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Zhang M, Wu J, Zhang Y, Shang H. Recent Advances of Neoadjuvant Immunotherapy for Urothelial Bladder Cancer. Ann Surg Oncol 2024; 31:5851-5859. [PMID: 38995447 DOI: 10.1245/s10434-024-15725-8] [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: 05/13/2024] [Accepted: 06/19/2024] [Indexed: 07/13/2024]
Abstract
Urothelial bladder cancer is one of the most common malignant tumors of the urinary system, which accounts for 90~95% of urothelial carcinoma. Despite the current standard neoadjuvant management for localized urothelial MIBC (T2-4cN0M0) is cisplatin-based chemotherapy before radical cystectomy, there still had poor performances and less overall survival benefits in patients with localized urothelial MIBC. Moreover, nearly half of MIBC patients were ineligible for receiving cisplatin because of chronic kidney disease and performance status. Although immunotherapy, immune checkpoint inhibitors (ICIs) has been identified as first or second-line treatments for localized and metastasis bladder cancer based on less adverse reactions and favorable outcomes, neoadjuvant immunotherapy had rarely used for the treatment of these patients because of less large-scale clinical randomized studies and limited outcomes. Therefore, we reviewed the advances of efficacy and safety with neoadjuvant immunotherapy for urothelial bladder cancer depended on published articles and clinical studies, which could provide more theoretical evidences and promising strategy for clinical therapeutic development.
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Affiliation(s)
- Mengjie Zhang
- The Affiliated Henan Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian Wu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongxin Zhang
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Haojie Shang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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2
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Viveiros N, Flores BC, Lobo J, Martins-Lima C, Cantante M, Lopes P, Deantonio C, Palu C, Sainson RC, Henrique R, Jerónimo C. Detailed bladder cancer immunoprofiling reveals new clues for immunotherapeutic strategies. Clin Transl Immunology 2022; 11:e1402. [PMID: 36092481 PMCID: PMC9440624 DOI: 10.1002/cti2.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/22/2022] [Accepted: 06/17/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives Bladder cancer (BlCa) is the tenth most frequent malignancy worldwide and the costliest to treat and monitor. Muscle-invasive BlCa (MIBC) has a dismal prognosis, entailing the need for alternative therapies for the standard radical cystectomy. Checkpoint blockade immunotherapy has been approved for high-grade non-muscle-invasive BlCa (HG NMIBC) and metastatic disease, but its effectiveness in localised MIBC remains under scrutiny. Herein, we sought to characterise and compare the immune infiltrate of HG NMIBC and MIBC samples, including ICOS expression, a targetable immune checkpoint associated with regulatory T cell(Tregs)-mediated immunosuppression. Methods Immunohistochemistry for CD83, CD20, CD68, CD163, CD3, CD8, CD4, FoxP3/ICOS and PD-L1 was performed in HG NMIBC and MIBC samples (n = 206), and positive staining was quantified in the peritumoral and/or intratumoral tissue compartments with QuPath imaging software. Results CD20+ B cells, CD68+ and CD163+ tumor-associated macrophages were significantly increased in MIBCs and associated with poor prognosis. In turn, higher infiltration of T cells was associated with prolonged survival, with exception of the CD4+ helper subset. Intratumoral expression of CD3 and CD8 was independent prognostic factors for increased disease-free survival (DFS) in multivariable analysis. Remarkably, Tregs (FoxP3+/FoxP3+ICOS+) were found differentially distributed between tissue compartments. PD-L1 immunoexpression independently predicted a shorter DFS and associated with higher infiltration of FoxP3+ICOS+ Tregs. Conclusions Immune infiltrates of HG NMIBC and MIBC display significant differences that may help selecting patients for immunotherapies. Considering ICOS immunoexpression results, it might constitute a relevant therapeutic target, eventually in combination with anti-PD-1/PD-L1 therapies, for certain BlCa patient subsets.
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Affiliation(s)
- Nicole Viveiros
- Cancer Biology and Epigenetics Group Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network) Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC) Porto Portugal
| | - Bianca Ct Flores
- Cancer Biology and Epigenetics Group Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network) Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC) Porto Portugal
| | - João Lobo
- Cancer Biology and Epigenetics Group Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network) Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC) Porto Portugal.,Department of Pathology Portuguese Oncology Institute of Porto (IPO Porto) Porto Portugal.,Department of Pathology and Molecular Immunology School of Medicine and Biomedical Sciences- University of Porto (ICBAS-UP) Porto Portugal
| | - Cláudia Martins-Lima
- Cancer Biology and Epigenetics Group Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network) Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC) Porto Portugal.,Department of Precision Medicine University of Campania "Luigi Vanvitelli" Naples Italy
| | - Mariana Cantante
- Cancer Biology and Epigenetics Group Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network) Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC) Porto Portugal.,Department of Pathology Portuguese Oncology Institute of Porto (IPO Porto) Porto Portugal
| | - Paula Lopes
- Cancer Biology and Epigenetics Group Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network) Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC) Porto Portugal.,Department of Pathology Portuguese Oncology Institute of Porto (IPO Porto) Porto Portugal
| | | | | | | | - Rui Henrique
- Cancer Biology and Epigenetics Group Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network) Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC) Porto Portugal.,Department of Pathology Portuguese Oncology Institute of Porto (IPO Porto) Porto Portugal.,Department of Pathology and Molecular Immunology School of Medicine and Biomedical Sciences- University of Porto (ICBAS-UP) Porto Portugal
| | - Carmen Jerónimo
- Cancer Biology and Epigenetics Group Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network) Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC) Porto Portugal.,Department of Pathology and Molecular Immunology School of Medicine and Biomedical Sciences- University of Porto (ICBAS-UP) Porto Portugal
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Hu X, Li G, Wu S. Advances in Diagnosis and Therapy for Bladder Cancer. Cancers (Basel) 2022; 14:3181. [PMID: 35804953 PMCID: PMC9265007 DOI: 10.3390/cancers14133181] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Bladder cancer (BCa) is one of the most common and expensive urinary system malignancies for its high recurrence and progression rate. In recent years, immense amounts of studies have been carried out to bring a more comprehensive cognition and numerous promising clinic approaches for BCa therapy. The development of innovative enhanced cystoscopy techniques (optical techniques, imaging systems) and tumor biomarkers-based non-invasive urine screening (DNA methylation-based urine test) would dramatically improve the accuracy of tumor detection, reducing the risk of recurrence and progression of BCa. Moreover, intravesical instillation and systemic therapeutic strategies (cocktail therapy, immunotherapy, vaccine therapy, targeted therapy) also provide plentiful measures to break the predicament of BCa. Several exploratory clinical studies, including novel surgical approaches, pharmaceutical compositions, and bladder preservation techniques, emerged continually, which are supposed to be promising candidates for BCa clinical treatment. Here, recent advances and prospects of diagnosis, intravesical or systemic treatment, and novel drug delivery systems for BCa therapy are reviewed in this paper.
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Affiliation(s)
- Xinzi Hu
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China; (X.H.); (G.L.)
- Department of Urology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen 518116, China
| | - Guangzhi Li
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China; (X.H.); (G.L.)
- Department of Urology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen 518116, China
| | - Song Wu
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China; (X.H.); (G.L.)
- Department of Urology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen 518116, China
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4
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Basile G, Bandini M, Raggi D, Marandino L, Pederzoli F, Salonia A, Briganti A, Montorsi F, Kulkarni SB, Necchi A. Bladder-sparing combination treatments for muscle-invasive bladder cancer: A plea for standardized assessment and definition of clinical trials endpoints. Urol Oncol 2021; 40:37-44. [PMID: 34840076 DOI: 10.1016/j.urolonc.2021.10.012] [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: 08/18/2021] [Revised: 10/03/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
Radical cystectomy is the standard of care for muscle invasive bladder cancer, although it represents a surgical procedure with high complication and mortality burden. Thus, more and more emphasis has been placed in favor of alternative treatments especially for patients who are unfit for or aim to avoid radical cystectomy. In this context, preclinical studies highlighted that chemoradiation therapy (CRT) may have immunomodulatory properties on tumor microenvironment with a consequent increase in immune biomarkers. Thus, following the encouraging results reached by immune checkpoint inhibitors (ICIs) in both metastatic and localized disease, CRT and ICIs combination treatment gained momentum as bladder-sparing option and several clinical trials were recently launched both as concurrent and sequential treatments. A narrative review of the literature was performed to summarize the rationale and clinical outcomes of trials testing CRT and ICIs combination. Promising results were recently released mainly from phase II trials reporting clinal complete response rates from 48% to 83%. Moreover, combination treatment, both as concurrent and sequential schedules, appeared to be quite tolerable. However, interpretation of preliminary findings is made difficult due to the heterogeneity of clinical endpoints among trials, patient population included and different measurement of response to treatment. Novel bladder-sparing strategies are finally gaining momentum in bladder cancer treatment. Despite preliminary findings are encouraging, harmonization of terminology and definition of clinical endpoints among trials will be mandatory to correctly assess the potential role of CRT and immunotherapy combination as bladder-sparing solution in routine clinical practice.
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Affiliation(s)
- Giuseppe Basile
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Marco Bandini
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Raggi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Marandino
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Pederzoli
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Andrea Necchi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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Martinez-Vidal L, Murdica V, Venegoni C, Pederzoli F, Bandini M, Necchi A, Salonia A, Alfano M. Causal contributors to tissue stiffness and clinical relevance in urology. Commun Biol 2021; 4:1011. [PMID: 34446834 PMCID: PMC8390675 DOI: 10.1038/s42003-021-02539-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Mechanomedicine is an emerging field focused on characterizing mechanical changes in cells and tissues coupled with a specific disease. Understanding the mechanical cues that drive disease progression, and whether tissue stiffening can precede disease development, is crucial in order to define new mechanical biomarkers to improve and develop diagnostic and prognostic tools. Classically known stromal regulators, such as fibroblasts, and more recently acknowledged factors such as the microbiome and extracellular vesicles, play a crucial role in modifications to the stroma and extracellular matrix (ECM). These modifications ultimately lead to an alteration of the mechanical properties (stiffness) of the tissue, contributing to disease onset and progression. We describe here classic and emerging mediators of ECM remodeling, and discuss state-of-the-art studies characterizing mechanical fingerprints of urological diseases, showing a general trend between increased tissue stiffness and severity of disease. Finally, we point to the clinical potential of tissue stiffness as a diagnostic and prognostic factor in the urological field, as well as a possible target for new innovative drugs.
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Affiliation(s)
- Laura Martinez-Vidal
- Vita-Salute San Raffaele University, Milan, Italy.
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Valentina Murdica
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Chiara Venegoni
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Filippo Pederzoli
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Bandini
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Andrea Salonia
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
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6
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Ferro M, de Cobelli O, Musi G, Lucarelli G, Terracciano D, Pacella D, Muto T, Porreca A, Busetto GM, Del Giudice F, Soria F, Gontero P, Cantiello F, Damiano R, Crocerossa F, Farhan ARA, Autorino R, Vartolomei MD, Muto M, Marchioni M, Mari A, Scafuri L, Minervini A, Longo N, Chiancone F, Perdona S, De Placido P, Verde A, Catellani M, Luzzago S, Mistretta FA, Ditonno P, Caputo VF, Battaglia M, Zamboni S, Antonelli A, Greco F, Russo GI, Hurle R, Crisan N, Manfredi M, Porpiglia F, Di Lorenzo G, Crocetto F, Buonerba C. Three vs. Four Cycles of Neoadjuvant Chemotherapy for Localized Muscle Invasive Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Multi-Institutional Analysis. Front Oncol 2021; 11:651745. [PMID: 34046347 PMCID: PMC8144638 DOI: 10.3389/fonc.2021.651745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Three or four cycles of cisplatin-based chemotherapy is the standard neoadjuvant treatment prior to cystectomy in patients with muscle-invasive bladder cancer. Although NCCN guidelines recommend 4 cycles of cisplatin-gemcitabine, three cycles are also commonly administered in clinical practice. In this multicenter retrospective study, we assessed a large and homogenous cohort of patients with urothelial bladder cancer (UBC) treated with three or four cycles of neoadjuvant cisplatin-gemcitabine followed by radical cystectomy, in order to explore whether three vs. four cycles were associated with different outcomes. METHODS Patients with histologically confirmed muscle-invasive UBC included in this retrospective study had to be treated with either 3 (cohort A) or 4 (cohort B) cycles of cisplatin-gemcitabine as neoadjuvant therapy before undergoing radical cystectomy with lymphadenectomy. Outcomes including pathologic downstaging to non-muscle invasive disease, pathologic complete response (defined as absence of disease -ypT0), overall- and cancer-specific- survival as well as time to recurrence were compared between cohorts A vs. B. RESULTS A total of 219 patients treated at 14 different high-volume Institutions were included in this retrospective study. Patients who received 3 (cohort A) vs. 4 (cohort B) cycles of neoadjuvant cisplatin-gemcitabine were 160 (73,1%) vs. 59 (26,9%).At univariate analysis, the number of neoadjuvant cycles was not associated with either pathologic complete response, pathologic downstaging, time to recurrence, cancer specific, and overall survival. Of note, patients in cohort B vs. A showed a worse non-cancer specific overall survival at univariate analysis (HR= 2.53; 95 CI= 1.05 - 6.10; p=0.046), although this finding was not confirmed at multivariate analysis. CONCLUSIONS Our findings suggest that 3 cycles of cisplatin-gemcitabine may be equally effective, with less long-term toxicity, compared to 4 cycles in the neoadjuvant setting.
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Affiliation(s)
- Matteo Ferro
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Ottavio de Cobelli
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Gennaro Musi
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Tommaso Muto
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy
| | | | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Cittá della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, AOU Cittá della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Francesco Cantiello
- Department of Urology, University of Catanzaro, UNIVERSITÁ “MAGNA GRÆCIA” di Catanzaro, Catanzaro, Italy
| | - Rocco Damiano
- Department of Urology, University of Catanzaro, UNIVERSITÁ “MAGNA GRÆCIA” di Catanzaro, Catanzaro, Italy
| | - Fabio Crocerossa
- Department of Urology, University of Catanzaro, UNIVERSITÁ “MAGNA GRÆCIA” di Catanzaro, Catanzaro, Italy
| | - Abdal Rahman Abu Farhan
- Department of Urology, University of Catanzaro, UNIVERSITÁ “MAGNA GRÆCIA” di Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, United States
| | - Mihai Dorin Vartolomei
- Department of Urology, Vienna General Hospital, Vienna, Austria
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Tirgu Mures, Romania
| | - Matteo Muto
- Department of Hematology, Oncology and Radiotherapy Azienda ospedaliera San Giuseppe Moscati, Avellino, Avelino, Italy
| | - Michele Marchioni
- Department of Urology, G. D’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Luca Scafuri
- Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Nicola Longo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | | | - Sisto Perdona
- Division of Urology, Istituto Nazionale Tumori Fondazione G. Pascale (IRCCS), Naples, Italy
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Verde
- Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Michele Catellani
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Stefano Luzzago
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | | | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Francesco Caputo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Stefania Zamboni
- Department of Urology, Civil Hospital of Brescia, Brescia, Italy
| | - Alessandro Antonelli
- Department of Urology, Civil Hospital of Brescia, Brescia, Italy
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona - Polo Chirurgico Confortini - Borgo Trento, Verona, Italy
| | - Francesco Greco
- Department of Urology, Humanitas Gavazzeni, IRRCS, Bergamo, Italy
| | | | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicolae Crisan
- Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy, Ciuj Napoca, Romania
| | - Matteo Manfredi
- Urology Unit - Department of Oncology, School of Medicine, University of Turin, Turin, Italy
| | - Francesco Porpiglia
- Urology Unit - Department of Oncology, School of Medicine, University of Turin, Turin, Italy
| | - Giuseppe Di Lorenzo
- Department of Urology, Humanitas Research Hospital Milano, Milan, Italy
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Felice Crocetto
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Carlo Buonerba
- Rare Tumor Reference Center, Federico II University Hospital, Naples, Italy
- Centro di Referenza Nazionale per l’Analisi e Studio di Correlazione tra Ambiente, Animale e Uomo, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Italy
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7
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Basile G, Pederzoli F, Bandini M, Raggi D, Gallina A, Salonia A, Briganti A, Montorsi F, Spiess PE, Necchi A. Intermediate- and high-risk nonmuscle invasive bladder cancer: Where do we stand? Urol Oncol 2021; 39:631-641. [PMID: 33766463 DOI: 10.1016/j.urolonc.2021.02.020] [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: 01/04/2021] [Revised: 02/10/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The standard of care for intermediate- and high-risk non-muscle invasive bladder cancer (NMIBC) patients is transurethral resection of bladder tumor followed by intravesical adjuvant immunotherapy with Bacillus Calmette-Guerin (BCG). However, a non-negligible portion of patients is doomed to fail BCG-therapy and, consequently, undergo radical cystectomy as only treatment option available. In this context, effective options to improve tumor response, thus delaying or even avoiding radical cystectomy, are urgently needed. A narrative review of the literature was performed to summarize the rationale and the clinical outcomes regarding the use of immunotherapy and novel therapeutic perspectives both for BCG-treated and BCG-naïve NMIBC patients. RESULTS Several clinical trials are currently investigating immune checkpoint inhibitors and novel targeted approaches, including cancer vaccines, for NMIBC patients with BCG-naïve and BCG-unresponsive disease. Despite the lack of long-term safety data, novel therapeutic options, both by systemic and intravesical delivery, demonstrated a good tolerability, antitumor efficacy, and low rates of recurrence and/or progression to muscle-invasive disease. CONCLUSIONS Although clinical data available are mostly limited to phase I/II trials, novel targeted therapies have raised as an effective and reliable approach for patients failing BCG and for those who are therapy naïve. Phase III trials will be crucial in order to change the current clinical practice, after many years in which BCG was the only therapy available for intermediate- and high-risk NMIBC patients.
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Affiliation(s)
- Giuseppe Basile
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Filippo Pederzoli
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Bandini
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Gallina
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Andrea Necchi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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Alfano M, Salonia A, Necchi A. Re: Madhuri Koti, Molly A. Ingersoll, Shilpa Gupta, et al. Sex Differences in Bladder Cancer Immunobiology and Outcomes: A Collaborative Review with Implications for Treatment. Eur Urol Oncol 2020;3:622-30. Eur Urol Oncol 2020; 3:802-803. [PMID: 33153935 DOI: 10.1016/j.euo.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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