pathologic complete response (pCR) for patients with muscle-invasive bladder cancer with secondary analyses of pathological downstaging and toxicity. MATERIALS AND METHODS This systematic review and meta-analysis identified studies of patients with muscle-invasive bladder cancer treated with neoadjuvant GC compared to ddMVAC from PubMed, Web of Science, and EMBASE. Random-effect models for pooled log-transformed hazard ratios (HR) for OS and PFS and pooled odds ratios for pCR and downstaging were developed using the generic inverse variance method and Mantel-Haenszel method, respectively. RESULTS Ten studies were identified (4 OS, 2 PFS, and 6 pCR clinical endpoints). Neoadjuvant ddMVAC improved OS (HR 0.71 [95% confidence intervals 0.56; 0.90]), PFS (HR 0.76 [95% confidence intervals 0.60; 0.97]), and pathological downstaging (odds ratio 1.34 [95% confidence interval 1.01; 1.78]) as compared to GC. There was no significant difference between regimens for pCR rates (odds ratio 1.38 [95% confidence interval 0.90; 2.12]). Treatment toxicity was greater with ddMVAC. Limitations result from differences in number of ddMVAC cycles and patient selection between studies. CONCLUSION Neoadjuvant ddMVAC is associated with improved OS and PFS vs gemcitabine/cisplatin for patients with muscle-invasive bladder cancer before radical cystectomy. Although rates of pathological complete response were not significantly different, pathological downstaging correlated with OS. ddMVAC should be preferred over gemcitabine/cisplatin for patients with muscle-invasive bladder cancer who can tolerate its greater toxicity.
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Affiliation(s)
- Corbin J Eule
- University of Colorado Cancer Center, Division of Medical Oncology, Department of Medicine, Aurora, CO.
| | - Adam Warren
- University of Colorado Cancer Center, Population Health Shared Resource, Aurora, CO.
| | - Elizabeth Molina Kuna
- University of Colorado Cancer Center, Population Health Shared Resource, Aurora, CO.
| | - Eryn B Callihan
- University of Colorado Cancer Center, Division of Medical Oncology, Department of Medicine, Aurora, CO.
| | - Simon P Kim
- University of Colorado Cancer Center, Division of Urology, Department of Surgery, Aurora, CO.
| | - Thomas W Flaig
- University of Colorado Cancer Center, Division of Medical Oncology, Department of Medicine, Aurora, CO.
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Kim S, St-Laurent MP, Black P. Biomarker challenges in the pursuit of personalized neoadjuvant chemotherapy for muscle-invasive bladder cancer: conclusions from SWOG S1314. Transl Androl Urol 2024; 13:458-462. [PMID: 38590957 PMCID: PMC10999026 DOI: 10.21037/tau-23-620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/08/2024] [Indexed: 04/10/2024] Open
Affiliation(s)
- Sandra Kim
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Marie-Pier St-Laurent
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Lerner SP, McConkey DJ, Tangen CM, Meeks JJ, Flaig TW, Hua X, Daneshmand S, Alva AS, Lucia MS, Theodorescu D, Goldkorn A, Milowsky MI, Choi W, Bangs R, Gustafson DL, Plets M, Thompson IM. Association of Molecular Subtypes with Pathologic Response, PFS, and OS in a Phase II Study of COXEN with Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer. Clin Cancer Res 2024; 30:444-449. [PMID: 37966367 PMCID: PMC10824507 DOI: 10.1158/1078-0432.ccr-23-0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/25/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE The Coexpression Extrapolation (COXEN) gene expression model with chemotherapy-specific scores [for methotrexate, vinblastine, adriamycin, cisplatin (ddMVAC) and gemcitabine/cisplatin (GC)] was developed to identify responders to neoadjuvant chemotherapy (NAC). We investigated RNA-based molecular subtypes as additional predictive biomarkers for NAC response, progression-free survival (PFS), and overall survival (OS) in patients treated in S1314. EXPERIMENTAL DESIGN A total of 237 patients were randomized between four cycles of ddMVAC (51%) and GC (49%). On the basis of Affymetrix transcriptomic data, we determined subtypes using three classifiers: TCGA (k = 5), Consensus (k = 6), and MD Anderson (MDA; k = 3) and assessed subtype association with path response to NAC and determined associations with COXEN. We also tested whether each classifier contributed additional predictive power when added to a model based on predefined stratification (strat) factors (PS 0 vs. 1; T2 vs. T3, T4a). RESULTS A total of 155 patients had gene expression results, received at least three of four cycles of NAC, and had pT-N response based on radical cystectomy. TCGA three-group classifier basal-squamous (BS)/neuronal, luminal (Lum), Lum infiltrated, and GC COXEN score yielded the largest AUCs for pT0 (0.59, P = 0.28; 0.60, P = 0.18, respectively). For downstaging ( CONCLUSIONS The Consensus classifier, based in part on the TCGA and MDA classifiers, modestly improved prediction for pathologic downstaging but subtypes were not associated with PFS or OS.
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Affiliation(s)
| | | | | | - Joshua J Meeks
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Thomas W Flaig
- University of Colorado, School of Medicine, Aurora, Colorado
| | - Xing Hua
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - M Scott Lucia
- University of Colorado, School of Medicine, Aurora, Colorado
| | | | - Amir Goldkorn
- University of Southern California, Los Angeles, California
| | - Matthew I Milowsky
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | | | - Rick Bangs
- SWOG Cancer Research Network, Portland, Oregon
| | | | - Melissa Plets
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ian M Thompson
- CHRISTUS Medical Center Hospital, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Wen F, Lin T, Zhang P, Shen Y. RC48-ADC combined with tislelizumab as neoadjuvant treatment in patients with HER2-positive locally advanced muscle-invasive urothelial bladder cancer: a multi-center phase Ib/II study (HOPE-03). Front Oncol 2024; 13:1233196. [PMID: 38269021 PMCID: PMC10806139 DOI: 10.3389/fonc.2023.1233196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Background Bladder cancer with high expression of human epidermal growth factor receptor-2 (HER2) is related to pathological malignancy and poor prognosis. The standard care for muscle-invasive urothelial bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph node dissection. For HER2-positive MIBC, the efficacy of cisplatin-based NAC is unsatisfactory, and adverse reactions are inevitable or even intolerable. New regimens with higher efficiency and lower toxicity need to be explored in the neoadjuvant setting for this population. Methods HOPE-03 is a multi-center, open-label, single-arm, phase Ib/II study aiming to evaluate the safety and efficacy of RC48-ADC (disitamab vedotin (DV)), a humanized anti-HER2 antibody conjugated with monomethyl auristatin E, and tislelizumab (PD-1 antibody) as a novel neoadjuvant treatment combination in patients with HER2-positive locally advanced urothelial MIBC. Fifty-one patients with cT2-4bN0-3M0-1a pathology- and imaging-diagnosed HER2 positive (immunohistochemistry status 3+ or 2+ or 1+) MIBC were recruited. Of these patients, six were enrolled in the dose-escalation phase (three patients in the RC48-ADC 1.5 mg/kg group and three patients in the 2.0 mg/kg group), and 45 patients were enrolled in the phase II study (the expected recommended phase II dose for RC48-ADC was 2.0 mg/kg). Patients without disease progression received radical cystectomy or bladder-sparing therapies as their preference after neoadjuvant treatment. The primary endpoints were clinical complete remission rate (cCR rate; T0/Ta/Tis), pathological complete remission rate (pCR rate), and safety. The secondary endpoints were overall survival (OS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and quality of life. Discussion The HOPE-03 trial provides a description of the safety profile of RC-48 and tislelizumab combination in the neoadjuvant treatment of HER2-positive locally advanced urothelial MIBC, and the efficacy is explored as well in this population. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=137111, identifier ChiCTR2200060153.
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Affiliation(s)
- Feng Wen
- Abdominal Oncology Ward, Division of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tianhai Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Peng Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yali Shen
- Abdominal Oncology Ward, Division of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Nair SS, Chakravarty D, Patel V, Bhardwaj N, Tewari AK. Genitourinary cancer neoadjuvant therapies: current and future approaches. Trends Cancer 2023; 9:1041-1057. [PMID: 37684128 DOI: 10.1016/j.trecan.2023.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/30/2023] [Accepted: 07/19/2023] [Indexed: 09/10/2023]
Abstract
Neoadjuvant therapies can improve tolerability, reduce tumor volume to facilitate surgery, and assess subsequent treatment response. Therefore, there is much enthusiasm for expanding the benefits of cancer therapies to the neoadjuvant setting to reduce recurrence and improve survival in patients with localized or locally advanced genitourinary (GU) cancer. This approach is clinically pertinent because these treatments are administered primarily to treatment-naive patients and can elicit the greatest drug response. In addition, the results are not impacted by other anticancer treatments. While neoadjuvant therapies have been the standard treatment for bladder cancer in the past, they are presently restricted to clinical trials for renal and prostate cancer (PCa); however, changes are imminent. Precision neoadjuvant therapies will be ushered in by biomarker-stratified neoadjuvant trials with appropriate survival endpoints and comprehensive correlative and imaging studies. This review discusses neoadjuvant studies in GU malignancies and how they inform future study design considerations.
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Affiliation(s)
- Sujit S Nair
- Department of Urology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Dimple Chakravarty
- Department of Urology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Vaibhav Patel
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nina Bhardwaj
- Department of Urology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Ashutosh K Tewari
- Department of Urology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Ohtsu A, Arai S, Fujizuka Y, Miyazawa Y, Nomura M, Sekine Y, Koike H, Matsui H, Shibata Y, Ito K, Suzuki K. Predictive models of long-term survival outcomes following radical cystectomy. Cancer Med 2023; 12:21118-21128. [PMID: 37902172 PMCID: PMC10726758 DOI: 10.1002/cam4.6670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/20/2023] [Accepted: 10/20/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Identifying the likelihood of life-threatening recurrence after radical cystectomy by reliable and user-friendly predictive models remains an unmet need in the clinical management of invasive bladder cancer. METHODS A total of 204 consecutive patients undergoing open radical cystectomy (ORC) for bladder cancer were retrospectively enrolled between May 2005 and August 2020. Clinicopathological and peri-ORC therapeutic data were extracted from clinical records. We explored predictive factors that significantly affected the primary endpoint of overall survival (OS) and secondary endpoints of cancer-specific survival (CSS) and recurrence-free survival (RFS). RESULTS During a median follow-up of 3.9 years, 42 (20.6%) and 10 (4.9%) patients died due to bladder cancer and other causes, respectively. Five-year RFS, CSS, and OS were 66.5%, 77.6%, and 75.4%, respectively. Pathological T and N categories and lymphovascular invasion (LVI) significantly affected RFS by Cox regression analysis. Accordingly, clinical T and pathological N categories and LVI significantly affected CSS. Clinical T and pathological N categories, LVI, age, and ORC tumor grade significantly affected OS. Based on the assessment score for each independent risk factor, we developed the Gunma University Oncology Study Group (GUOSG) score, which predicts RFS, CSS, and OS. The GUOSG score classified four groups for RFS, three for CSS, and five for OS, with statistically significant distribution for nearly all comparisons. CONCLUSIONS The GUOSG model is helpful to show individualized prognosis and functions as a risk-stratified historical cohort for assessing the lifelong efficacy of new salvage treatment regimens.
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Affiliation(s)
- Akira Ohtsu
- Department of UrologyGunma University Graduate School of MedicineMaebashiJapan
| | - Seiji Arai
- Department of UrologyGunma University Graduate School of MedicineMaebashiJapan
| | - Yuji Fujizuka
- Department of UrologyGunma University Graduate School of MedicineMaebashiJapan
| | - Yoshiyuki Miyazawa
- Department of UrologyGunma University Graduate School of MedicineMaebashiJapan
| | - Masashi Nomura
- Department of UrologyGunma University Graduate School of MedicineMaebashiJapan
| | - Yoshitaka Sekine
- Department of UrologyGunma University Graduate School of MedicineMaebashiJapan
| | - Hidekazu Koike
- Department of UrologyGunma University Graduate School of MedicineMaebashiJapan
| | - Hiroshi Matsui
- Department of UrologyGunma University Graduate School of MedicineMaebashiJapan
| | - Yasuhiro Shibata
- Department of UrologyTakasaki General Medical CenterTakasakiJapan
| | - Kazuto Ito
- Department of UrologyKurosawa HospitalTakasakiJapan
| | - Kazuhiro Suzuki
- Department of UrologyGunma University Graduate School of MedicineMaebashiJapan
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Flaig TW, Tangen CM, Daneshmand S, Alva AS, Lucia MS, McConkey DJ, Theodorescu D, Goldkorn A, Milowsky MI, Bangs R, MacVicar GR, Bastos BR, Fowles JS, Gustafson DL, Plets M, Thompson IM, Lerner SP. Long-term Outcomes from a Phase 2 Study of Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer (SWOG S1314; NCT02177695). Eur Urol 2023; 84:341-347. [PMID: 37414705 PMCID: PMC10659139 DOI: 10.1016/j.eururo.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/15/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The COXEN gene expression model was evaluated for prediction of response to neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC). OBJECTIVE To conduct a secondary analysis of the association of each COXEN score with event-free survival (EFS) and overall survival (OS) and by treatment arm. DESIGN, SETTING, AND PARTICIPANTS This was a randomized phase 2 trial of neoadjuvant gemcitabine-cisplatin (GC) or dose-dense methotrexate-vinblastine-adriamycin-cisplatin (ddMVAC) in MIBC. INTERVENTION Patients were randomized to ddMVAC (every 14 d) or GC (every 21 d), both for four cycles. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS EFS events were defined as progression or death before scheduled surgery, a decision to not undergo surgery, recurrence, or death due to any cause after surgery. Cox regression was used to evaluate the COXEN score or treatment arm association with EFS and OS. RESULTS AND LIMITATIONS A total of 167 evaluable patients were included in the COXEN analysis. The COXEN scores were not significantly prognostic for OS or EFS in the respective arms, but the GC COXEN score had a hazard ratio (HR) of 0.45 (95% confidence interval [CI] 0.20-0.99; p = 0.047) when the arms were pooled. In the intent-to-treat analysis (n = 227), there was no significant difference between ddMVAC and GC for OS (HR 0.87, 95% CI 0.54-1.40; p = 0.57) or EFS (HR 0.86, 95% CI 0.59-1.26; p = 0.45). Among the 192 patients who underwent surgery, pathologic response (pT0 vs downstaging vs no response) was strongly correlated with superior postsurgical survival (5-yr OS 90%, 89% and 52%, respectively). CONCLUSIONS The COXEN GC score has prognostic value for patients receiving cisplatin-based neoadjuvant treatment. The randomized, prospective design provides estimates of OS and EFS for GC and ddMVAC in this population. Pathologic response ( PATIENT SUMMARY In this study, we evaluated a biomarker to predict the response to chemotherapy. The results did not meet the preset study parameters, but our study provides information on clinical outcomes with the use of chemotherapy before surgery for bladder cancer.
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Affiliation(s)
- Thomas W Flaig
- School of Medicine, University of Colorado, Aurora, CO, USA.
| | | | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - M Scott Lucia
- School of Medicine, University of Colorado, Aurora, CO, USA
| | | | | | - Amir Goldkorn
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Matthew I Milowsky
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Rick Bangs
- Southwestern Oncology Group, San Antonio, TX, USA
| | | | | | | | | | - Melissa Plets
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian M Thompson
- CHRISTUS Medical Center Hospital, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Seth P Lerner
- Scott Department of Urology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
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Paster IC, Zeng J, Recio-Boiles A, Chipollini J. Gender, Racial and Ethnic Differences in Pathologic Response Following Neoadjuvant Chemotherapy for Bladder Cancer Patients. Urology 2023; 178:105-113. [PMID: 37230271 DOI: 10.1016/j.urology.2023.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate trends and racial variations of pathologic complete response (CR) in patients with muscle-invasive bladder cancer undergoing cystectomy. MATERIALS AND METHODS The National Cancer Database was queried for patients with non-metastatic muscle-invasive bladder cancer who underwent neoadjuvant chemotherapy and surgery. The primary endpoints, CR and mortality, were evaluated using the Cochran-Armitage test, multivariable regression, and Kaplan-Meier analyses. RESULTS The cohort comprised 9955 patients. Non-Hispanic Black (NHB) patients were younger (P < .001), had a higher clinical tumor (P < .001), and had higher clinical node (P = .029) stages at presentation. CR for non-Hispanic White (NHW), NHB, and Hispanic patients were 12.6%, 10.1%, and 11.8%, respectively (P = .030). There was a significant increase in CR trends for NHW patients (P < .001) and increases in NHB (P = .311) and Hispanic patients (P = .236). On multivariable analysis, NHW females had lower odds of achieving CR (odds ratio: 0.83, 95% CI: 0.71-0.97); however, NHB males (hazard ratio: 1.21, 1.01-1.44) and NHB females (hazard ratio: 1.25, 1.03-1.53) had higher overall mortality in adjusted analysis. Survival differences were not observed in patients who achieved CR, regardless of racial background; however, for those with residual disease, the 2-year survival probabilities were 60.7%, 62.5%, and 51.1% for NHW, HW, and NHB patients, respectively (log-rank P = .010). CONCLUSION Our findings revealed differences in chemotherapy response based on gender and race or ethnicity. The CR trends for all racial or ethnic groups increased over time. However, Black patients were found to have worse survival, particularly when residual disease was present. Clinical studies with more underrepresented minorities are needed to verify biological differences in response to neoadjuvant chemotherapy.
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Affiliation(s)
| | - Jiping Zeng
- Department of Urology, University of Arizona, Tucson, AZ
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11
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Ko WS, Kim SJ. Predictive Value of 18 F-FDG PET/CT for Assessment of Tumor Response to Neoadjuvant Chemotherapy in Bladder Cancer. Clin Nucl Med 2023; 48:574-580. [PMID: 36976654 DOI: 10.1097/rlu.0000000000004639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVE The purpose of the current study was to evaluate the diagnostic accuracies of 18 F-FDG PET/CT for prediction of tumor response to neoadjuvant chemotherapy in bladder cancer (BC) patients through a systematic review and meta-analysis. PATIENTS AND METHODS The PubMed, Cochrane database, and Embase database were searched from inception through November 30, 2022 for studies evaluating diagnostic performance of 18 F-FDG PET/CT for prediction of tumor response to neoadjuvant chemotherapy in BC patients. Based on data extracted from patient-based and lesion-based analysis, we calculated the pooled sensitivity and specificity with the 95% confidence intervals (CIs). Also, we calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves. RESULTS Across 5 studies (12 results), the pooled sensitivity of 18 F-FDG PET/CT was 0.84 (95% CI, 0.72-0.91), and the pooled specificity was 0.75 (95% CI, 0.59-0.86). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 3.3 (95% CI, 2.0-5.6) and negative likelihood ratio (LR-) of 0.22 (95% CI, 0.12-0.38). The pooled diagnostic odds ratio was 15 (95% CI, 7-36). The pooled sensitivity of 18 F-FDG PET/CT for prediction of pathologic complete response was 0.68 (95% CI, 0.56-0.78), and the pooled specificity was 0.77 (95% CI, 0.60-0.88). The pooled sensitivity of 18 F-FDG PET/CT for prediction of clinical response and nonresponse was 0.94 (95% CI, 0.85-0.98), and a pooled specificity was 0.73 (95% CI, 0.42-0.91). CONCLUSIONS 18 F-FDG PET/CT showed a good diagnostic performance for prediction of tumor response to neoadjuvant chemotherapy in BC patients.
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Affiliation(s)
- Woo Seog Ko
- From the Department of Internal Medicine, Pusan National University Hospital, Busan
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12
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Jin Y, Li J, Tang C, He K, Shan D, Yan S, Deng G. A risk signature of necroptosis-related lncRNA to predict prognosis and probe molecular characteristics for male with bladder cancer. Medicine (Baltimore) 2023; 102:e33664. [PMID: 37145007 PMCID: PMC10158872 DOI: 10.1097/md.0000000000033664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
Bladder cancer (BC) is a frequently diagnosed cancer with high mortality. Male patients have a higher risk of developing BC than female patients. As a type of caspase-independent cell death, necroptosis plays a significant role in the occurrence and progression of BC. The aberrant function of long non-coding RNAs (lncRNAs) plays an indispensable role in GI. However, the relationship between lncRNA and necroptosis in male patients with BC remains unclear. The clinical information and RNA-sequencing profiles of all BC patients were retrieved from The Cancer Genome Atlas Program. A total of 300 male participants were selected for the study. We conducted to identify the necroptosis-related lncRNAs (NRLs) by Pearson correlation analysis. Subsequently, least absolute shrinkage and selection operator Cox regression were conducted to establish a risk signature with overall survival-related NRLs in the training set and to validate it in the testing set. Finally, we verified the effectiveness of the 15-NRLs signature in prognostic prediction and therapy via survival analysis, receiver operating characteristic curve analysis, and Cox regression. Furthermore, we analyzed the correlation between the signature risk score and pathway enrichment analysis, immune cell infiltration, anticancer drug sensitivity, and somatic gene mutations. We developed 15-NRLs (AC009974.1, AC140118.2, LINC00323, LINC02872, PCAT19, AC017104.1, AC134312.5, AC147067.2, AL139351.1, AL355922.1, LINC00844, AC069503.1, AP003721.1, DUBR, LINC02863) signature, and divided patients into a high-risk group and low-risk group through the median risk score. Kaplan-Meier and receiver operating characteristic curves showed that the prognosis prediction had satisfactory accuracy. Cox regression analysis indicated that the 15-NRLs signature was a risk factor independent of various clinical parameters. Additionally, immune cell infiltration, half-maximal inhibitory concentration, and somatic gene mutations differed significantly among different risk subsets, implying that the signature could assess the clinical efficacy of chemotherapy and immunotherapy. This 15-NRLs risk signature may be helpful in assessing the prognosis and molecular features of male patients with BC and improve treatment modalities, thus can be further applied clinically.
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Affiliation(s)
- Yuzhou Jin
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiacheng Li
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Chenhao Tang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Kangwei He
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Donggang Shan
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Shenze Yan
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Gang Deng
- Hangzhou First People’s Hospital, Hangzhou, China
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13
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Fahey CC, Shevach JW, Flippot R, Albiges L, Haas NB, Beckermann KE. Triplet Strategies in Metastatic Clear Cell Renal Cell Carcinoma: A Worthy Option in the First-Line Setting? Am Soc Clin Oncol Educ Book 2023; 43:e389650. [PMID: 37207297 DOI: 10.1200/edbk_389650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Significant strides have been made in the frontline treatment of patients with advanced clear cell renal cell carcinoma (ccRCC). There are multiple standard-of-care doublet regimens consisting of either the combined dual immune checkpoint inhibitors, ipilimumab and nivolumab, or combinations of a vascular endothelial growth factor receptor tyrosine kinase inhibitor and an immune checkpoint inhibitor. Currently, there is an emergence of clinical trials examining triplet combinations. In COSMIC-313, a randomized phase III trial for patients with untreated advanced ccRCC, the triplet combination of ipilimumab, nivolumab, and cabozantinib was compared with a contemporary control arm of ipilimumab and nivolumab. While patients receiving the triplet regimen demonstrated improved progression-free survival, these patients also experienced greater toxicity and the overall survival data are still maturing. In this article, we discuss the role of doublet therapy as standard of care, the current data available for the promise of triplet therapy, the rationale to continue pursuing trials with triplet combinations, and factors for clinicians and patients to consider when choosing among frontline treatments. We present ongoing trials with an adaptive design that may serve as alternative methods for escalating from doublet to triplet regimens in the frontline setting and explore clinical factors and emerging predictive biomarkers (both baseline and dynamic) that may guide future trial design and frontline treatment for patients with advanced ccRCC.
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Affiliation(s)
- Catherine C Fahey
- Division of Hematology Oncology, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Jeffrey W Shevach
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ronan Flippot
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Naomi B Haas
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kathryn E Beckermann
- Division of Hematology Oncology, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
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14
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Culine S, Harter V, Krucker C, Gravis G, Fléchon A, Chevreau C, Mahammedi H, Laguerre B, Guillot A, Joly F, Fontugne J, Allory Y, Pfister C. Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial. Cancers (Basel) 2023; 15:cancers15061742. [PMID: 36980628 PMCID: PMC10046214 DOI: 10.3390/cancers15061742] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023] Open
Abstract
Neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy and pelvic lymph node dissection is the optimal treatment for patients with muscle-invasive bladder cancer. In recent years, the VESPER trial showed a statistically significant higher progression-free survival with dd-MVAC (dose dense methotrexate, vinblastine, doxorubicin, and cisplatin) compared to GC (gemcitabine and cisplatin). In the present report, we refine the characterization and outcome of patients whose cystectomy specimens were pathologically free of cancer (pathological complete response, pCR). We confirm that these patients portend a better outcome as compared to patients with invasive disease (≥pT1N0) at cystectomy. Nested variant and lymphovascular invasion were identified as adverse predictive factors of pCR. Progression-free survival probability three years after pCR on cystectomy was about 85%, regardless of the NAC regimen. A lower creatinine clearance and the delivery of less than four cycles were associated with a higher risk of relapse. Predicting the efficacy of NAC remains a major challenge. The planned analysis of molecular subtypes in the VESPER trial could help predict which patients may achieve complete response and better outcome.
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Affiliation(s)
- Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Nord, Université de Paris Cité, Avenue Claude Vellefaux, 75010 Paris, France
- Correspondence: ; Tel.: +33-142-494-247
| | - Valentin Harter
- North-West Canceropole Data Center, Baclesse Cancer Center, 14000 Caen, France
| | - Clémentine Krucker
- CNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmette Institute, 13009 Marseille, France
| | - Aude Fléchon
- Department of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, France
| | - Christine Chevreau
- Department of Medical Oncology, ICR-IUCT Oncopole, 31100 Toulouse, France
| | - Hakim Mahammedi
- Department of Medical Oncology, Jean Perrin Cancer Center, 63011 Clermont-Ferrand, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Eugène Marquis Cancer Center, 35042 Rennes, France
| | - Aline Guillot
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42270 St Priest en Jarez, France
| | - Florence Joly
- Department of Medical Oncology, Baclesse Cancer Center, 14000 Caen, France
| | - Jacqueline Fontugne
- CNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, France
- Department of Pathology, Institut Curie, 92210 Saint-Cloud, France
- Université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Yves Allory
- CNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, France
- Department of Pathology, Institut Curie, 92210 Saint-Cloud, France
- Université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Christian Pfister
- Department of Urology, Clinical Investigation Center, Inserm 1404, Charles Nicolle University Hospital, 76000 Rouen, France
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15
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Guneri-Sozeri PY, Özden-Yılmaz G, Kisim A, Cakiroglu E, Eray A, Uzuner H, Karakülah G, Pesen-Okvur D, Senturk S, Erkek-Ozhan S. FLI1 and FRA1 transcription factors drive the transcriptional regulatory networks characterizing muscle invasive bladder cancer. Commun Biol 2023; 6:199. [PMID: 36805539 PMCID: PMC9941102 DOI: 10.1038/s42003-023-04561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
Bladder cancer is mostly present in the form of urothelium carcinoma, causing over 150,000 deaths each year. Its histopathological classification as muscle invasive (MIBC) and non-muscle invasive (NMIBC) is the most prominent aspect, affecting the prognosis and progression of this disease. In this study, we defined the active regulatory landscape of MIBC and NMIBC cell lines using H3K27ac ChIP-seq and used an integrative approach to combine our findings with existing data. Our analysis revealed FRA1 and FLI1 as two critical transcription factors differentially regulating MIBC regulatory landscape. We show that FRA1 and FLI1 regulate the genes involved in epithelial cell migration and cell junction organization. Knock-down of FRA1 and FLI1 in MIBC revealed the downregulation of several EMT-related genes such as MAP4K4 and FLOT1. Further, ChIP-SICAP performed for FRA1 and FLI1 enabled us to infer chromatin binding partners of these transcription factors and link this information with their target genes. Finally, we show that knock-down of FRA1 and FLI1 result in significant reduction of invasion capacity of MIBC cells towards muscle microenvironment using IC-CHIP assays. Our results collectively highlight the role of these transcription factors in selection and design of targeted options for treatment of MIBC.
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Affiliation(s)
- Perihan Yagmur Guneri-Sozeri
- grid.21200.310000 0001 2183 9022Izmir Biomedicine and Genome Center, Inciralti, 35340 Izmir, Turkey ,grid.21200.310000 0001 2183 9022Dokuz Eylül University Izmir International Biomedicine and Genome Institute, Inciralti, 35340 Izmir, Turkey
| | - Gülden Özden-Yılmaz
- grid.21200.310000 0001 2183 9022Izmir Biomedicine and Genome Center, Inciralti, 35340 Izmir, Turkey
| | - Asli Kisim
- grid.419609.30000 0000 9261 240XIzmir Institute of Technology, Urla, 35430 Izmir, Turkey
| | - Ece Cakiroglu
- grid.21200.310000 0001 2183 9022Izmir Biomedicine and Genome Center, Inciralti, 35340 Izmir, Turkey ,grid.21200.310000 0001 2183 9022Dokuz Eylül University Izmir International Biomedicine and Genome Institute, Inciralti, 35340 Izmir, Turkey
| | - Aleyna Eray
- grid.21200.310000 0001 2183 9022Izmir Biomedicine and Genome Center, Inciralti, 35340 Izmir, Turkey ,grid.21200.310000 0001 2183 9022Dokuz Eylül University Izmir International Biomedicine and Genome Institute, Inciralti, 35340 Izmir, Turkey
| | - Hamdiye Uzuner
- grid.21200.310000 0001 2183 9022Izmir Biomedicine and Genome Center, Inciralti, 35340 Izmir, Turkey ,grid.21200.310000 0001 2183 9022Dokuz Eylül University Izmir International Biomedicine and Genome Institute, Inciralti, 35340 Izmir, Turkey
| | - Gökhan Karakülah
- grid.21200.310000 0001 2183 9022Izmir Biomedicine and Genome Center, Inciralti, 35340 Izmir, Turkey ,grid.21200.310000 0001 2183 9022Dokuz Eylül University Izmir International Biomedicine and Genome Institute, Inciralti, 35340 Izmir, Turkey
| | - Devrim Pesen-Okvur
- grid.419609.30000 0000 9261 240XIzmir Institute of Technology, Urla, 35430 Izmir, Turkey
| | - Serif Senturk
- grid.21200.310000 0001 2183 9022Izmir Biomedicine and Genome Center, Inciralti, 35340 Izmir, Turkey ,grid.21200.310000 0001 2183 9022Dokuz Eylül University Izmir International Biomedicine and Genome Institute, Inciralti, 35340 Izmir, Turkey
| | - Serap Erkek-Ozhan
- Izmir Biomedicine and Genome Center, Inciralti, 35340, Izmir, Turkey.
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16
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Tomita Y, Kobayashi K, Kimura G, Oya M, Uemura H, Nishiyama H, Galsky MD, Nasroulah F, Collette S, Broughton E, Ünsal-Kaçmaz K, Kamisuki Y, Bajorin DF. Adjuvant nivolumab versus placebo following radical surgery for high-risk muscle-invasive urothelial carcinoma: a subgroup analysis of Japanese patients enrolled in the phase 3 CheckMate 274 trial. Jpn J Clin Oncol 2023; 53:16-25. [PMID: 36300304 PMCID: PMC9825712 DOI: 10.1093/jjco/hyac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The phase 3 CheckMate 274 trial demonstrated superiority of adjuvant nivolumab over placebo after radical surgery in patients with high-risk muscle-invasive urothelial carcinoma. However, the efficacy and safety of adjuvant nivolumab in Japanese patients with muscle-invasive urothelial carcinoma have not been clarified. METHODS Patients with muscle-invasive urothelial carcinoma were randomized to adjuvant nivolumab 240 mg or placebo (every 2 weeks via intravenous infusion) up to 120 days after radical surgery in CheckMate 274. RESULTS Of 49 patients in the Japanese subgroup, 27 and 22 patients were randomized to nivolumab and placebo, respectively. Eleven and 8 patients, respectively, had tumor PD-L1 expression level of 1% or more. The median disease-free survival times in the nivolumab and placebo groups were 29.67 months (95% confidence interval 7.79-not reached) and 9.72 months (95% confidence interval 4.73-not reached), respectively (hazard ratio 0.77, 95% confidence interval 0.35-1.69). The corresponding values in patients with tumor PD-L1 expression level of 1% or more were 29.67 months (95% confidence interval 2.63-not reached) and 25.95 months (95% confidence interval 5.59-not reached) (hazard ratio 1.10, 95% confidence interval 0.31-3.92), respectively. Treatment-related adverse events of Grade 3-4 occurred in 25.9 and 13.6% of patients in the nivolumab and placebo groups, respectively. The most common treatment-related adverse events in the nivolumab group were lipase increased, amylase increased and diarrhea. The changes in quality of life scores from baseline over time were similar in both groups. CONCLUSIONS The efficacy and safety results in the Japanese subgroup were consistent with the overall population of CheckMate 274.
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Affiliation(s)
- Yoshihiko Tomita
- Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ko Kobayashi
- Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Hospital, Faculty of Medicine, Osaka, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | | | | | | | | | | | - Dean F Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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17
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Einerhand SM, van Dijk N, van Dorp J, de Feijter JM, van Montfoort ML, van de Kamp MW, Schaake EE, Boellaard TN, Hendricksen K, van der Heijden MS, van Rhijn BW. Survival after Neoadjuvant/Induction Combination Immunotherapy versus Combination Platinum-based Chemotherapy for Locally Advanced (Stage III) Urothelial Cancer. Int J Cancer 2022; 151:2004-2011. [PMID: 35603905 DOI: 10.1002/ijc.34125] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/05/2022]
Abstract
Despite treatment with cisplatin-based chemotherapy and surgical resection, clinical outcomes of patients with locally advanced urothelial carcinoma (UC) remain poor. We compared neoadjuvant/induction platinum-based combination chemotherapy (NAIC) with combination immune checkpoint inhibition (cICI). We identified 602 patients who attended our outpatient bladder cancer clinic in 2018-2019. Patients were included if they received NAIC or cICI for cT3-4aN0M0 or cT1-4aN1-3M0 UC. NAIC consisted of cisplatin-based chemotherapy or gemcitabine-carboplatin in case of cisplatin-ineligibility. A subset of patients (cisplatin-ineligibility or refusal of NAIC) received ipilimumab plus nivolumab in the NABUCCO-trial (NCT03387761). Treatments were compared using the log-rank test and propensity score-weighted Cox regression models. We included 107 stage III UC patients treated with NAIC (n=83) or cICI (n=24). NAIC was discontinued in 11 patients due to progression (n=6;7%) or toxicity (n=5;6%), while cICI was discontinued in 6 patients (25%) after 2 cycles due to toxicity (p=0.205). After NAIC, patients had surgical resection (n=50;60%), chemoradiation (n=26;30%), or no consolidating treatment due to progression (n=5;6%) or toxicity (n=2;2%). After cICI, all patients underwent resection. After resection (n=74), complete pathological response (ypT0N0) was achieved in 11 (22%) NAIC-patients and 11 (46%) cICI-patients (p=0.056). Median (IQR) follow-up was 26 (20-32) months. cICI was associated with superior progression-free survival (p=0.003) and overall survival (p=0.003) compared to NAIC. Our study showed superior survival in stage III UC patients pretreated with cICI if compared to NAIC. Our findings provide a strong rationale for validation of cICI for locally advanced UC in a comparative phase-3 trial.
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Affiliation(s)
- Sarah Mh Einerhand
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nick van Dijk
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jeroen van Dorp
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeantine M de Feijter
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Maaike W van de Kamp
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eva E Schaake
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kees Hendricksen
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel S van der Heijden
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bas Wg van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
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18
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Funt SA, Lattanzi M, Whiting K, Al-Ahmadie H, Quinlan C, Teo MY, Lee CH, Aggen D, Zimmerman D, McHugh D, Apollo A, Durdin TD, Truong H, Kamradt J, Khalil M, Lash B, Ostrovnaya I, McCoy AS, Hettich G, Regazzi A, Jihad M, Ratna N, Boswell A, Francese K, Yang Y, Folefac E, Herr HW, Donat SM, Pietzak E, Cha EK, Donahue TF, Goh AC, Huang WC, Bajorin DF, Iyer G, Bochner BH, Balar AV, Mortazavi A, Rosenberg JE. Neoadjuvant Atezolizumab With Gemcitabine and Cisplatin in Patients With Muscle-Invasive Bladder Cancer: A Multicenter, Single-Arm, Phase II Trial. J Clin Oncol 2022; 40:1312-1322. [PMID: 35089812 PMCID: PMC9797229 DOI: 10.1200/jco.21.01485] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/03/2021] [Accepted: 12/15/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Neoadjuvant gemcitabine and cisplatin (GC) followed by radical cystectomy (RC) is standard for patients with muscle-invasive bladder cancer (MIBC). On the basis of the activity of atezolizumab (A) in metastatic BC, we tested neoadjuvant GC plus A for MIBC. METHODS Eligible patients with MIBC (cT2-T4aN0M0) received a dose of A, followed 2 weeks later by GC plus A every 21 days for four cycles followed 3 weeks later by a dose of A before RC. The primary end point was non-muscle-invasive downstaging to < pT2N0. RESULTS Of 44 enrolled patients, 39 were evaluable. The primary end point was met, with 27 of 39 patients (69%) < pT2N0, including 16 (41%) pT0N0. No patient with < pT2N0 relapsed and four (11%) with ≥ pT2N0 relapsed with a median follow-up of 16.5 months (range: 7.0-33.7 months). One patient refused RC and two developed metastatic disease before RC; all were considered nonresponders. The most common grade 3-4 adverse event (AE) was neutropenia (n = 16; 36%). Grade 3 immune-related AEs occurred in five (11%) patients with two (5%) requiring systemic steroids. The median time from last dose of chemotherapy to surgery was 7.8 weeks (range: 5.1-17 weeks), and no patient failed to undergo RC because of AEs. Four of 39 (10%) patients had programmed death-ligand 1 (PD-L1)-positive tumors and were all < pT2N0. Of the patients with PD-L1 low or negative tumors, 23 of 34 (68%) achieved < pT2N0 and 11 of 34 (32%) were ≥ pT2N0 (P = .3 for association between PD-L1 and < pT2N0). CONCLUSION Neoadjuvant GC plus A is a promising regimen for MIBC and warrants further study. Patients with < pT2N0 experienced improved relapse-free survival. The PD-L1 positivity rate was low compared with published data, which limits conclusions regarding PD-L1 as a predictive biomarker.
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Affiliation(s)
- Samuel A. Funt
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | - Min Yuen Teo
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Chung-Han Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - David Aggen
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Danielle Zimmerman
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Deaglan McHugh
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Arlyn Apollo
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Hong Truong
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Asia S. McCoy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Grace Hettich
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Marwah Jihad
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neha Ratna
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Yuanquan Yang
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Edmund Folefac
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Harry W. Herr
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Eugene K. Cha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alvin C. Goh
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Dean F. Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Gopa Iyer
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Arjun V. Balar
- New York University Langone Medical Center, New York, NY
| | - Amir Mortazavi
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Jonathan E. Rosenberg
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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19
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Gabrielson AT, Daniels MJ, Rowe J, Alam R, Lee EJ, Matoso A, De Felice A, Hahn N, Hoffman-Censits J, Bivalacqua TJ, Kates M. Residual CIS after neoadjuvant chemotherapy and radical cystectomy for muscle invasive bladder cancer: Implications for neoadjuvant trials. Urol Oncol 2022; 40:164.e9-164.e16. [DOI: 10.1016/j.urolonc.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/21/2021] [Accepted: 11/26/2021] [Indexed: 11/26/2022]
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20
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Benkhadra R, Nayfeh T, Patibandla SK, Peterson C, Prokop L, Alhalabi O, Murad MH, Mao SS. Systematic Review and Meta-Analysis of Cisplatin Based Neoadjuvant Chemotherapy in Muscle Invasive Bladder Cancer. Bladder Cancer 2022; 8:5-17. [PMID: 38994516 PMCID: PMC11181744 DOI: 10.3233/blc-201511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 09/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cisplatin-based neoadjuvant chemotherapy is the standard of care for muscle invasive bladder cancer (MIBC). OBJECTIVE To compare the efficacy and safety of the two most commonly used cisplatin-based regimens; gemcitabine, and cisplatin (GC) vs. accelerated (dose-dense: dd) or conventional methotrexate, vinblastine, adriamycin, and cisplatin (MVAC). METHODS We searched MEDLINE, Embase, Scopus and other sources. Outcomes of interest included overall survival, downstaging to pT≤1, pathologic complete response (pCR), recurrence, and toxicity. Meta-analysis was conducted using the random-effects model. RESULTS We identified 24 studies. Efficacy outcomes were comparable between MVAC and GC for MIBC. dd-MVAC was associated with favorable efficacy compared to GC in terms of downstaging (OR 1.45; 95%CI 1.15-1.82) and all-cause mortality at longest follow-up (OR 0.63; 95%CI 0.44-0.81). However, GC was associated with a better safety profile in terms of febrile neutropenia (OR 0.32; 95%CI 0.13-0.80), anemia (OR 0.32; 95%CI 0.18-0.54), nausea and vomiting (OR 0.27; 95%CI 0.12-0.65) compared to dd-MVAC. Compared to MVAC, patients receiving GC had an increased risk of developing grade 3-4 thrombocytopenia (OR 4.70; 95%CI 1.59-13.89) and a lower risk of nausea and vomiting (OR 0.05; 95%CI 0.01-0.31). Certainty in the estimates was very low for most outcomes. CONCLUSIONS Efficacy and safety outcomes were comparable between MVAC and GC for MIBC. Including non-peer-reviewed studies showed higher efficacy with dd-MVAC. A phase III randomized trial comparing the two regimens is needed to guide clinical practice.
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Affiliation(s)
| | - Tarek Nayfeh
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Omar Alhalabi
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M. Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Shifeng S. Mao
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
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21
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Sonpavde GP, Mouw KW, Mossanen M. Therapy for Muscle-Invasive Urothelial Carcinoma: Controversies and Dilemmas. J Clin Oncol 2022; 40:1275-1280. [PMID: 35271295 DOI: 10.1200/jco.21.02928] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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Affiliation(s)
- Guru P Sonpavde
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kent W Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Matthew Mossanen
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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22
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Neoadjuvant and Adjuvant Therapy for Muscle-Invasive Bladder Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Refining neoadjuvant therapy clinical trial design for muscle-invasive bladder cancer before cystectomy: a joint US Food and Drug Administration and Bladder Cancer Advocacy Network workshop. Nat Rev Urol 2022; 19:37-46. [PMID: 34508246 DOI: 10.1038/s41585-021-00505-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 02/08/2023]
Abstract
The success of the use of novel therapies in the treatment of advanced urothelial carcinoma has contributed to growing interest in evaluating these therapies at earlier stages of the disease. However, trials evaluating these therapies in the neoadjuvant setting must have clearly defined study elements and appropriately selected end points to ensure the applicability of the trial and enable interpretation of the study results. To advance the development of rational trial design, a public workshop jointly sponsored by the US Food and Drug Administration and the Bladder Cancer Advocacy Network convened in August 2019. Clinicians, clinical trialists, radiologists, biostatisticians, patients, advocates and other stakeholders discussed key elements and end points when designing trials of neoadjuvant therapy for muscle-invasive bladder cancer (MIBC), identifying opportunities to refine eligibility, design and end points for neoadjuvant trials in MIBC. Although pathological complete response (pCR) is already being used as a co-primary end point, both individual-level and trial-level surrogacy for time-to-event end points, such as event-free survival or overall survival, remain incompletely characterized in MIBC. Additionally, use of pCR is limited by heterogeneity in pathological evaluation and the fact that the magnitude of pCR improvement that might translate into a meaningful clinical benefit remains unclear. Given existing knowledge gaps, capture of highly granular patient-related, tumour-related and treatment-related characteristics in the current generation of neoadjuvant MIBC trials will be critical to informing the design of future trials.
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24
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Impact of 18 FDG- PET CT in the management of Muscle Invasive Bladder Cancer. Clin Genitourin Cancer 2022; 20:297-297.e6. [DOI: 10.1016/j.clgc.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/26/2021] [Accepted: 01/09/2022] [Indexed: 11/21/2022]
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25
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Mazza C, Gaydou V, Eymard JC, Birembaut P, Untereiner V, Côté JF, Brocheriou I, Coeffic D, Villena P, Larré S, Vuiblet V, Piot O. Identification of Neoadjuvant Chemotherapy Response in Muscle-Invasive Bladder Cancer by Fourier-Transform Infrared Micro-Imaging. Cancers (Basel) 2021; 14:cancers14010021. [PMID: 35008184 PMCID: PMC8750189 DOI: 10.3390/cancers14010021] [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: 11/05/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Assessing the tumor response to chemotherapy is a paramount predictive step to improve patient care. Infrared spectroscopy probes the chemical composition of samples, and in combination with statistical multivariate processing, presents the capacity to highlight subtle molecular alterations associated with malignancy characteristics. Microscopic infrared imaging of tissue samples reveals spectral heterogeneity within histological structures, providing a new approach to characterize tumoral heterogeneity. We have taken advantage of the analytical capabilities of mid-infrared spectral imaging to implement a classification model to predict the response of a tumor to chemotherapy. Our development was demonstrated in muscle-invasive bladder cancer (MIBC) by comparing samples from responders and non-responders to neoadjuvant chemotherapy. Abstract Background: Neoadjuvant chemotherapy (NAC) improves survival in responder patients. However, for non-responders, the treatment represents an ineffective exposure to chemotherapy and its potential adverse events. Predicting the response to treatment is a major issue in the therapeutic management of patients, particularly for patients with muscle-invasive bladder cancer. Methods: Tissue samples of trans-urethral resection of bladder tumor collected at the diagnosis time, were analyzed by mid-infrared imaging. A sequence of spectral data processing was implemented for automatic recognition of informative pixels and scoring each pixel according to a continuous scale (from 0 to 10) associated with the response to NAC. The ground truth status of the responder or non-responder was based on histopathological examination of the samples. Results: Although the TMA spots of tumors appeared histologically homogeneous, the infrared approach highlighted spectral heterogeneity. Both the quantification of this heterogeneity and the scoring of the NAC response at the pixel level were used to construct sensitivity and specificity maps from which decision criteria can be extracted to classify cancerous samples. Conclusions: This proof-of-concept appears as the first to evaluate the potential of the mid-infrared approach for the prediction of response to neoadjuvant chemotherapy in MIBC tissues.
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Affiliation(s)
- Camille Mazza
- Jean Godinot Institute, 51100 Reims, France; (C.M.); (J.-C.E.)
| | - Vincent Gaydou
- BioSpecT (Translational BioSpectroscopy) EA 7506, SFR Santé, Université de Reims Champagne-Ardenne, 51100 Reims, France; (V.G.); (S.L.)
| | | | - Philippe Birembaut
- Department of Biopathology, University Hospital of Reims, 51100 Reims, France;
| | - Valérie Untereiner
- Cellular and Tissular Imaging Platform (PICT), Université de Reims Champagne-Ardenne, 51100 Reims, France;
| | - Jean-François Côté
- Department of Biopathology, Hôpital de la Pitié-Salpêtrière, APHP, 51100 Paris, France; (J.-F.C.); (I.B.)
| | - Isabelle Brocheriou
- Department of Biopathology, Hôpital de la Pitié-Salpêtrière, APHP, 51100 Paris, France; (J.-F.C.); (I.B.)
| | - David Coeffic
- Polyclinique Courlancy, 51100 Reims, France; (D.C.); (P.V.)
| | | | - Stéphane Larré
- BioSpecT (Translational BioSpectroscopy) EA 7506, SFR Santé, Université de Reims Champagne-Ardenne, 51100 Reims, France; (V.G.); (S.L.)
- Department of Urology, University Hospital of Reims, 51100 Reims, France
| | - Vincent Vuiblet
- BioSpecT (Translational BioSpectroscopy) EA 7506, SFR Santé, Université de Reims Champagne-Ardenne, 51100 Reims, France; (V.G.); (S.L.)
- Department of Biopathology, University Hospital of Reims, 51100 Reims, France;
- Correspondence: (V.V.); (O.P.)
| | - Olivier Piot
- BioSpecT (Translational BioSpectroscopy) EA 7506, SFR Santé, Université de Reims Champagne-Ardenne, 51100 Reims, France; (V.G.); (S.L.)
- Cellular and Tissular Imaging Platform (PICT), Université de Reims Champagne-Ardenne, 51100 Reims, France;
- Correspondence: (V.V.); (O.P.)
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26
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Gopalakrishnan D, Elsayed AS, Hussein AA, Jing Z, Li Q, Wagner AA, Aboumohamed A, Roupret M, Balbay D, Wijburg C, Stockle M, Dasgupta P, Khan MS, Wiklund P, Hosseini A, Peabody J, Shigemura K, Trump D, Guru KA, Chatta G. Impact of neoadjuvant chemotherapy on survival and recurrence patterns after robot-assisted radical cystectomy for muscle-invasive bladder cancer: Results from the International Robotic Cystectomy Consortium. Int J Urol 2021; 29:197-205. [PMID: 34923677 DOI: 10.1111/iju.14749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyze the impact of neoadjuvant chemotherapy on survival and recurrence patterns in muscle-invasive bladder cancer after robot-assisted radical cystectomy. MATERIALS AND METHODS The International Robotic Cystectomy Consortium database was reviewed to identify patients who underwent robot-assisted radical cystectomy for muscle-invasive bladder cancer between 2002 and 2019. Survival outcomes, response rates, and recurrence patterns were compared between patients who received neoadjuvant chemotherapy and those who did not. Survival distributions were estimated using Kaplan-Meier analyses and compared using the log-rank test. RESULTS A total of 1370 patients with muscle-invasive bladder cancer were identified, of whom 353 (26%) received neoadjuvant chemotherapy. After a median follow-up of 27 months, neoadjuvant chemotherapy recipients had higher 3-year overall survival (74% vs 57%; log-rank P < 0.01), 3-year cancer-specific survival (83% vs 73%; log-rank P = 0.03), and 3-year relapse-free survival (64% vs 48%; log-rank P < 0.01). Neoadjuvant chemotherapy was a predictor of higher overall survival, cancer-specific survival, and relapse-free survival in univariate but not multivariate analysis. Pathological downstaging (46% vs 23%; P < 0.01), complete responses (24% vs 8%; P < 0.01), and margin negativity (95% vs 91%; P < 0.01) at robot-assisted radical cystectomy were more common in the neoadjuvant chemotherapy group. Neoadjuvant chemotherapy recipients had lower distant (15% vs 22%; P < 0.01) but similar locoregional (12% vs 13%; P = 0.93) recurrence rates. CONCLUSIONS In this analysis from a large international database, patients with muscle-invasive bladder cancer who received neoadjuvant chemotherapy before robot-assisted radical cystectomy had higher rates of survival, pathological downstaging, and margin-negative resections. They also experienced fewer distant recurrences.
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Affiliation(s)
| | - Ahmed S Elsayed
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Ahmed A Hussein
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Zhe Jing
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Qiang Li
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Andrew A Wagner
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ahmed Aboumohamed
- Montefiore Medical Center (Albert Einstein College of Medicine), Bronx, New York, USA
| | - Morgan Roupret
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France
| | | | - Carl Wijburg
- Rijnstate Hospital - Stichting, Arnhem, The Netherlands
| | - Michael Stockle
- Saarland University Hospital and Saarland University Faculty of Medicine, Department of Urology and Pediatric Urology, Homburg, Germany
| | | | | | | | | | | | | | - Donald Trump
- University of Virginia, Charlottesville, Virginia, USA
| | - Khurshid A Guru
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Gurkamal Chatta
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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27
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Martinez Chanza N, Soukane L, Barthelemy P, Carnot A, Gil T, Casert V, Vanhaudenarde V, Sautois B, Staudacher L, Van den Brande J, Culine S, Seront E, Gizzi M, Albisinni S, Tricard T, Fantoni JC, Paesmans M, Caparica R, Roumeguere T, Awada A. Avelumab as neoadjuvant therapy in patients with urothelial non-metastatic muscle invasive bladder cancer: a multicenter, randomized, non-comparative, phase II study (Oncodistinct 004 - AURA trial). BMC Cancer 2021; 21:1292. [PMID: 34856936 PMCID: PMC8638545 DOI: 10.1186/s12885-021-08990-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/10/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Cisplatin-based neoadjuvant chemotherapy (NAC) followed by surgery is the standard treatment for patients with non-metastatic muscle invasive bladder cancer (MIBC). Unfortunately, many patients are not candidates to receive cisplatin due to renal impairment. Additionally, no predictive biomarkers for pathological complete response (pCR) are currently validated in clinical practice. Studies evaluating immune checkpoint inhibitors in the peri-operative setting are emerging with promising results. Clinical trials are clearly required in the neoadjuvant setting in order to improve therapeutic strategies. Methods and analysis Oncodistinct 004 – AURA is an ongoing multicenter phase II randomized trial assessing the efficacy and safety of avelumab single-agent or combined to different NAC regimens in patients with non-metastatic MIBC. Patients are enrolled in two distinct cohorts according to their eligibility to receive cisplatin-based NAC. In the cisplatin eligible cohort, patients are randomized in a 1:1 fashion to receive avelumab combined with cisplatin-gemcitabine or with dose-dense methotrexate-vinblastine-doxorubicin-cisplatin. In the cisplatin ineligible cohort, patients are randomized at a 1:1 ratio to paclitaxel-gemcitabine associated to avelumab or avelumab alone. Primary endpoint is pCR. Secondary endpoints are pathological response and safety. Ethics and dissemination The study is approved by ethics committee from all participating centers. All participants provide informed consent prior inclusion to the study. Once completed, results will be published in peer-reviewed journals. Trial registration number ClinicalTrials.gov (NCT03674424).
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Affiliation(s)
- Nieves Martinez Chanza
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium. .,Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - Louisa Soukane
- Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Thierry Gil
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Vinciane Casert
- Centre Hospitalier Universitaire de Ambrois Paré, Mons, Belgium
| | | | - Brieuc Sautois
- University Hospital of Liege (CHU Sart Tilman), Liège, Belgium
| | | | | | | | | | - Marco Gizzi
- Grand Hopital de Charleroi, Charleroi, Belgium
| | - Simone Albisinni
- Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thibault Tricard
- Institut de Cancérologie Strasbourg Europe ICANS, Strasbourg, France
| | | | - Marianne Paesmans
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Rafael Caparica
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguere
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.,Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ahmad Awada
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
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28
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Pak JS, Haas CR, Anderson CB, DeCastro GJ, Benson MC, McKiernan JM. Survival and oncologic outcomes of complete transurethral resection of bladder tumor prior to neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Oncol 2021; 39:787.e9-787.e15. [PMID: 33865688 DOI: 10.1016/j.urolonc.2021.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/15/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Prior studies have shown that pathologic complete response at radical cystectomy, a significant prognostic factor, can be attributed to both neoadjuvant chemotherapy (NAC) and high-quality transurethral resections (TURBT) prior to NAC. It remains unclear whether the visual completeness of TURBT prior to NAC plays an important role in subsequent outcomes. We sought to assess the association of completeness of TURBT prior to NAC with response and survival outcomes. METHODS AND MATERIALS We retrospectively reviewed all patients with clinically localized muscle-invasive bladder cancer at our institution who received NAC from 2000 to 2017. Complete TURBT was defined as resection of all visible tumor in entirety, resection to normal-appearing muscle, and/or repeat pre-NAC TURBT revealing cT0. Patients who were restaged as cT0 after NAC and refused cystectomy were placed on an active surveillance/delayed intervention (ASDI) protocol. The primary endpoints were overall and cancer-specific survival. The secondary endpoints were recurrence-free and muscle-invasive recurrence-free survival. RESULTS Of 93 patients, 62 (67%) underwent complete TURBT prior to chemotherapy. Compared to patients with incomplete TURBT, those with complete TURBT had lower rates of variant histology (13% vs. 32%) and hydronephrosis (15% vs. 39%). Also, 36% of patients with incomplete TURBT had ≥cT3 disease prior to NAC, compared to none in the complete TURBT cohort. Patients with complete TURBT were more likely to defer RC and pursue ASDI (61% vs. 32%). Those with complete TURBT had lower rates of pT2 or higher disease at cystectomy (48% vs. 75%), with a lower rate of N+ disease trending towards significance (17% vs. 37%). Patients with complete TURBT had higher 5-year overall (77% vs. 46%, P = 0.003) and cancer-specific (85% vs. 50%, P = 0.001) survival. On Cox regression analysis, complete TURBT was significantly associated with superior cancer-specific, recurrence-free, and muscle-invasive recurrence-free survival. CONCLUSIONS A complete TURBT prior to NAC is associated with improved survival and oncologic outcomes in this cohort with muscle-invasive bladder cancer. The extent to which complete TURBT simply represents a proxy for less aggressive disease or is actually a beneficial therapeutic intervention which improves response to chemotherapy is difficult to define retrospectively.
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Affiliation(s)
- Jamie S Pak
- Department of Urology, Columbia University Irving Medical Center,NY.
| | | | | | - G Joel DeCastro
- Department of Urology, Columbia University Irving Medical Center,NY
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29
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Koskinen I, Boström PJ, Taimen P, Salminen A, Tervahartiala M, Sairanen J, Erickson A, Mirtti T. Prediction of neo-adjuvant chemotherapy response in bladder cancer: the impact of clinical parameters and routine biomarkers. Scand J Urol 2021; 55:448-454. [PMID: 34498951 DOI: 10.1080/21681805.2021.1962403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the role of clinical parameters and immunohistochemical (IHC) biomarkers in their feasibility to predict the effect of neo-adjuvant chemotherapy (NAC) in patients with muscle-invasive urothelial bladder cancer (MIBC). MATERIALS AND METHODS The first 76 consecutive patients with MIBC treated with NAC and radical cystectomy in two University hospitals in Finland between 2008 and 2013 were chosen for this study. After excluding patients with non-urothelial cancer, less than two cycles of chemotherapy, no tissue material for IHC analysis or non-muscle-invasive bladder cancer in re-review, 59 patients were included in the final analysis. A tissue microarray block was constructed from the transurethral resection samples and IHC stainings of Ki-67, p53, Her-2 and EGFR were made. The correlations between histological features in transurethral resection samples and immune-histochemical stainings were calculated. The associations of clinicopathological parameters and IHC stainings with NAC response were evaluated. Factors affecting survival were estimated. RESULTS The complete response rate after NAC was 44%. A higher number of chemotherapy cycles was associated with better response to neo-adjuvant chemotherapy. No response to neo-adjuvant chemotherapy and female gender was associated with decreased cancer-specific survival. The IHC stainings used failed to show an association with neo-adjuvant chemotherapy response and overall or cancer specific survival. CONCLUSIONS Patients who do not respond to neo-adjuvant chemotherapy do significantly worse than responders. This study could not find clinical tools to distinguish responders from non-responders. Further studies preferably with larger cohorts addressing this issue are warranted to improve the selection of patients for neo-adjuvant chemotherapy.
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Affiliation(s)
- I Koskinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - P J Boström
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - P Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Pathology, Turku University Hospital, Turku, Finland
| | - A Salminen
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - M Tervahartiala
- Department of Surgery, Lohja Regional Hospital, Lohja, Finland
| | - J Sairanen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Erickson
- Department of Pathology (HUSLAB), Helsinki University Hospital and University of Helsinki, Helsinki, Finland and FIMM.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - T Mirtti
- Department of Pathology (HUSLAB), Helsinki University Hospital and University of Helsinki, Helsinki, Finland and FIMM
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30
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Chemotherapy for Muscle-invasive Bladder Cancer: Impact of Cisplatin Delivery on Renal Function and Local Control Rate in the Randomized Phase III VESPER (GETUG-AFU V05) Trial. Clin Genitourin Cancer 2021; 19:554-562. [PMID: 34602349 DOI: 10.1016/j.clgc.2021.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cisplatin-based combination chemotherapy before surgery is the standard of care for muscle-invasive bladder cancer. However, the optimal chemotherapy modalities have not been precisely defined to date. PATIENTS AND METHODS In the VESPER trial, patients received after randomization either gemcitabine and cisplatin (GC, 4 cycles) or methotrexate, vinblastine, doxorubicin and cisplatin (dose dense [dd]-MVAC, 6 cycles). Creatinine clearance (CrCl) was calculated before each cycle according to the Cockroft and Gault formula. Definition criteria for local control after neoadjuvant chemotherapy included pathological complete response (ypT0N0), pathological downstaging (<ypT2N0) and organ-confined disease (<ypT3N0) at cystectomy. Baseline and treatment characteristics were studied in multivariate logistic models to determine their potential role for each type of pathological responses. RESULTS A total of 2128 cycles of chemotherapy were delivered, including 2120 (99.6%) with cisplatin. Full doses of cisplatin were given in 1866 (88%) cycles. Twenty-three (4.7%) patients had to stop chemotherapy (12 GC, 11 dd-MVAC) because of renal failure. No difference in CrCl median values was observed between the 2 regimens during the first 4 cycles. A mild decrease occurred thereafter in patients treated with 2 additional cycles of dd-MVAC. A minimum total dose of 270 mg/m2 for cisplatin was mandatory to optimize pathological complete responses. CONCLUSION At least 4 cycles of cisplatin-based chemotherapy should be delivered before cystectomy. Increasing the number of cycles beyond 4 cycles does not lead to a clinically significant deterioration in renal function but without obvious gain on local control.
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Roumiguie M, Contreras-Sanz A, Kumar G, Black PC. Reconciling differences in impact of molecular subtyping on response to cisplatin-based chemotherapy. Nat Commun 2021; 12:4833. [PMID: 34376681 PMCID: PMC8355281 DOI: 10.1038/s41467-021-24837-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mathieu Roumiguie
- Vancouver Prostate Center, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
- Department of Urology, CHU-Institut Universitaire du Cancer-Oncopôle, Toulouse, France.
| | - Alberto Contreras-Sanz
- Vancouver Prostate Center, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Gunjan Kumar
- Vancouver Prostate Center, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Peter C Black
- Vancouver Prostate Center, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
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Dellis A, Zakopoulou R, Kougioumtzopoulou A, Tzannis K, Koutsoukos K, Fragkoulis C, Kostouros E, Papatsoris A, Varkarakis I, Stravodimos K, Boutati E, Pagoni S, Seferlis M, Chrisofos M, Kouloulias V, Ntoumas K, Deliveliotis C, Constantinides C, Dimopoulos MA, Bamias A. Referral for "Neoadjuvant Chemotherapy" for Muscle-Invasive Bladder Cancer to a Multidisciplinary Board: Patterns, Management and Outcomes. Cancer Manag Res 2021; 13:5941-5955. [PMID: 34354376 PMCID: PMC8331106 DOI: 10.2147/cmar.s317500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Utilization of neoadjuvant chemotherapy for the treatment of muscle invasive bladder cancer in everyday practice differs from that of clinical trials. We describe the patterns of referral for “neoadjuvant chemotherapy”, treatment and outcomes in a multidisciplinary tumor board. Methods This was an observational study. Patients referred for neoadjuvant chemotherapy received 4 cycles of dose-dense gemcitabine/cisplatin and were then assessed for definitive local therapy. Patients had a minimum follow-up of 2 years. Primary objective was a 3-year disease-free survival rate. Results Forty-six patients (clinical stages II: 28, IIIA: 9, IIIB: 4, IVA: 3, missing: 2) were included. Following chemotherapy, 30 underwent radical cystectomy, 8 radiotherapy and 8 no further therapy. Pathological downstaging was observed in 14 (46.6%) of the 30 patients who underwent radical cystectomy; clinical TNM staging was correlated with disease-free survival in the whole population, while clinical and pathological stages, as well as pathological downstaging, were correlated with disease-free survival in patients undergoing radical cystectomy. Three-year disease-free survival rates for the whole cohort and for patients undergoing radical cystectomy were 67.3% (95% confidence interval [CI]: 51–79.2) and 65.2 (95% CI: 44.9–79.6), respectively. Conclusion Real-world muscle invasive bladder cancer patients who receive neoadjuvant chemotherapy are characterized by more advanced diseases and less frequent radical surgery than those included in clinical trials. Nevertheless, outcomes were comparable and, therefore, offering patients with stage II–IVA muscle invasive bladder cancer neoadjuvant chemotherapy after assessment by multidisciplinary tumor boards should be strongly encouraged.
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Affiliation(s)
- Athanasios Dellis
- 2nd Department of Surgery, National & Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece
| | - Roubini Zakopoulou
- Oncology Unit, Department of Clinical Therapeutics, National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Andromahi Kougioumtzopoulou
- Radiotherapy Unit, 2nd Department of Radiology, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Kimon Tzannis
- Oncology Unit, Department of Clinical Therapeutics, National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Konstantinos Koutsoukos
- Oncology Unit, Department of Clinical Therapeutics, National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | | | - Efthymios Kostouros
- 3rd Department of Internal Medicine, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, National & Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Ioannis Varkarakis
- 2nd Department of Urology, National & Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Konstantinos Stravodimos
- First Department of Urology, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Eleni Boutati
- 2nd Propaedeutic Department of Internal Medicine, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Stamata Pagoni
- 3rd Department of Internal Medicine, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | | | - Michael Chrisofos
- 3rd Department of Urology, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Vasilios Kouloulias
- Radiotherapy Unit, 2nd Department of Radiology, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Ntoumas
- Department of Urology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Charalambos Deliveliotis
- 2nd Department of Urology, National & Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Constantine Constantinides
- First Department of Urology, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Meletios A Dimopoulos
- Oncology Unit, Department of Clinical Therapeutics, National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Montazeri K, Dranitsaris G, Thomas JD, Curran C, Preston MA, Steele GS, Kilbridge KL, Mantia C, Ravi P, McGregor BA, Mossanen M, Sonpavde G. An economic analysis comparing health care resource use and cost of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin versus gemcitabine and cisplatin as neoadjuvant therapy for muscle invasive bladder cancer. Urol Oncol 2021; 39:834.e1-834.e7. [PMID: 34162500 DOI: 10.1016/j.urolonc.2021.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/11/2021] [Accepted: 04/23/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE To compare healthcare resource utilization (HRU) and costs associated with dose-dense methotrexate, vinblastine, doxorubicin, cisplatin (ddMVAC) and gemcitabine, cisplatin (GC) as neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC). METHODS Patient treated at Dana-Farber Cancer Institute from 2010 to 2019 were identified. HRU data on chemotherapy administered, supportive medications, patient monitoring, clinic, infusion, emergency department (ED) visits and hospitalization were collected retrospectively. Unit costs for HRU components were obtained from the Centers for Medicare and Medicaid Website and HRU was compared between groups using quantile regression analysis. RESULTS 137 patients were included; 51 received ddMVAC and 86 GC. Baseline characteristics were similar, except lower mean age (P < 0.001) and higher proportion of ECOG-PS = 0 (P < 0.001) for ddMVAC. ddMVAC required more granulocyte-colony stimulating factor support (P < 0.001), central line placement (P = 0.017), cardiac imaging (P < 0.001), and infusion visits (P < 0.001), whereas GC required more clinic visits. ED visits were higher for ddMVAC (P = 0.048), while chemotherapy cycle delays and hospitalization days were higher for GC (P = 0.008). After adjusting for ECOG-PS and age, the cost per patient was approximately 41% lower (95%CI: 28% to 52%; P < 0.001) for GC vs. ddMVAC, which translated to a median adjusted cost savings of $7,410 (95%CI: $5,474-$9,347) per patient. CONCLUSIONS Although excess HRU did not clearly favor one regimen, adjusting for PS and age indicated lower costs with GC vs. ddMVAC. Given the similar cumulative cisplatin delivery with both regimens, the associated values and costs supports the preferential selection of GC in the neoadjuvant setting of MIBC.
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Affiliation(s)
- K Montazeri
- Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - J D Thomas
- Beth Israel Deaconess Medical Center, Boston, MA
| | - C Curran
- Beth Israel Deaconess Medical Center, Boston, MA
| | - M A Preston
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - G S Steele
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - K L Kilbridge
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - C Mantia
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA
| | - P Ravi
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA
| | - B A McGregor
- Beth Israel Deaconess Medical Center, Boston, MA
| | - M Mossanen
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - G Sonpavde
- Beth Israel Deaconess Medical Center, Boston, MA.
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Flaig TW, Tangen CM, Daneshmand S, Alva A, Lerner SP, Lucia MS, McConkey DJ, Theodorescu D, Goldkorn A, Milowsky MI, Bangs R, MacVicar GR, Bastos BR, Fowles JS, Gustafson DL, Plets M, Thompson IM. A Randomized Phase II Study of Coexpression Extrapolation (COXEN) with Neoadjuvant Chemotherapy for Bladder Cancer (SWOG S1314; NCT02177695). Clin Cancer Res 2021; 27:2435-2441. [PMID: 33568346 PMCID: PMC8219246 DOI: 10.1158/1078-0432.ccr-20-2409] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/23/2020] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Dose-dense methotrexate-vinblastine-adriamycin-cisplatin (ddMVAC) and gemcitabine-cisplatin (GC) are accepted neoadjuvant regimens for muscle-invasive bladder cancer. The aim of this study was to validate the score from a coexpression extrapolation (COXEN) algorithm-generated gene expression model (GEM) as a biomarker in patients undergoing radical cystectomy. PATIENTS AND METHODS Eligibility included cT2-T4a N0 M0, urothelial bladder cancer, ≥ 5 mm of viable tumor, cisplatin eligible, with plan for cystectomy; 237 patients were randomized between ddMVAC, given every 14 days for four cycles, and GC, given every 21 days for four cycles. The primary objective assessed prespecified dichotomous treatment-specific COXEN score as predictive of pT0 rate or ≤ pT1 (downstaging) at surgery. RESULTS Among 167 evaluable patients, the OR for pT0 with the GC GEM score in GC-treated patients was 2.63 [P = 0.10; 95% confidence interval (CI), 0.82-8.36]; for the ddMVAC COXEN GEM score with ddMVAC treatment, the OR was 1.12 (P = 0.82, 95% CI, 0.42-2.95). The GC GEM score was applied to pooled arms (GC and ddMVAC) for downstaging with an OR of 2.33 (P = 0.02; 95% CI, 1.11-4.89). In an intention-to-treat analysis of eligible patients (n = 227), pT0 rates for ddMVAC and GC were 28% and 30% (P = 0.75); downstaging was 47% and 40% (P = 0.27), respectively. CONCLUSIONS Treatment-specific COXEN scores were not significantly predictive for response to individual chemotherapy treatment. The COXEN GEM GC score was significantly associated with downstaging in the pooled arms. Additional biomarker development is planned.
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Affiliation(s)
- Thomas W Flaig
- University of Colorado, School of Medicine, Aurora, Colorado.
| | | | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ajjai Alva
- University of Michigan, Ann Arbor, Michigan
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | - M Scott Lucia
- University of Colorado, School of Medicine, Aurora, Colorado
| | | | | | - Amir Goldkorn
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Matthew I Milowsky
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | | | | | | | | | | | - Melissa Plets
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ian M Thompson
- CHRISTUS Medical Center Hospital, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Ravi P, Pond GR, Diamantopoulos LN, Su C, Alva A, Jain RK, Skelton WP, Gupta S, Tward JD, Olson KM, Singh P, Grunewald CM, Niegisch G, Lee JL, Gallina A, Bandini M, Necchi A, Mossanen M, McGregor BA, Curran C, Grivas P, Sonpavde GP. Optimal pathological response after neoadjuvant chemotherapy for muscle-invasive bladder cancer: results from a global, multicentre collaboration. BJU Int 2021; 128:607-614. [PMID: 33909949 DOI: 10.1111/bju.15434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate outcomes of patients achieving a post-treatment pathological stage of <ypT2N0 at radical cystectomy (RC) following neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) to identify an optimal definition of pathological response. PATIENTS AND METHODS Patients from 10 international centres who underwent NAC for cT2-4aN0-1 MIBC and achieved <ypT2N0 disease at RC were included. The primary outcome was time to recurrence, either local or distant. Kaplan-Meier and Cox proportional hazards regression were used to evaluate associations between clinicopathological variables and outcomes. RESULTS A total of 625 patients were included. The median age was 66 years and 80% were male. Gemcitabine and cisplatin (GC, 56%) and methotrexate, vinblastine, doxorubicin and cisplatin (MVAC)/dose-dense (dd)MVAC (32%) were the most common NAC regimens. ypT0, pure ypTis, ypTa ±ypTis and ypT1 ± ypTis were attained in 58.1%, 20.0%, 7.6% and 14.2% of patients, respectively. The cumulative incidence of recurrence at 5 years was 9%, 16%, 29% and 30%, respectively. Pathological stage was prognostic for recurrence, with ypTa ± Tis (hazard ratio [HR] 3.20, 95% confidence interval [CI] 1.40-7.30) and ypT1 ± Tis disease (HR 4.03, 95% CI 2.13-7.63) associated with a significantly higher recurrence risk. Pure ypTis (HR 1.66, 95% CI 0.82-3.38) and the type of NAC regimen (ddMVAC: HR 1.59, 95% CI 0.55-4.56; MVAC: HR 1.18, 9%% CI 0.25-5.54; reference: GC) were not associated with recurrence. CONCLUSION We propose that optimal pathological response after NAC be defined as attainment of ypT0N0/ypTisN0 at RC. Patients with ypTaN0 or ypT1N0 disease (with or without Tis) at RC displayed a significantly higher risk of recurrence and may be candidates for trials investigating adjuvant therapy.
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Affiliation(s)
- Praful Ravi
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Leonidas N Diamantopoulos
- Fred Hutchinson Cancer Research Center Seattle, University of Washington, Seattle, WA, USA.,University of Pittsburg Medical Center, Pittsburgh, PA, USA
| | | | - Ajjai Alva
- University of Michigan, Ann Arbor, MI, USA
| | | | | | - Sumati Gupta
- University of Utah's Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Jonathan D Tward
- University of Utah's Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | | | - Camilla M Grunewald
- Department of Urology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Guenter Niegisch
- Department of Urology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matthew Mossanen
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Petros Grivas
- Fred Hutchinson Cancer Research Center Seattle, University of Washington, Seattle, WA, USA
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Ma J, Black PC. Current Perioperative Therapy for Muscle Invasive Bladder Cancer. Hematol Oncol Clin North Am 2021; 35:495-511. [PMID: 33958147 DOI: 10.1016/j.hoc.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radical cystectomy is curative in only approximately 50% of patients with muscle-invasive bladder cancer. Although perioperative radiotherapy has been tested with the intent of improving locoregional disease control, there currently is no role for this modality in routine care. Perioperative systemic therapy is used with the intent of reducing the risk of systemic recurrence. Robust trial evidence supports the use of neoadjuvant cisplatin-based chemotherapy, with adjuvant chemotherapy offered as an alternative if neoadjuvant therapy is not administered. Perioperative immunotherapy represents the next frontier in perioperative therapy. Further biomarker development is required to guide treatment in individual patients.
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Affiliation(s)
- Joshua Ma
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Peter C Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada.
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Pourhanifeh MH, Mottaghi R, Razavi ZS, Shafiee A, Hajighadimi S, Mirzaei H. Therapeutic Applications of Curcumin and its Novel Formulations in the Treatment of Bladder Cancer: A Review of Current Evidence. Anticancer Agents Med Chem 2021; 21:587-596. [PMID: 32767956 DOI: 10.2174/1871520620666200807223832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/26/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022]
Abstract
Bladder cancer, a life-threatening serious disease, is responsible for thousands of cancer-associated deaths worldwide. Similar to other malignancies, standard treatments of bladder cancer, such as Chemoradiotherapy, are not efficient enough in the affected patients. It means that, according to recent reports in the case of life quality as well as the survival time of bladder cancer patients, there is a critical requirement for exploring effective treatments. Recently, numerous investigations have been carried out to search for appropriate complementary treatments or adjuvants for bladder cancer therapy. Curcumin, a phenolic component with a wide spectrum of biological activities, has recently been introduced as a potential anti-cancer agent. It has been shown that this agent exerts its therapeutic effects via targeting a wide range of cellular and molecular pathways involved in bladder cancer. Herein, the current data on curcumin therapy for bladder cancer are summarized.
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Affiliation(s)
| | - Reza Mottaghi
- Department of Oral and Maxillofacial Surgery, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra S Razavi
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Alimohammad Shafiee
- Division of General Internal Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - Sarah Hajighadimi
- Division of General Internal Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
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Challapalli A, Masson S, White P, Dailami N, Pearson S, Rowe E, Koupparis A, Oxley J, Abdelaziz A, Ash-Miles J, Bravo A, Foulstone E, Perks C, Holly J, Persad R, Bahl A. A Single-arm Phase II Trial of Neoadjuvant Cabazitaxel and Cisplatin Chemotherapy for Muscle-Invasive Transitional Cell Carcinoma of the Urinary Bladder. Clin Genitourin Cancer 2021; 19:325-332. [PMID: 33727028 DOI: 10.1016/j.clgc.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle-invasive bladder cancer. However, response rates and survival remain suboptimal. We evaluated the efficacy, safety, and tolerability of cisplatin plus cabazitaxel. METHODS A phase II single-arm trial was designed to recruit at least 26 evaluable patients. This would give 80% power to detect the primary endpoint, an objective response rate defined as a pathologic complete response plus partial response (pathologic downstaging), measured by pathologic staging at cystectomy (p0 = 0.35 and p1 = 0.60, α = 0.05). RESULTS Objective response was seen in 15 of 26 evaluable patients (57.7%) and more than one- third of patients achieved a pathologic complete response (9/26; 34.6%). Seventy-eight percent of the patients (21/27) completed all cycles of treatment, with only 6.7% of the reported adverse events being graded 3 or 4. There were 6 treatment-related serious adverse event reported, but no suspected unexpected serious adverse reactions. In the patients who achieved an objective response, the median progression-free survival and overall survival were not reached (median follow-up of 41.5 months). In contrast, the median progression-free survival (7.2 months) and overall survival (16.9 months) were significantly worse (P = .001, log-rank) in patients who did not achieve an objective response. CONCLUSION Cabazitaxel plus cisplatin for neoadjuvant treatment of muscle-invasive bladder cancer can be considered a well-tolerated and effective regimen before definitive therapy with higher rates (57.7%) of objective response, comparing favorably to that with of cisplatin/gemcitabine (23%-26%). These results warrant further evaluation in a phase III study.
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Affiliation(s)
| | - Susan Masson
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Paul White
- Department of Statistics, University of the West of England, Bristol, UK
| | - Narges Dailami
- Department of Statistics, University of the West of England, Bristol, UK
| | - Sylvia Pearson
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Edward Rowe
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Anthony Koupparis
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Jon Oxley
- Department of Pathology, North Bristol NHS Trust, Bristol, UK
| | - Ahmed Abdelaziz
- Department of Oncology, Ain Shams University Hospitals, Egypt
| | | | - Alicia Bravo
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Emily Foulstone
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Claire Perks
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeff Holly
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Raj Persad
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Amit Bahl
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK.
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Nassif EF, Mlecnik B, Thibault C, Auvray M, Bruni D, Colau A, Compérat E, Bindea G, Catteau A, Fugon A, Boquet I, Martel M, Camparo P, Colin P, Zakopoulou R, Bamias A, Bennamoun M, Barthere X, D’acremont B, Lefevre M, Audenet F, Mejean A, Verkarre V, Oudard S, Galon J. The Immunoscore in Localized Urothelial Carcinoma Treated with Neoadjuvant Chemotherapy: Clinical Significance for Pathologic Responses and Overall Survival. Cancers (Basel) 2021; 13:cancers13030494. [PMID: 33525361 PMCID: PMC7865364 DOI: 10.3390/cancers13030494] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary The prognosis of localized muscle-invasive bladder cancer is poor and the prognostic and predictive biomarkers of the response to treatment are lacking. We retrospectively investigated the role of the Immunoscore in the neoadjuvant setting, where the Immunoscore is a standardized quantitative assay of lymphocytes in the tumor microenvironment. We found it allowed for the stratification of patient prognoses and the prediction of response to neoadjuvant chemotherapy. Abstract (1) Background—The five-year overall survival (OS) of muscle-invasive bladder cancer (MIBC) with neoadjuvant chemotherapy and cystectomy is around 50%. There is no validated biomarker to guide the treatment decision. We investigated whether the Immunoscore (IS) could predict the pathologic response to neoadjuvant chemotherapy and survival outcomes. (2) Methods—This retrospective study evaluated the IS in 117 patients treated using neoadjuvant chemotherapy for localized MIBC from six centers (France and Greece). Pre-treatment tumor samples were immunostained for CD3+ and CD8+ T cells and quantified to determine the IS. The results were associated with the response to neoadjuvant chemotherapy, time to recurrence (TTR), and OS. (3) Results—Low (IS-0), intermediate (IS-1–2), and high (IS-3–4) ISs were observed in 36.5, 43.7, and 19.8% of the cohort, respectively. IS was positively associated with a pathologic complete response (pCR; p-value = 0.0096). A high IS was found in 35.7% of patients with a pCR, whereas it was found in 11.3% of patients without a pCR. A low IS was observed in 48.4% of patients with no pCR and in 21.4% of patients with a pCR. Low-, intermediate-, and high-IS patients had five-year recurrence-free rates of 37.2%, 36.5%, and 72.6%, respectively. In the multivariable analysis, a high IS was associated with a prolonged TTR (high vs. low: p = 0.0134) and OS (high vs. low: p = 0.011). (4) Conclusions—This study showed the significant prognostic and predictive roles of IS regarding localized MIBC.
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Affiliation(s)
- Elise F. Nassif
- Oncology Department, Hopital Européen Georges Pompidou, University of Paris, 75015 Paris, France; (E.F.N.); (C.T.); (M.A.)
| | - Bernhard Mlecnik
- Centre de Recherche des Cordeliers, Laboratory of Integrative Cancer Immunology, INSERM, Université de Paris, 75015 Paris, France; (B.M.); (D.B.); (G.B.); (J.G.)
- Inovarion, 75005 Paris, France
| | - Constance Thibault
- Oncology Department, Hopital Européen Georges Pompidou, University of Paris, 75015 Paris, France; (E.F.N.); (C.T.); (M.A.)
| | - Marie Auvray
- Oncology Department, Hopital Européen Georges Pompidou, University of Paris, 75015 Paris, France; (E.F.N.); (C.T.); (M.A.)
| | - Daniela Bruni
- Centre de Recherche des Cordeliers, Laboratory of Integrative Cancer Immunology, INSERM, Université de Paris, 75015 Paris, France; (B.M.); (D.B.); (G.B.); (J.G.)
| | - Alexandre Colau
- Urology Department, Diaconnesses Hospital, 75020 Paris, France;
| | - Eva Compérat
- Pathology Department, Diaconnesses Hospital, 75012 Paris, France;
| | - Gabriela Bindea
- Centre de Recherche des Cordeliers, Laboratory of Integrative Cancer Immunology, INSERM, Université de Paris, 75015 Paris, France; (B.M.); (D.B.); (G.B.); (J.G.)
| | - Aurélie Catteau
- HalioDx, 13009 Marseille, France; (A.C.); (A.F.); (I.B.); (M.M.)
| | - Aurélie Fugon
- HalioDx, 13009 Marseille, France; (A.C.); (A.F.); (I.B.); (M.M.)
| | - Isabelle Boquet
- HalioDx, 13009 Marseille, France; (A.C.); (A.F.); (I.B.); (M.M.)
| | - Marine Martel
- HalioDx, 13009 Marseille, France; (A.C.); (A.F.); (I.B.); (M.M.)
| | | | - Pierre Colin
- Urology Department, La Louvière, 59042 Lille, France;
| | - Roubini Zakopoulou
- Oncology Department, Alexandra Hospital, 11528 Athens, Greece; (R.Z.); (A.B.)
| | - Aristotelis Bamias
- Oncology Department, Alexandra Hospital, 11528 Athens, Greece; (R.Z.); (A.B.)
| | - Mostefa Bennamoun
- Oncology Department, Institut Mutualiste Montsouris, 75014 Paris, France; (M.B.); (X.B.)
| | - Xavier Barthere
- Oncology Department, Institut Mutualiste Montsouris, 75014 Paris, France; (M.B.); (X.B.)
| | - Bruno D’acremont
- Urology Department, Clinique St Jean De Dieu, 75007 Paris, France;
| | - Marine Lefevre
- Department of Pathology, Institut Mutualiste Montsouris, 75014 Paris, France;
| | - Francois Audenet
- Urology Department, Hopital Européen Georges Pompidou, AP-HP—Université de Paris, 75015 Paris, France; (F.A.); (V.V.)
| | - Arnaud Mejean
- Pathology Department, Hopital Européen Georges Pompidou, 75015 Paris, France;
| | - Virginie Verkarre
- Urology Department, Hopital Européen Georges Pompidou, AP-HP—Université de Paris, 75015 Paris, France; (F.A.); (V.V.)
| | - Stéphane Oudard
- Oncology Department, Hopital Européen Georges Pompidou, University of Paris, 75015 Paris, France; (E.F.N.); (C.T.); (M.A.)
- Correspondence: ; Tel.: +33-156-093-447
| | - Jérôme Galon
- Centre de Recherche des Cordeliers, Laboratory of Integrative Cancer Immunology, INSERM, Université de Paris, 75015 Paris, France; (B.M.); (D.B.); (G.B.); (J.G.)
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Cai Z, Jin H, Chen J, Hu J, Li H, Yi Z, Zu X. Adjuvant chemotherapy in patients with locally advanced bladder cancer after neoadjuvant chemotherapy and radical cystectomy: a systematic review and pooled analysis. Transl Androl Urol 2021; 10:283-291. [PMID: 33532317 PMCID: PMC7844510 DOI: 10.21037/tau-20-571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NAC) could ameliorate the stage of locally advanced bladder cancer (LABC) which is defined in pT3/T4 and/or pN+, improve overall survival (OS) before radical cystectomy (RC). However, for LABC, the decision to use adjuvant chemotherapy (AC) after NAC and RC is still controversial. Methods We performed a comprehensive search of the PubMed, Embase, and Cochrane Library databases for literature that reported prognosis after using AC following NAC and RC. Cumulative analyses of hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were performed. We performed all analyses by Review Manager software, version 5.3, and Stata 15.0. Results Six retrospective cohort studies were included, involving 4,346 patients. Pooled analysis results showed that using AC after NAC and RC can improve OS (HR =0.83, 95% CI: 0.74-0.94, P=0.002; I2 =0%) and cancer-specific survival (CSS) (HR =0.56, 95% CI: 0.32-0.99, P=0.04; I2 =0%) but cannot extend recurrence-free survival (RFS) (HR =0.52, 95% CI: 0.27-1.01, P=0.05; I2 =53%) for LABC patients. Conclusions This pooled analysis shows that AC after NAC and RC can improve the prognosis for patients with LABC.
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Affiliation(s)
- Zhiyong Cai
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Hang Jin
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiao Hu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Huihuang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenglin Yi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Abstract
PURPOSE OF REVIEW Systemic treatment of advanced urogenital malignancies has changed significantly in recent years and it will continue to change rapidly in upcoming years. It is the scope of this review article to providing the reader with the most recently approved treatment strategies to be used in daily routine for the individualized and most optimal treatment of our patients. RECENT FINDINGS Immunooncological therapy (IOT) has emerged as the treatment of choice in metastatic renal cell carcinoma and we describe the most relevant clinical trials and we will give some differential therapeutic recommendation who might be best treated with which combination therapy considering both oncological efficacy and treatment-related toxicity. New neoadjuvant treatment options for muscle-invasive bladder cancer are reported. With regard to metastatic prostate cancer, the landscape of medical therapy is continuously evolving and the new, and most relevant therapeutic strategies for metastatic hormone-naive and castration-resistant PCA are described. Last, but not least, we highlight latest developments in the management of advanced testis cancer. SUMMARY The novel treatment options reported in this article are ready for use in daily routine and already represent or will shortly represent new guideline-recommended therapies.
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Neoadjuvant PD-L1 plus CTLA-4 blockade in patients with cisplatin-ineligible operable high-risk urothelial carcinoma. Nat Med 2020; 26:1845-1851. [PMID: 33046869 PMCID: PMC9768836 DOI: 10.1038/s41591-020-1086-y] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/28/2020] [Indexed: 01/25/2023]
Abstract
Immune checkpoint therapy is being tested in the neoadjuvant setting for patients with localized urothelial carcinoma1,2, with one study reporting data in cisplatin-ineligible patients who received anti-PD-L1 monotherapy2. The study reported that patients with bulky tumors, a known high-risk feature defined as greater than clinical T2 disease, had fewer responses, with pathological complete response rate of 17%2. Here we report on the first pilot combination neoadjuvant trial ( NCT02812420 ) with anti-PD-L1 (durvalumab) plus anti-CTLA-4 (tremelimumab) in cisplatin-ineligible patients, with all tumors identified as having high-risk features (n = 28). High-risk features were defined by bulky tumors, variant histology, lymphovascular invasion, hydronephrosis and/or high-grade upper tract disease3-5. The primary endpoint was safety and we observed 6 of 28 patients (21%) with grade ≥3 immune-related adverse events, consisting of asymptomatic laboratory abnormalities (n = 4), hepatitis and colitis (n = 2). We also observed pathological complete response of 37.5% and downstaging to pT1 or less in 58% of patients who completed surgery (n = 24). In summary, we provide initial safety, efficacy and biomarker data with neoadjuvant combination anti-PD-L1 plus anti-CTLA-4, which warrants further development for patients with localized urothelial carcinoma, especially cisplatin-ineligible patients with high-risk features who do not currently have an established standard-of-care neoadjuvant treatment.
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Linch M, Lee AJX. Positioning checkpoint blockade in urothelial cancer: PURE-01 and PEANUTS. Ann Oncol 2020; 31:1601-1602. [PMID: 33068729 DOI: 10.1016/j.annonc.2020.10.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- M Linch
- Department of Oncology, University College London Cancer Institute, London, UK.
| | - Alvin J X Lee
- Department of Oncology, University College London Cancer Institute, London, UK
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Zhang K, Chen L, Zhang Z, Cao J, He L, Li L. Ubiquitin-like protein FAT10: A potential cardioprotective factor and novel therapeutic target in cancer. Clin Chim Acta 2020; 510:802-811. [DOI: 10.1016/j.cca.2020.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
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Immune checkpoint inhibition in upper tract urothelial carcinoma. World J Urol 2020; 39:1357-1367. [PMID: 33128595 DOI: 10.1007/s00345-020-03502-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Immunotherapy is changing the way we think about and treat urothelial carcinoma (UC). The PD-1/PD-L1 pathway inhibition has shown robust efficacy, associated with an acceptable toxicity profile, in patients with locally advanced and metastatic unresectable disease, addressing a high decades-old unmet medical need. MATERIAL AND METHODS Using the Pubmed database, we conducted a literature review for English written published articles up to June 2020. The highest available evidence for the immunotherapy treatment of UC with ICIs were evaluated. The leading phase one, two and three clinical trials were considered for inclusion (n = 12). Patient's data were extracted from studies depicting the UTUC subpopulation. RESULTS Two monoclonal antibodies targeting PD-1 (pembrolizumab and nivolumab) and three to its ligand PD-L1 (atezolizumab, avelumab, and durvalumab) have obtained US FDA and EMA approval for the second-line treatment of platinum-pretreated patients, between 2016 and 2019. Atezolizumab and Pembrolizumab are even currently approved in the first-line setting for cisplatin ineligible patients, with PD-L1- positive tumor. The neoadjuvant scenario in localized high-risk disease is still evolving, with the first data available to date limited to the muscle-invasive bladder carcinoma. The management of patients with upper tract urothelial carcinoma (UTUC: renal pelvis and ureters) is complicated by the lack of specific high-level evidence, due to the rarity of the disease. No published studies addressing immunotherapy in UTUC patients only are available. The largest clinical trials aimed at UC patients, regardless of the upper or lower location of the primary tumor, have enrolled a minority of patients with UTUC, providing the data on which our current knowledge is based. However, targeted scientific efforts are needed to improve our level of care. CONCLUSIONS This review summarizes the main currently available evidence on the use of the PD-1/PD-L1 pathway inhibition with reference to patients presenting with UTUC.
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Sardana R, Mishra SK, Williamson SR, Mohanty A, Mohanty SK. Immune checkpoints and their inhibitors: Reappraisal of a novel diagnostic and therapeutic dimension in the urologic malignancies. Semin Oncol 2020; 47:367-379. [PMID: 33160642 DOI: 10.1053/j.seminoncol.2020.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Abstract
Advances in molecular immunology have unveiled some of the complexity of the mechanisms regulating cellular immune responses and led to the successful targeting of immune checkpoints in attempts to enhance antitumor T cell responses. Surgery, chemotherapy, and radiation therapy have been the mainstay of treatment in urologic malignancies. Immune checkpoint molecules such as cytotoxic T-lymphocyte associated protein-4, programmed cell death protein-1, and programmed death-ligand 1 have been shown to play central roles in evading cancer immunity. Thus these molecules have been targeted by inhibitors for the management of cancers forming the basis of immunotherapy. Immunotherapy is now among the first line therapeutic options for metastatic renal cell carcinomas. In advanced bladder cancer, immunotherapy is the standard of care in the second line and the first line for cisplatin ineligible patients. There continues to be ongoing research to identify the role if any of immunotherapy in testicular, prostatic, and penile cancers. The ideal biomarker for response to immunotherapy is still elusive. Although programmed death-ligand 1 immunohistochemical testing has been widely used across the globe as a biomarker for immunotherapy, companion diagnostic tests have inherent issues with testing and reporting and cannot have universal applicability. Additional biomarkers including, tumor mutational burden, deficient mismatch repair, high microsatellite instability, and immune gene expression profiling are being evaluated in various clinical trials. This review appraises the data of immunotherapy in the management of urologic malignancies.
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Affiliation(s)
- Rohan Sardana
- Department of Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Sourav K Mishra
- Department of Medical Oncology, Advanced Medical Research Institute, Bhubaneswar, India
| | - Sean R Williamson
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Abhishek Mohanty
- Principal Research Officer Head of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India.
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D'Andrea D, Matin S, Black PC, Petros FG, Zargar H, Dinney CP, Cookson MS, Kassouf W, Dall'Era MA, McGrath JS, Wright JL, Thorpe AC, Morgan TM, Holzbeierlein JM, Bivalacqua TJ, Sridhar SS, North S, Barocas DA, Lotan Y, Stephenson AJ, van Rhijn BW, Spiess PE, Daneshmand S, Shariat SF. Comparative effectiveness of neoadjuvant chemotherapy in bladder and upper urinary tract urothelial carcinoma. BJU Int 2020; 127:528-537. [PMID: 32981193 PMCID: PMC8246716 DOI: 10.1111/bju.15253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective To assess the differential response to neoadjuvant chemotherapy (NAC) in patients with urothelial carcinoma of the bladder (UCB) compared to upper tract urothelial carcioma (UTUC) treated with radical surgery. Patients and Methods Data from 1299 patients with UCB and 276 with UTUC were obtained from multicentric collaborations. The association of disease location (UCB vs UTUC) with pathological complete response (pCR, defined as a post‐treatment pathological stage ypT0N0) and pathological objective response (pOR, defined as ypT0‐Ta‐Tis‐T1N0) after NAC was evaluated using logistic regression analyses. The association with overall (OS) and cancer‐specific survival (CSS) was evaluated using Cox regression analyses. Results A pCR was found in 250 (19.2%) patients with UCB and in 23 (8.3%) with UTUC (P < 0.01). A pOR was found in 523 (40.3%) patients with UCB and in 133 (48.2%) with UTUC (P = 0.02). On multivariable logistic regression analysis, patients with UTUC were less likely to have a pCR (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.27–0.70; P < 0.01) and more likely to have a pOR (OR 1.57, 95% CI 1.89–2.08; P < 0.01). On univariable Cox regression analyses, UTUC was associated with better OS (hazard ratio [HR] 0.80, 95% CI 0.64–0.99, P = 0.04) and CSS (HR 0.63, 95% CI 0.49–0.83; P < 0.01). On multivariable Cox regression analyses, UTUC remained associated with CSS (HR 0.61, 95% CI 0.45–0.82; P < 0.01), but not with OS. Conclusions Our present findings suggest that the benefit of NAC in UTUC is similar to that found in UCB. These data can be used as a benchmark to contextualise survival outcomes and plan future trial design with NAC in urothelial cancer.
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Affiliation(s)
- David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Surena Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Firas G Petros
- Department of Urology and Kidney Transplant, Eleanor N. Dana Cancer Center, The University of Toledo Medical Center, Toledo, OH, USA
| | - Homayoun Zargar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,Department of Urology, Western Health, Melbourne, Vic., Australia
| | - Colin P Dinney
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Michael S Cookson
- Department of Urology, Center and The Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Wassim Kassouf
- Division of Urology, Department of Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Marc A Dall'Era
- Department of Urology, Davis Medical Center, University of California at Davis, Sacramento, CA, USA
| | - John S McGrath
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Andrew C Thorpe
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Todd M Morgan
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Trinity J Bivalacqua
- Department of Urology, The Johns Hopkins School of Medicine, The James Buchanan Brady Urological Institute, Baltimore, MD, USA
| | - Srikala S Sridhar
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Scott North
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew J Stephenson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bas W van Rhijn
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Departments of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Urology, University of Jordan, Amman, Jordan.,European Association of Urology Research Foundation, Arnhem, The Netherlands
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Does the administration of preoperative pembrolizumab lead to sustained remission post-cystectomy? First survival outcomes from the PURE-01 study ☆. Ann Oncol 2020; 31:1755-1763. [PMID: 32979511 DOI: 10.1016/j.annonc.2020.09.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Initial studies of preoperative checkpoint inhibition before radical cystectomy (RC) have shown promising pathologic complete responses. We aimed to analyze the survival outcomes of patients enrolled in the PURE-01 study (NCT02736266). PATIENTS AND METHODS We report the results of the secondary end points of PURE-01 in the final population of 143 patients. In particular, we report the event-free survival (EFS) outcomes, defined as the time from the first cycle of pembrolizumab to radiographic disease progression precluding RC, initiation of neoadjuvant chemotherapy (NAC), recurrence after RC, or death from any cause. Other end points were recurrence-free survival (RFS) and overall survival (OS). Subgroup analyses were carried out, including pathological response category, clinical complete responses (CR) assessed via multiparametric magnetic resonance imaging (mpMRI), and molecular subtyping. Cox regression analyses for EFS were also carried out. RESULTS After a median [interquartile range (IQR)] follow-up of 23 (15-29) months, 12- and 24-month EFS were 84.5% [95% confidence interval (CI): 78.5-90.9] and 71.7% (62.7-82). The prognosis was favorable across all the different pathological response subgroups, with the exception of ypN+ (N = 21), showing a 24-month RFS (95% CI) of 39.3% (19.2% to 80.5%). A statistically significant EFS benefit was observed in patients with a clinical CR (P = 0.002). Programmed cell-death-ligand-1 combined positive score was significantly associated with longer EFS in multivariable analyses. Four patients refused RC after clinical evidence of CR, and none of them have recurred after a median follow-up of 10 months (IQR: 11-15). The claudin-low subtype displayed a numerically longer EFS after pembrolizumab and RC compared with the other subtypes. CONCLUSIONS The EFS results from PURE-01 revealed that the immunotherapy effect was maintained post-RC in most patients. Pembrolizumab compared favorably with neoadjuvant chemotherapy, irrespective of the biomarker status. Molecular subtyping may be a useful tool to select the patients who are predicted to benefit the most from neoadjuvant pembrolizumab.
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Abstract
Bladder cancer accounts for nearly 170,000 deaths worldwide annually. For over 4 decades, the systemic management of muscle-invasive and advanced bladder cancer has primarily consisted of platinum-based chemotherapy. Over the past 10 years, innovations in sequencing technologies have led to rapid genomic characterization of bladder cancer, deepening our understanding of bladder cancer pathogenesis and exposing potential therapeutic vulnerabilities. On the basis of its high mutational burden, immune checkpoint inhibitors were investigated in advanced bladder cancer, revealing durable responses in a subset of patients. These agents are now approved for several indications and highlight the changing treatment landscape of advanced bladder cancer. In addition, commonly expressed molecular targets were leveraged to develop targeted therapies, such as fibroblast growth factor receptor inhibitors and antibody-drug conjugates. The molecular characterization of bladder cancer and the development of novel therapies also have stimulated investigations into optimizing treatment approaches for muscle-invasive bladder cancer. Herein, the authors review the history of muscle-invasive and advanced bladder cancer management, highlight the important molecular characteristics of bladder cancer, describe the major advances in treatment, and offer future directions for therapeutic development.
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Affiliation(s)
- Vaibhav G Patel
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William K Oh
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Yan H, Dittmar F, Schagdarsurengin U, Wagenlehner F. The Clinical Application and Potential Roles of Circulating Tumor Cells in Bladder Cancer and Prostate Cancer. Urology 2020; 145:30-37. [PMID: 32634447 DOI: 10.1016/j.urology.2020.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 11/17/2022]
Abstract
Circulating tumor cells (CTCs) are considered to be promising biomarkers in malignant diseases. Recently, molecular profiles of CTCs in prostate cancer (PCa) and the role of CTCs in neoadjuvant chemotherapy and transurethral resections of bladder cancer (BCa) are intensely studied. However, localized PCa and nonmuscle-invasive BCa are less investigated and discussed. Moreover, the benefit and feasibility of clinical applications of CTCs should be critically questioned and reevaluated. This review focuses mainly on clinical issues and lesser on methodologies, and summarizes the quintessence of available works dealing with clinical applications of CTCs in PCa and BCa management.
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Affiliation(s)
- Hang Yan
- Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany; Working Group Epigenetics of Urogenital System, Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany
| | - Florian Dittmar
- Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany
| | - Undraga Schagdarsurengin
- Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany; Working Group Epigenetics of Urogenital System, Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany
| | - Florian Wagenlehner
- Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany.
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