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Shore ND, Boorjian SA, Canter DJ, Ogan K, Karsh LI, Downs TM, Gomella LG, Kamat AM, Lotan Y, Svatek RS, Bivalacqua TJ, Grubb RL, Krupski TL, Lerner SP, Woods ME, Inman BA, Milowsky MI, Boyd A, Treasure FP, Gregory G, Sawutz DG, Yla-Herttuala S, Parker NR, Dinney CPN. Intravesical rAd-IFNα/Syn3 for Patients With High-Grade, Bacillus Calmette-Guerin-Refractory or Relapsed Non-Muscle-Invasive Bladder Cancer: A Phase II Randomized Study. J Clin Oncol 2017; 35:3410-3416. [PMID: 28834453 DOI: 10.1200/jco.2017.72.3064] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Many patients with high-risk non-muscle-invasive bladder cancer (NMIBC) are either refractory to bacillus Calmette-Guerin (BCG) treatment or may experience disease relapse. We assessed the efficacy and safety of recombinant adenovirus interferon alfa with Syn3 (rAd-IFNα/Syn3), a replication-deficient recombinant adenovirus gene transfer vector, for patients with high-grade (HG) BCG-refractory or relapsed NMIBC. Methods In this open-label, multicenter (n = 13), parallel-arm, phase II study ( ClinicalTrials.gov identifier: NCT01687244), 43 patients with HG BCG-refractory or relapsed NMIBC received intravesical rAd-IFNα/Syn3 (randomly assigned 1:1 to 1 × 1011 viral particles (vp)/mL or 3 × 1011 vp/mL). Patients who responded at months 3, 6, and 9 were retreated at months 4, 7, and 10. The primary end point was 12-month HG recurrence-free survival (RFS). All patients who received at least one dose were included in efficacy and safety analyses. Results Forty patients received rAd-IFNα/Syn3 (1 × 1011 vp/mL, n = 21; 3 × 1011 vp/mL, n = 19) between November 5, 2012, and April 8, 2015. Fourteen patients (35.0%; 90% CI, 22.6% to 49.2%) remained free of HG recurrence 12 months after initial treatment. Comparable 12-month HG RFS was noted for both doses. Of these 14 patients, two experienced recurrence at 21 and 28 months, respectively, after treatment initiation, and one died as a result of an upper tract tumor at 17 months without a recurrence. rAd-IFNα/Syn3 was well tolerated; no grade four or five adverse events (AEs) occurred, and no patient discontinued treatment because of an adverse event. The most frequently reported drug-related AEs were micturition urgency (n = 16; 40%), dysuria (n = 16; 40%), fatigue (n = 13; 32.5%), pollakiuria (n = 11; 28%), and hematuria and nocturia (n = 10 each; 25%). Conclusion rAd-IFNα/Syn3 was well tolerated. It demonstrated promising efficacy for patients with HG NMIBC after BCG therapy who were unable or unwilling to undergo radical cystectomy.
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Affiliation(s)
- Neal D Shore
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Stephen A Boorjian
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Daniel J Canter
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Kenneth Ogan
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Lawrence I Karsh
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Tracy M Downs
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Leonard G Gomella
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Ashish M Kamat
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Yair Lotan
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Robert S Svatek
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Trinity J Bivalacqua
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Robert L Grubb
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Tracey L Krupski
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Seth P Lerner
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Michael E Woods
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Brant A Inman
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Matthew I Milowsky
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Alan Boyd
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - F Peter Treasure
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Gillian Gregory
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - David G Sawutz
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Seppo Yla-Herttuala
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Nigel R Parker
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Colin P N Dinney
- Neal D. Shore, Carolina Urologic Research Center, Myrtle Beach, SC; Stephen A. Boorjian, Mayo Clinic, Rochester, MN; Daniel J. Canter, Ochsner Health System, New Orleans, LA; Kenneth Ogan, Emory University, Atlanta, GA; Lawrence I. Karsh, The Urology Center of Colorado, Denver, CO; Tracy M. Downs, University of Wisconsin, Madison, WI; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Ashish M. Kamat and Colin P.N. Dinney, University of Texas MD Anderson Cancer Center; Seth P. Lerner, Baylor College of Medicine, Houston; Yair Lotan, University of Texas Southwestern Medical Center, Dallas; Robert S. Svatek, University of Texas Health Science Center at San Antonio, San Antonio, TX; Trinity J. Bivalacqua, Johns Hopkins School of Medicine, Baltimore, MD; Robert L. Grubb III, Washington University, St Louis, MO; Tracey L. Krupski, University of Virginia, Charlottesville, VA; Michael E. Woods and Matthew I. Milowsky, University of North Carolina, Chapel Hill; Brant A. Inman, Duke University, Durham, NC; Alan Boyd, Alan Boyd Consultants, Cottenham; F. Peter Treasure, Peter Treasure Statistical Services, King's Lynn, United Kingdom; Gillian Gregory, David G. Sawutz, and Nigel R. Parker, FKD Therapies Oy; and Seppo Yla-Herttuala, A.I. Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
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Kamat AM, Sylvester RJ, Böhle A, Palou J, Lamm DL, Brausi M, Soloway M, Persad R, Buckley R, Colombel M, Witjes JA. Definitions, End Points, and Clinical Trial Designs for Non-Muscle-Invasive Bladder Cancer: Recommendations From the International Bladder Cancer Group. J Clin Oncol 2016; 34:1935-44. [PMID: 26811532 DOI: 10.1200/jco.2015.64.4070] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide recommendations on appropriate clinical trial designs in non-muscle-invasive bladder cancer (NMIBC) based on current literature and expert consensus of the International Bladder Cancer Group. METHODS We reviewed published trials, guidelines, meta-analyses, and reviews and provided recommendations on eligibility criteria, baseline evaluations, end points, study designs, comparators, clinically meaningful magnitude of effect, and sample size. RESULTS NMIBC trials must be designed to provide the most clinically relevant data for the specific risk category of interest (low, intermediate, or high). Specific eligibility criteria and baseline evaluations depend on the risk category being studied. For the population of patients for whom bacillus Calmette-Guérin (BCG) has failed, the type of failure (BCG unresponsive, refractory, relapsing, or intolerant) should be clearly defined to make comparisons across trials feasible. Single-arm designs may be relevant for the BCG-unresponsive population. Here, a clinically meaningful initial complete response rate (for carcinoma in situ) or recurrence-free rate (for papillary tumors) of at least 50% at 6 months, 30% at 12 months, and 25% at 18 months is recommended. For other risk levels, randomized superiority trial designs are recommended; noninferiority trials are to be used sparingly given the large sample size required. Placebo control is considered unethical for all intermediate- and high-risk strata; therefore, control arms should comprise the current guideline-recommended standard of care for the respective risk level. In general, trials should use time to recurrence or recurrence-free survival as the primary end point and time to progression, toxicity, disease-specific survival, and overall survival as potential secondary end points. Realistic efficacy thresholds should be set to ensure that novel therapies receive due review by regulatory bodies. CONCLUSION The International Bladder Cancer Group has developed formal recommendations regarding definitions, end points, and clinical trial designs for NMIBC to encourage uniformity among studies in this disease.
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Affiliation(s)
- Ashish M Kamat
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
| | - Richard J Sylvester
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Andreas Böhle
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Joan Palou
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Donald L Lamm
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Maurizio Brausi
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Mark Soloway
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Raj Persad
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Roger Buckley
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Marc Colombel
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - J Alfred Witjes
- Ashish M. Kamat, University of Texas MD Anderson Cancer Center, Houston, TX; Richard J. Sylvester, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Andreas Böhle, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany; Joan Palou, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Donald L. Lamm, University of Arizona and BCG Oncology, Phoenix, AZ; Maurizio Brausi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy; Mark Soloway, University of Miami School of Medicine, Miami, FL; Raj Persad, Bristol Royal Infirmary and Bristol Urological Institute, Bristol, United Kingdom; Roger Buckley, North York General Hospital, Toronto, Ontario, Canada; Marc Colombel, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France; and J. Alfred Witjes, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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