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Brown JT, Narayan VM, Joshi SS, Harik L, Jani AB, Bilen MA. Challenges and opportunities in the management of non-urothelial bladder cancers. Cancer Treat Res Commun 2023; 34:100663. [PMID: 36527979 DOI: 10.1016/j.ctarc.2022.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
Urothelial carcinoma accounts for approximately 90% of all bladder cancer diagnoses. Localized, muscle-invasive disease is often managed with a multidisciplinary approach including either neoadjuvant chemotherapy (NAC) followed by radical cystectomy or concurrent chemoradiation, whereas multiple immunotherapies and novel antibody drug conjugates have recently joined platinum-based chemotherapy as standard of care therapy for metastatic disease. However, the clinical trials leading to these standards often require majority if not complete urothelial histology for eligibility. As many as one quarter of patients diagnosed with bladder cancer will have either divergent differentiation of their urothelial carcinoma or an alternate epithelial tumor such as squamous cell carcinoma, adenocarcinoma, or small cell carcinoma; even more rare are non-epithelial tumors such as sarcoma. The rarity of these diseases and their general exclusion from treatment within prospective clinical trials has created a challenging situation where treatment plans are often derived from case series or extrapolated from other disease types and outcomes are poor compared to pure urothelial carcinoma. In this review, we summarize the existing data on the diagnosis and treatment of epithelial, non-urothelial bladder cancers including adenocarcinoma, squamous cell carcinoma, and small cell carcinoma in their localized and advances stages. We will also review the current clinical trial landscape investigating novel approaches to these diseases.
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Affiliation(s)
- Jacqueline T Brown
- Winship Cancer Institute, Emory University, Atlanta, GA, United States; Emory University School of Medicine, Department of Hematology and Medical Oncology, Atlanta, GA, United States.
| | - Vikram M Narayan
- Winship Cancer Institute, Emory University, Atlanta, GA, United States; Emory University School of Medicine, Department of Urology, Atlanta, GA, United States
| | - Shreyas S Joshi
- Winship Cancer Institute, Emory University, Atlanta, GA, United States; Emory University School of Medicine, Department of Urology, Atlanta, GA, United States
| | - Lara Harik
- Winship Cancer Institute, Emory University, Atlanta, GA, United States; Emory University School of Medicine, Department of Pathology and Laboratory Medicine, Atlanta, GA, United States
| | - Ashesh B Jani
- Winship Cancer Institute, Emory University, Atlanta, GA, United States; Emory University School of Medicine, Department of Radiation Oncology, Atlanta, GA, United States
| | - Mehmet Asim Bilen
- Winship Cancer Institute, Emory University, Atlanta, GA, United States; Emory University School of Medicine, Department of Hematology and Medical Oncology, Atlanta, GA, United States
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Kageyama T, Soga N, Sekito S, Kato S, Ogura Y, Kojima T, Kanai M, Inoue T. Dramatic response to pembrolizumab after pseudoprogression in a patient with advanced metastatic castration‐resistant prostate cancer. IJU Case Rep 2022; 5:442-445. [DOI: 10.1002/iju5.12508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Takumi Kageyama
- Department of Nephro‐Urologic Surgery and Andrology Mie University Graduate School of Medicine Tsu Mie Japan
- Department of Urology Aichi Cancer Center Hospital Nagoya Aichi Japan
- Department of Urology Suzuka General Hospital Suzuka Mie Japan
| | - Norihito Soga
- Department of Urology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Sho Sekito
- Department of Urology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Yuji Ogura
- Department of Urology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Takahiro Kojima
- Department of Urology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Masahiro Kanai
- Department of Urology Suzuka General Hospital Suzuka Mie Japan
| | - Takahiro Inoue
- Department of Nephro‐Urologic Surgery and Andrology Mie University Graduate School of Medicine Tsu Mie Japan
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Bandini M, Pederzoli F, Madison R, Briganti A, Ross JS, Niegisch G, Yu EY, Bamias A, Agarwal N, Sridhar SS, Rosenberg JE, Bellmunt J, Pal SK, Galsky MD, Lucianò R, Gallina A, Salonia A, Montorsi F, Ali SM, Chung JH, Necchi A. Unfavorable Cancer-specific Survival After Neoadjuvant Chemotherapy and Radical Cystectomy in Patients With Bladder Cancer and Squamous Cell Variant: A Multi-institutional Study. Clin Genitourin Cancer 2020; 18:e543-e556. [PMID: 32144050 PMCID: PMC8491463 DOI: 10.1016/j.clgc.2020.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/13/2020] [Accepted: 01/30/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nonurothelial carcinoma (UC) malignancies have traditionally been considered to have a more aggressive clinical course, and little is known about their response to neoadjuvant therapy. We examined the effect of neoadjuvant chemotherapy (NAC) on a large population of patients with bladder cancer (BCa) with different histologic variants (HVs). PATIENTS AND METHODS We relied on a retrospective, multicenter database of 2858 patients with BCa who had undergone radical cystectomy with or without NAC from 1990 to 2017. Pure and mixed HVs were grouped into 6 categories: squamous cell carcinoma (SCC; n = 283; 45%), other subtypes (n = 95; 15%), micropapillary (n = 85; 14%), adenocarcinoma (n = 65; 10%), small cell (n = 54; 8.6%), and sarcomatous (n = 47; 7.6%). Kaplan-Meier and Cox regression analyses were used to examine cancer-specific survival (CSS) according to the HV, using pure UC as the reference. Logistic regression models were used to examine the odds of clinical-to-pathologic downstaging after NAC according to the HV. RESULTS Overall, we identified 2229 cases of pure UC and 629 cases of BCa with HVs at radical cystectomy. Of the 450 NAC-treated patients, only those patients with SCC (n = 44; 9.8%) had had worse CSS (median CSS, 33 vs. 116 months; P < .001) and higher mortality rates (hazard ratio, 2.1; P = .03) compared with those with pure UC (n = 328; 72.9%). The results of the analyses were also confirmed when the pure and mixed cases were considered separately. After adjusting for NAC, only SCC showed a lower rate of clinical-to-pathologic downstaging (odds ratio, 0.4; P = .03) compared with UC. CONCLUSIONS SCC was the HV exhibiting the lowest effect of NAC in terms of activity and CSS. Compared with pure UC, SCC seemed to be insensitive to traditional NAC regimens.
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Affiliation(s)
- Marco Bandini
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Filippo Pederzoli
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Alberto Briganti
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Jeffrey S Ross
- Foundation Medicine, Cambridge, MA; Upstate Medical University, Syracuse, NY
| | - Günter Niegisch
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Evan Y Yu
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake, UT
| | - Srikala S Sridhar
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Matthew D Galsky
- Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - Roberta Lucianò
- Department of Pathology, Ospedale San Raffaele, Milan, Italy
| | - Andrea Gallina
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Chen J, Mu F, Lu T, Ma Y, Du D, Xu K. A Gallbladder Carcinoma Patient With Pseudo-Progressive Remission After Hydrogen Inhalation. Onco Targets Ther 2019; 12:8645-8651. [PMID: 31695424 PMCID: PMC6804672 DOI: 10.2147/ott.s227217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/03/2019] [Indexed: 01/10/2023] Open
Abstract
Background Hydrogen therapy has been reported to convert exhausted programmed cell death receptor (PD-1)+CD8+ T cells to PD-1-CD8+ T cells, in advanced colorectal cancer patients, which is associated with significantly prolonged survival. Case presentation A 72-year-old female patient presented with metastatic gallbladder cancer and underwent symptomatic treatment combined with hydrogen therapy. The tumors were initially enlarged and displayed increased tumor marker expression following hydrogen inhalation therapy, after which they continued to remit, similar to the pseudo-progression that occurs after anti-PD-1 treatment. During one month of hydrogen therapy, the patient's gallbladder and liver tumors continued to progress, and intestinal obstruction occurred. The intestinal obstruction was gradually relieved after symptomatic treatment, and the metastases in the abdominal cavity gradually decreased in size, anemia and hypoalbuminemia were corrected, and both the lymphocyte and tumor marker levels returned to normal. The patient was able to resume normal life two and a half months after hydrogen inhalation and survived over 10 months. Conclusion This is the first report of pseudo-progression followed by sustained remission after hydrogen inhalation. This phenomenon is similar to the pseudo-progression-remission pattern that occurs following PD-1 antibody treatment. These findings suggest that hydrogen may have an inhibitory effect on PD-1 expression.
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Affiliation(s)
- Jibing Chen
- Fuda Cancer Hospital of Jinan University, Guangzhou 510665, People's Republic of China.,Fuda Cancer Institute of Guangzhou City, Guangzhou 510665, People's Republic of China
| | - Feng Mu
- Fuda Cancer Hospital of Jinan University, Guangzhou 510665, People's Republic of China
| | - Tianyu Lu
- Fuda Cancer Hospital of Jinan University, Guangzhou 510665, People's Republic of China
| | - Yangyang Ma
- Fuda Cancer Hospital of Jinan University, Guangzhou 510665, People's Republic of China
| | - Duanming Du
- Intervention Department, The Second People's Hospital of Shenzhen, Shenzhen 518035, People's Republic of China
| | - Kecheng Xu
- Fuda Cancer Hospital of Jinan University, Guangzhou 510665, People's Republic of China.,Fuda Cancer Institute of Guangzhou City, Guangzhou 510665, People's Republic of China
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