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Clauser S, Palermo M, Palermo S, Comploj E, Hanspeter E, Mian C, Trenti E, Krüger S, Krause P, Mazzucato G, Pycha A. [An extremely rare case of multiple recurrences of urothelial carcinoma in an ileal neobladder: a case report and review of the literature]. Aktuelle Urol 2024. [PMID: 39260375 DOI: 10.1055/a-2383-0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
In up to 18% of patients, recurrence is observed after curative radical cystectomy. Tumour recurrence occurs in most cases in the locoregional lymph node, as well as in the remaining urinary tract, but very rarely in the orthotopic neobladder. We report a case of multiple recurrence of urothelial carcinoma solely in the orthotopic neobladder of a male patient, 10 years after surgery, without involvement of the urethra or upper urinary tract. Therefore, the patient underwent resection of the neobladder with conversion to a sigmoid conduit. Nevertheless approximately 6 months later the patient developed widespread metastases and died a few months later. Currently, no guidelines are available for the treatment of these rare cases. We present our experience, together with revision of the current literature on this issue.
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Affiliation(s)
- Silvia Clauser
- Department of Urology, Hospital of Bolzano, EBU Center, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
| | | | - Salvatore Palermo
- Department of Urology, Hospital of Bolzano, EBU Center, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
| | - Evi Comploj
- Department of Urology, Hospital of Bolzano, EBU Center, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
| | - Esther Hanspeter
- Department of Histopathology, Hospital of Bolzano, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
| | - Christine Mian
- Department of Histopathology, Hospital of Bolzano, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
| | - Emanuela Trenti
- Department of Urology, Hospital of Bolzano, EBU Center, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
| | - Sara Krüger
- Department of Urology, Hospital of Bolzano, EBU Center, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
| | - Philipp Krause
- Department of Urology, Hospital of Bolzano, EBU Center, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
| | - Giovanni Mazzucato
- Department of Urology, Hospital of Bolzano, EBU Center, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
| | - Armin Pycha
- Department of Urology, Hospital of Bolzano, EBU Center, Teaching Hospital of Paracelsus Medical Universitiy (PMU), Bolzano, Italy
- Sigmund Freud Private University, Medical School, Vienna, Austria
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Gontero P, Birtle A, Capoun O, Compérat E, Dominguez-Escrig JL, Liedberg F, Mariappan P, Masson-Lecomte A, Mostafid HA, Pradere B, Rai BP, van Rhijn BWG, Seisen T, Shariat SF, Soria F, Soukup V, Wood R, Xylinas EN. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ)-A Summary of the 2024 Guidelines Update. Eur Urol 2024:S0302-2838(24)02514-4. [PMID: 39155194 DOI: 10.1016/j.eururo.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND AND OBJECTIVE This publication represents a summary of the updated 2024 European Association of Urology (EAU) guidelines for non-muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ. The information presented herein is limited to urothelial carcinoma, unless specified otherwise. The aim is to provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation. METHODS For the 2024 guidelines on NMIBC, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS Key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with NMIBC. The guidelines stress the importance of defining patients' risk stratification and treating them appropriately. CONCLUSIONS AND CLINICAL IMPLICATIONS This overview of the 2024 EAU guidelines offers valuable insights into risk factors, diagnosis, classification, prognostic factors, treatment, and follow-up of NMIBC. These guidelines are designed for effective integration into clinical practice.
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Affiliation(s)
- Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy.
| | - Alison Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Otakar Capoun
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | | | - Fredrik Liedberg
- Institute of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Western General Hospital, The University of Edinburgh, Edinburgh, UK
| | | | - Hugh A Mostafid
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Benjamin Pradere
- Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Thomas Seisen
- Urology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University Vienna, Vienna, Austria
| | - Francesco Soria
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Viktor Soukup
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Robert Wood
- EAU Guidelines Office, Arnhem, The Netherlands
| | - Evanguelos N Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, Paris, France
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Wang B, Bao EH, Jiang BL, Yang L, Liu Y, Xia L, Wang JH, Wang L, Zhu PY. Signal mining and gender differences analysis of adverse events in NMIBC treatment with gemcitabine and BCG bladder instillation based on the FAERS database. Expert Opin Drug Saf 2024. [PMID: 39096111 DOI: 10.1080/14740338.2024.2388212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To explore safety differences and perform a gender-based analysis of adverse events related to gemcitabine and Bacillus Calmette-Guérin (BCG) vaccine using the U.S. FDA Adverse Event Reporting System (FAERS) database. METHODS Using the Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR) methods, adverse events associated with gemcitabine and BCG were mined from FAERS database reports spanning from Q1 2004 to Q3 2023. RESULTS The study extracted 37,855 reports with gemcitabine and 5,455 reports with BCG as the primary suspected drugs. Adverse events were more prevalent in males (male-to-female ratio: gemcitabine 1.10, BCG 4.25). Differences in high-frequency adverse events among the top 20 signals were detected for both drugs. Both drugs affected similar organ systems, including potential pulmonary, ocular, and renal toxicity, with gemcitabine showing a broader range of adverse events. Gender analysis revealed fewer adverse reactions to gemcitabine in females, while males had fewer adverse reactions to BCG. CONCLUSION Differences in high-frequency adverse events between gemcitabine and BCG, including some not listed on drug labels, were observed. Both drugs affect similar organ systems, with gemcitabine showing a broader range of adverse events. Gender differences in adverse events were notable.
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Affiliation(s)
- Ben Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, China
| | - Er-Hao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, China
| | - Bing-Lei Jiang
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, China
| | - Lin Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, China
| | - Ying Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, China
| | - Long Xia
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, China
| | - Jia-Hao Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, China
| | - Li Wang
- Department of Urology, Lanzhou University Second Hospital, China
| | - Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, China
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4
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Scilipoti P, Longoni M, de Angelis M, Re C, Bertini A, Cannoletta D, Burgio G, Lucianò R, Rosiello G, Colombo R, Gandaglia G, Salonia A, Montorsi F, Briganti A, Moschini M. Mitomycin C vs. Bacillus Calmette-Guerin for treatment of intermediate-risk nonmuscle invasive bladder cancer patients-A comparative analysis from a single center. Urol Oncol 2024:S1078-1439(24)00538-6. [PMID: 39060208 DOI: 10.1016/j.urolonc.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/13/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Induction followed by 1 year maintenance instillation of intravesical Bacillus Calmette-Guerin (BCG) is the standard treatment for intermediate-risk (IR) nonmuscle invasive bladder cancer (NMIBC) patients. Few data exist on the efficacy of Mitomycin C (MMC) instillation in this setting. METHODS We retrospectively analyzed 226 IR-NMIBC patients classified by the International Bladder Cancer Group (IBCG) and 250 IR-NMIBC intravescical treatment-naïve patients classified by the European Association of Urology (EAU). All patients received either a full induction course of BCG or 40 mg/40 ml MMC from 2012 to 2022. Optimal treatment was defined as 1-year maintenance for BCG and 11 monthly maintenance instillations for MMC. Kaplan-Meier analysis estimated recurrence-free survival (RFS) before and after inverse probability of treatment-weighting (IPTW) and progression-free survival (PFS). Multivariable Cox regression was used to evaluate difference in recurrence after adjustment for clinically relevant variables before and after IPTW. RESULTS Optimal BCG and MMC courses were administered to 21% of IR-IBCG and 23% of IR-EAU patients. At 4-years, patients treated with optimal MMC and BCG treatment had similar RFS and PFS in both EAU and IBCG groups. Patients receiving nonoptimal BCG compared to optimal MMC exhibited lower 4-year RFS after IPTW (82% vs. 68% in EAU and 82% vs. 65% in IBCG). At 4-year optimal MMC had greater PFS non optimal BCG. Optimal MMC treatment predicted recurrence in EAU (adjusted and weighted HR 0.33, 95% CI, 0.11-0.98) and IBCG (adjusted and weighted HR 0.29, 95% CI, 0.08-0.97) groups compared to nonoptimal BCG. CONCLUSIONS Optimal 40 mg/40 ml MMC treatment was as effective as optimal BCG in IR-IBCG and IR-EAU NMIBC patients, reducing both recurrence and progression compared to nonoptimal BCG. MMC could be a valid first line alternative to BCG for both IR-EAU and IR-IBCG intravescical treatment-naïve patients, during BCG shortages.
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Affiliation(s)
- Pietro Scilipoti
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Longoni
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Mario de Angelis
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Re
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Bertini
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Donato Cannoletta
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giusy Burgio
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Roberta Lucianò
- Department of Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Rosiello
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Renzo Colombo
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
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5
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Wang X, Wang Y, Che X, Zhou Z, Cheng B. The prognosis and safety of continuous saline bladder irrigation in patients after transurethral resection of bladder tumors: a systematic review and meta-analysis of comparative study. Updates Surg 2023; 75:1795-1806. [PMID: 37188906 DOI: 10.1007/s13304-023-01525-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/29/2023] [Indexed: 05/17/2023]
Abstract
The prognosis and safety of continuous saline bladder irrigation (CSBI) after transurethral resection of bladder tumor (TURB) as an alternative method needs to be explored. A literature review and meta-analysis were performed by searching PubMed, EMBASE, Cochrane Library databases and original references of the included articles. PRISMA checklists were followed. We used the GRADEpro GDT to assess the certainty of evidence from the results of our meta-analysis. A total of eight articles including 1600 patients were studied. The results indicated that patients received CSBI after TURB had no statistical differences compared to the control group in the recurrence-free survival and progression-free survival. However, the CSBI group showed significant improvements compared to the control group in terms of the number of recurrences during follow-up and the period to first recurrence except for the number of tumor progression during follow-up. Furthermore, patients treated with CSBI did not show an inferior effect than those treated with immediate intravesical chemotherapy (IC) in respects of recurrence-free survival, progression-free survival, the number of recurrences during follow-up, the number of tumor progression during follow-up and the period to first recurrence. But the immediate IC group had a higher incidence than the CSBI group in terms of macrohematuria, micturition pain, frequency of urination, dysuria, retention and local toxicities. Patients treated with CSBI after TURB showed a significant improvement compared to the control group in terms of the number of recurrences during follow-up and the period to first recurrence. However, compared to immediate IC, CSBI did not show an inferior effect except for lower incidence of adverse reactions.PROSPERO registration number CRD42021247088.
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Affiliation(s)
- Xiang Wang
- Department of Urology, Tengzhou Central People's Hospital, Tengzhou, 277500, China
| | - Yan Wang
- Department of Traditional Chinese Medicine, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Xuanyan Che
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhongbao Zhou
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Bo Cheng
- Department of Urology, Tengzhou Central People's Hospital, Tengzhou, 277500, China.
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Hien TT, Ambite I, Wan MLY, Cavalera M, Esmaeili P, Chaudhuri A, Sabari S, Babjuk M, Svanborg C. Long-term prevention of bladder cancer progression by alpha1-oleate alone or in combination with chemotherapy. Int J Cancer 2023; 153:584-599. [PMID: 36891980 DOI: 10.1002/ijc.34500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/10/2023]
Abstract
Bladder cancer is common and one of the most costly cancer forms, due to a lack of curative therapies. Recently, clinical safety and efficacy of the alpha1-oleate complex was demonstrated in a placebo-controlled study of nonmuscle invasive bladder cancer. Our study investigated if long-term therapeutic efficacy is improved by repeated treatment cycles and by combining alpha1-oleate with low-dose chemotherapy. Rapidly growing bladder tumors were treated by intravesical instillation of alpha1-oleate, Epirubicin or Mitomycin C alone or in combination. One treatment cycle arrested tumor growth, with a protective effect lasting at least 4 weeks in mice receiving 8.5 mM of alpha1-oleate alone or 1.7 mM of alpha-oleate combined with Epirubicin or Mitomycin C. Repeated treatment cycles extended protection, defined by a lack of bladder pathology and a virtual absence of bladder cancer-specific gene expression. Synergy with Epirubicin was detected at the lower alpha1-oleate concentration and in vitro, alpha1-oleate was shown to enhance the uptake and nuclear translocation of Epirubicin, by tumor cells. Effects at the chromatin level affecting cell proliferation were further suggested by reduced BrdU incorporation. In addition, alpha1-oleate triggered DNA fragmentation, defined by the TUNEL assay. The results suggest that bladder cancer development may be prevented long-term in the murine model, by alpha1-oleate alone or in combination with low-dose Epirubicin. In addition, the combination of alpha1-oleate and Epirubicin reduced the size of established tumors. Exploring these potent preventive and therapeutic effects will be of immediate interest in patients with bladder cancer.
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Affiliation(s)
- Tran Thi Hien
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Ines Ambite
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Murphy Lam Yim Wan
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Michele Cavalera
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Parisa Esmaeili
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Arunima Chaudhuri
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Samudra Sabari
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Marek Babjuk
- Department of Urology, Motol Hospital and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Catharina Svanborg
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
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Piombino C, Tonni E, Oltrecolli M, Pirola M, Pipitone S, Baldessari C, Dominici M, Sabbatini R, Vitale MG. Immunotherapy in urothelial cancer: current status and future directions. Expert Rev Anticancer Ther 2023; 23:1141-1155. [PMID: 37772970 DOI: 10.1080/14737140.2023.2265572] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/27/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Since 2016, the progressive use of immune checkpoint inhibitors (ICIs) starting from second-line treatment has led to an improvement in overall survival in locally advanced and metastatic urothelial cancer (UC). Clinical trials are underway testing the role of ICIs since the first stages of the disease, alone or in combination with standard therapies. AREAS COVERED This review summarizes the current updated evidence regarding the role of ICIs in the different stages of UC, the ongoing clinical trials exploring the potential benefit of immunotherapy alone or in combination with standard-of-care therapies, as well as the promising association of ICIs with antibody-drug conjugates (ADCs). EXPERT OPINION In the first-line setting, ICIs alone in platinum-unfit patients have shown unconvincing results; the ongoing EV-302 trial will probably suggest enfortumab vedotin plus pembrolizumab as a new effective option. The optimal duration of maintenance immunotherapy is still to be determined, finding a balance with the risk-benefit profile. The clinical benefit of ICIs as second-line treatment is limited to a subset of patients that cannot be definitively established yet. In the next 5 years, a lot of new ADCs will likely emerge for the treatment of UC.
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Affiliation(s)
- Claudia Piombino
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Elena Tonni
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Marco Oltrecolli
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Marta Pirola
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Stefania Pipitone
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Cinzia Baldessari
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Massimo Dominici
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Roberto Sabbatini
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
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8
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Almasi J, Thiesen J, Kraemer I. Physicochemical stability of ready-to-administer mitomycin C solutions for intravesical instillation. Eur J Hosp Pharm 2023:ejhpharm-2023-003743. [PMID: 37208150 DOI: 10.1136/ejhpharm-2023-003743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE The aim of the study was to investigate the physicochemical stability of mitomycin-containing medicinal products for bladder instillation, formulated with urea as excipient (mito-medac®, Mitomycin medac). For comparison, the stability of reconstituted Urocin® and Mitem® bladder instillation was studied. METHODS Mitomycin-containing medicinal products were either reconstituted with the prepackaged 0.9% NaCl solution, nominal volume 20 mL (mito-medac®, Mitem®, Urocin®) or with 20 mL water for injection (Mitomycin medac, Mitem®, Urocin®) to a nominal concentration of 1 mg/mL and stored at room temperature (20-25°C). Samples were taken immediately after reconstitution and after 24 hours. Physicochemical stability was determined by reverse-phase high performance liquid chromatography with photodiode array detection, measurement of pH and osmolarity, and inspection for visible particles or colour changes. RESULTS The initial pH values of the test solutions reconstituted with prepackaged 0.9% NaCl (5.2-5.6) were significantly lower than those reconstituted with water for injection (6.6-7.4). Solutions reconstituted with 0.9% NaCl solutions rapidly degraded and concentrations fell below the 90% limit after 24 hours of storage. When reconstituted with water for injection, degradation was less rapid. Concentrations of Mitomycin medac and Urocin remained above the 90% limit after 24 hours. CONCLUSIONS The physicochemical stability of mitomycin 1 mg/mL bladder instillation prepared with prepackaged 0.9% NaCl in prefilled PVC bags is less than 24 hours at room temperature. Unfavourable pH values of the solvents cause rapid degradation of mitomycin. Mitomycin solutions reconstituted at the point of care should be administered immediately to avoid degradation and loss of efficacy. Urea added as excipient did not accelerate degradation.
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Affiliation(s)
- Jannik Almasi
- Pharmacy, University Medical Center of the Johannes Gutenberg University, Mainz, Rheinland-Pfalz, Germany
| | - Judith Thiesen
- Pharmacy, University Medical Center of the Johannes Gutenberg University, Mainz, Rheinland-Pfalz, Germany
| | - Irene Kraemer
- Pharmacy, University Medical Center of the Johannes Gutenberg University, Mainz, Rheinland-Pfalz, Germany
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9
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Pradere B, Basile G, Seisen T. Re: Maria S. Lindgren, Eric Hansen, Nessn Azawi, Anna M. Nielsen, Lars Dyrskjøt, Jørgen B. Jensen. DaBlaCa-13 Study: Oncological Outcome of Short-term, Intensive Chemoresection with Mitomycin in Nonmuscle Invasive Bladder Cancer: Primary Outcome of a Randomized Controlled Trial. J Clin Oncol. In press. https://doi.org/10.1200/JCO.22.00470. Eur Urol 2023; 83:e105-e106. [PMID: 36717285 DOI: 10.1016/j.eururo.2022.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Benjamin Pradere
- Department of Urology UROSUD, La Croix Du Sud Hospital, Quint Fonsegrives, France; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Basile
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Thomas Seisen
- Department of Urology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, GRC 5, Predictive Onco-Urology, Paris, France.
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10
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Lenfant L, Pinar U, Rouprêt M, Seisen T. First-line Intravesical Chemotherapy for Non-muscle-invasive Bladder Cancer: Chimera or "Ne Plus Ultra"? Eur Urol 2023:S0302-2838(23)02637-4. [PMID: 36941147 DOI: 10.1016/j.eururo.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/03/2023] [Indexed: 03/23/2023]
Abstract
The efficacy of first-line intravesical chemotherapy for non-muscle-invasive bladder cancer has been tested in the neoadjuvant and chemoresection settings. However, the data available are highly heterogeneous and further high-quality studies are needed before its use can be embraced in either setting.
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Affiliation(s)
- Louis Lenfant
- Sorbonne University, GRC 5, Predictive Onco-urology, Department of Urology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-urology, Department of Urology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5, Predictive Onco-urology, Department of Urology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Thomas Seisen
- Sorbonne University, GRC 5, Predictive Onco-urology, Department of Urology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
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11
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Cimier A, Thach S, Lacroix B, Mariat C. [Evaluation of the efficacy and safety of HIVEC intravesical thermochemotherapy with intermediate-risk and high-risk non-muscle-invasive bladder cancer]. Prog Urol 2023; 33:254-264. [PMID: 36906430 DOI: 10.1016/j.purol.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/25/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Non-muscle-infiltrating cancers (NMIBC) represent 75% of bladder tumors. The objective of our study is to report a single-center experience of the efficacy and tolerability of HIVEC on intermediate- and high-risk NMIBC in adjuvant therapy. MATERIAL AND METHOD Between December 2016 and October 2020, patients with intermediate-risk or high-risk NMIBC were included. They were all treated with HIVEC as an adjuvant therapy to bladder resection. Efficacy was assessed by endoscopic follow-up and tolerance by a standardized questionnaire. RESULTS A total of 50 patients were included. The median age was 70years (34-88). The median follow-up time was 31 months (4-48). Forty-nine patients had cystoscopy as part of the follow-up. Nine recurred. One patient progressed to Cis. The 24-month recurrence-free survival was 86.6%. There were no severe adverse events (grade 3 or 4). The ratio of delivered instillations to planned instillations was 93%. CONCLUSION HIVEC with the COMBAT system is well tolerated in adjuvant treatment. However, it is not better than standard treatments, especially for intermediate-risk NMIBC. While waiting for recommendations, it cannot be proposed as an alternative to standard treatment. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- A Cimier
- Service d'urologie, CHU de Saint-Étienne, hôpital Nord, 42055 Saint-Étienne, France.
| | - S Thach
- Service d'urologie, clinique Mutualiste, 3, rue Le Verrier, 42000 Saint-Étienne, France
| | - B Lacroix
- Service d'urologie, clinique Mutualiste, 3, rue Le Verrier, 42000 Saint-Étienne, France
| | - C Mariat
- Service d'urologie, CHU de Saint-Étienne, hôpital Nord, 42055 Saint-Étienne, France
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12
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A 6-month maintenance schedule of mitomycin C after radical nephroureterectomy for upper tract urothelial carcinoma for the prevention of intravesical recurrence: a retrospective, single center study. World J Urol 2023; 41:1077-1083. [PMID: 36790518 DOI: 10.1007/s00345-023-04316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/22/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To show the effect of a 6-month (4 times weekly followed by 5 times monthly) maintenance mitomycin C regimen on the prevention of intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). METHODS A total of 119 patients undergoing a RNU between 2007 and 2021 in a single center hospital were retrospectively reviewed. A total of 66 patients were eligible for further analysis. 27 patients received no post-operative MMC (median follow-up: 110 months) and 39 patients received a 6-month (4 times weekly, 5 times monthly) maintenance regimen of MMC (median follow up: 48 months). The primary outcome was the 1-, 2- and 5-year bladder recurrence free survival (BRFS). RESULTS There was a significant difference (p = 0.001) in BRFS between the two groups. The 1-, 2, and 5-year BRFS for the MMC- group was 67%, 63% and 43%, respectively. The 1-, 2- and 5-year BRFS for the MMC + group was 95%, 86% and 86%, respectively. Univariate analysis showed no other potential prognostic factors that had a significant effect on the BRFS. CONCLUSION A 6-month maintenance schedule of MMC is effective at significantly reducing the risk of IVR after RNU for UTUC. We could not find any other significant prognostic factors to predict IVR.
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13
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Sun Z, Zhang W, Ye Z, Yuan L, Fu M, Liu X, Liang H, Han H. NIR-II-triggered doxorubicin release for orthotopic bladder cancer chemo-photothermal therapy. NANOSCALE 2022; 14:17929-17939. [PMID: 36325926 DOI: 10.1039/d2nr04200b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intravesical instillation has been widely utilized for bladder cancer treatment in clinic. However, due to the bladder mucosal barrier, its poor penetration efficiency and drug utilization limit the clinical therapeutic effectiveness and result in a high recurrence rate. Therefore, designing an efficient and controllable drug delivery nanoplatform is of great significance for bladder cancer treatment. Non-invasive therapy based on near-infrared-II (NIR-II) photothermal therapy (PTT) conduces to overcome bladder mucosal barrier and enhance drug delivery. Also, the photothermal nanomaterials, Au Hollow Nanorods (AuHNRs), demonstrate strong photothermal properties and drug loading capacity. Herein, a quaternized chitosan N-(2-hydroxyl)propyl-3-trimethyl ammonium chitosan chloride (HTCC)-modified nanocarrier Dox/NH4HCO3@AuHNRs-HTCC (DNAH) was designed for controlled drug release and enhanced penetration. The drug loading capacity of DNAH reached 117.20%. Also, the thermal decomposition of NH4HCO3 realized NIR-II-triggered gas-driven drug burst release, and the doxorubicin release was 2.79 times higher within 1 h after NIR-II irradiation. Also, the HTCC-modified nanocarriers significantly enhanced the bladder mucosal permeability as well as long-term drug retention, and the penetration efficiency of DNAH increased by 144%. In the orthotopic bladder cancer model, the tumor suppression rate and mouse survival time were significantly improved. DNAH showed potent inhibition of the orthotopic bladder tumor growth owing to the enhanced penetration and drug delivery. This work presents a potential drug delivery nanocarrier, which is promising for optimized bladder mucosal permeability and controlled drug burst release.
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Affiliation(s)
- Zhiduo Sun
- State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, Huazhong Agricultural University, Wuhan 430070, P. R. China.
| | - Weiyun Zhang
- Marshall Laboratory of Biomedical Engineering, Research Center for Biosensor and Nanotheranostic, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Guangdong 518060, P. R. China
| | - Zhichao Ye
- Department of Urology, Union Hospital, Tongji Medical College, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan 430070, P. R. China
| | - Li Yuan
- Department of Ultrasonography, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, P. R. China
| | - Manli Fu
- Department of Ultrasonography, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, P. R. China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, P. R. China
| | - Huageng Liang
- Department of Urology, Union Hospital, Tongji Medical College, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan 430070, P. R. China
| | - Heyou Han
- State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, Huazhong Agricultural University, Wuhan 430070, P. R. China.
- State Key Laboratory of Agricultural Microbiology, College of Science, Huazhong Agricultural University, Wuhan 430070, P. R. China
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14
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Heer R, Lewis R, Duncan A, Penegar S, Vadiveloo T, Clark E, Yu G, Mariappan P, Cresswell J, McGrath J, N'Dow J, Nabi G, Mostafid H, Kelly J, Ramsay C, Lazarowicz H, Allan A, Breckons M, Campbell K, Campbell L, Feber A, McDonald A, Norrie J, Orozco-Leal G, Rice S, Tandogdu Z, Taylor E, Wilson L, Vale L, MacLennan G, Hall E. Photodynamic versus white-light-guided resection of first-diagnosis non-muscle-invasive bladder cancer: PHOTO RCT. Health Technol Assess 2022; 26:1-144. [PMID: 36300825 PMCID: PMC9639219 DOI: 10.3310/plpu1526] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Around 7500 people are diagnosed with non-muscle-invasive bladder cancer in the UK annually. Recurrence following transurethral resection of bladder tumour is common, and the intensive monitoring schedule required after initial treatment has associated costs for patients and the NHS. In photodynamic diagnosis, before transurethral resection of bladder tumour, a photosensitiser that is preferentially absorbed by tumour cells is instilled intravesically. Transurethral resection of bladder tumour is then conducted under blue light, causing the photosensitiser to fluoresce. Photodynamic diagnosis-guided transurethral resection of bladder tumour offers better diagnostic accuracy than standard white-light-guided transurethral resection of bladder tumour, potentially reducing the chance of subsequent recurrence. OBJECTIVE The objective was to assess the clinical effectiveness and cost-effectiveness of photodynamic diagnosis-guided transurethral resection of bladder tumour. DESIGN This was a multicentre, pragmatic, open-label, parallel-group, non-masked, superiority randomised controlled trial. Allocation was by remote web-based service, using a 1 : 1 ratio and a minimisation algorithm balanced by centre and sex. SETTING The setting was 22 NHS hospitals. PARTICIPANTS Patients aged ≥ 16 years with a suspected first diagnosis of high-risk non-muscle-invasive bladder cancer, no contraindications to photodynamic diagnosis and written informed consent were eligible. INTERVENTIONS Photodynamic diagnosis-guided transurethral resection of bladder tumour and standard white-light cystoscopy transurethral resection of bladder tumour. MAIN OUTCOME MEASURES The primary clinical outcome measure was the time to recurrence from the date of randomisation to the date of pathologically proven first recurrence (or intercurrent bladder cancer death). The primary health economic outcome was the incremental cost per quality-adjusted life-year gained at 3 years. RESULTS We enrolled 538 participants from 22 UK hospitals between 11 November 2014 and 6 February 2018. Of these, 269 were allocated to photodynamic diagnosis and 269 were allocated to white light. A total of 112 participants were excluded from the analysis because of ineligibility (n = 5), lack of non-muscle-invasive bladder cancer diagnosis following transurethral resection of bladder tumour (n = 89) or early cystectomy (n = 18). In total, 209 photodynamic diagnosis and 217 white-light participants were included in the clinical end-point analysis population. All randomised participants were included in the cost-effectiveness analysis. Over a median follow-up period of 21 months for the photodynamic diagnosis group and 22 months for the white-light group, there were 86 recurrences (3-year recurrence-free survival rate 57.8%, 95% confidence interval 50.7% to 64.2%) in the photodynamic diagnosis group and 84 recurrences (3-year recurrence-free survival rate 61.6%, 95% confidence interval 54.7% to 67.8%) in the white-light group (hazard ratio 0.94, 95% confidence interval 0.69 to 1.28; p = 0.70). Adverse event frequency was low and similar in both groups [12 (5.7%) in the photodynamic diagnosis group vs. 12 (5.5%) in the white-light group]. At 3 years, the total cost was £12,881 for photodynamic diagnosis-guided transurethral resection of bladder tumour and £12,005 for white light. There was no evidence of differences in the use of health services or total cost at 3 years. At 3 years, the quality-adjusted life-years gain was 2.094 in the photodynamic diagnosis transurethral resection of bladder tumour group and 2.087 in the white light group. The probability that photodynamic diagnosis-guided transurethral resection of bladder tumour was cost-effective was never > 30% over the range of society's cost-effectiveness thresholds. LIMITATIONS Fewer patients than anticipated were correctly diagnosed with intermediate- to high-risk non-muscle-invasive bladder cancer before transurethral resection of bladder tumour and the ratio of intermediate- to high-risk non-muscle-invasive bladder cancer was higher than expected, reducing the number of observed recurrences and the statistical power. CONCLUSIONS Photodynamic diagnosis-guided transurethral resection of bladder tumour did not reduce recurrences, nor was it likely to be cost-effective compared with white light at 3 years. Photodynamic diagnosis-guided transurethral resection of bladder tumour is not supported in the management of primary intermediate- to high-risk non-muscle-invasive bladder cancer. FUTURE WORK Further work should include the modelling of appropriate surveillance schedules and exploring predictive and prognostic biomarkers. TRIAL REGISTRATION This trial is registered as ISRCTN84013636. FUNDING This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rakesh Heer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Anne Duncan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Steven Penegar
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Thenmalar Vadiveloo
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Emma Clark
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ge Yu
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - Joanne Cresswell
- Department of Urology, South Tees Hospitals NHS Trust, Middlesbrough, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter Hospital NHS Trust, Exeter, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Ghulam Nabi
- School of Medicine, University of Dundee, Dundee, UK
| | - Hugh Mostafid
- Department of Urology, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
| | - John Kelly
- University College London Cancer Institute, University College London Hospitals NHS Foundation Trust, London, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Henry Lazarowicz
- Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Angela Allan
- Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Matthew Breckons
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Campbell
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Louise Campbell
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Andy Feber
- University College London Cancer Institute, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Giovany Orozco-Leal
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Zafer Tandogdu
- University College London Cancer Institute, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Laura Wilson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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15
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Stærk K, Hjelmager JS, Alm M, Thomsen P, Andersen TE. A new catheter-integrated drug-delivery system for controlled intravesical mitomycin C release. Urol Oncol 2022; 40:409.e19-409.e26. [PMID: 35753849 DOI: 10.1016/j.urolonc.2022.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/01/2022] [Accepted: 05/24/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Intravesical treatment of bladder cancer is preferred over systemic administration. However, the efficacy of intravesical instillations is challenged by the periodic voiding that flushes out the instilled drug and ultimately reduces drug exposure to the bladder epithelium. Here, we demonstrate a new catheter-integrated drug-delivery concept that utilizes a silicone-based interpenetrating polymer network (IPN) as material for the catheter balloon, to facilitate continuous release of the bladder cancer adjuvant, Mitomycin C, from a balloon-reservoir to the urinary bladder. METHODS Long-term release properties and anti-carcinoma cell efficacy of released drug was investigated in vitro. Short-term release experiments were performed in live pigs to evaluate the IPN prototype catheter in a physiological relevant environment in vivo. RESULTS Sustained zero-order release of Mitomycin C was achieved for 12 days in vitro without refilling the balloon. Mitomycin C was released from the IPN-balloons into the urinary bladder of live pigs in concentrations adequate to inhibit carcinoma cell growth. CONCLUSION The IPN catheter represents a new drug-delivery concept for prolonged Mitomycin C delivery to the urinary bladder.
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Affiliation(s)
- Kristian Stærk
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Thomas Emil Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark.
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16
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Teoh JYC, Kamat AM, Black PC, Grivas P, Shariat SF, Babjuk M. Recurrence mechanisms of non-muscle-invasive bladder cancer - a clinical perspective. Nat Rev Urol 2022; 19:280-294. [PMID: 35361927 DOI: 10.1038/s41585-022-00578-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/24/2022]
Abstract
Non-muscle-invasive bladder cancer (NMIBC) is an early-stage cancer without invasion into the detrusor muscle layer. Transurethral resection of bladder tumour (TURBT) is a diagnostic and potentially curative procedure for NMIBC, but has some limitations, including difficulties in ascertaining complete tumour removal upon piecemeal resection and the possibility of tumour re-implantation after the procedure. The oncological control of NMIBC is far from satisfactory, with a 1-year recurrence rate of 15-61%, and a 5-year recurrence rate of 31-78%. Various recurrence mechanisms have been described for NMIBC, such as undetected tumours upon cystoscopy, incomplete resection during TURBT, tumour re-implantation after TURBT, drop metastasis from upper tract urothelial carcinoma and field change cancerization. Understanding the recurrence mechanisms from a clinical perspective has strong implications for the optimization of NMIBC oncological outcomes, as a cure for patients with NMIBC can only be achieved by tackling all possible recurrence mechanisms in a comprehensive manner.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. .,European Association of Urology-Young Academic Urologists (EAU-YAU) Urothelial Cancer Working Group, Amsterdam, Netherlands.
| | - Ashish M Kamat
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.,Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic
| | - Marek Babjuk
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic
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17
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Eilender BM, Katims AB, Pfail JL, Sfakianos J. Evolving Treatment in Non-muscle-Invasive Bladder Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, Dominguez Escrig JL, Gontero P, Liedberg F, Masson-Lecomte A, Mostafid AH, Palou J, van Rhijn BWG, Rouprêt M, Shariat SF, Seisen T, Soukup V, Sylvester RJ. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (Ta, T1, and Carcinoma in Situ). Eur Urol 2021; 81:75-94. [PMID: 34511303 DOI: 10.1016/j.eururo.2021.08.010] [Citation(s) in RCA: 585] [Impact Index Per Article: 195.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/15/2021] [Indexed: 02/08/2023]
Abstract
CONTEXT The European Association of Urology (EAU) has released an updated version of the guidelines on non-muscle-invasive bladder cancer (NMIBC). OBJECTIVE To present the 2021 EAU guidelines on NMIBC. EVIDENCE ACQUISITION A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines since the 2020 version was performed. Databases covered by the search included Medline, EMBASE, and the Cochrane Libraries. Previous guidelines were updated, and the level of evidence and grade of recommendation were assigned. EVIDENCE SYNTHESIS Tumours staged as Ta, T1 and carcinoma in situ (CIS) are grouped under the heading of NMIBC. Diagnosis depends on cystoscopy and histological evaluation of tissue obtained via transurethral resection of the bladder (TURB) for papillary tumours or via multiple bladder biopsies for CIS. For papillary lesions, a complete TURB is essential for the patient's prognosis and correct diagnosis. In cases for which the initial resection is incomplete, there is no muscle in the specimen, or a T1 tumour is detected, a second TURB should be performed within 2-6 wk. The risk of progression may be estimated for individual patients using the 2021 EAU scoring model. On the basis of their individual risk of progression, patients are stratified as having low, intermediate, high, or very high risk, which is pivotal to recommending adjuvant treatment. For patients with tumours presumed to be at low risk and for small papillary recurrences detected more than 1 yr after a previous TURB, one immediate chemotherapy instillation is recommended. Patients with an intermediate-risk tumour should receive 1 yr of full-dose intravesical bacillus Calmette-Guérin (BCG) immunotherapy or instillations of chemotherapy for a maximum of 1 yr. For patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. For patients at very high risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is also recommended for BCG-unresponsive tumours. The extended version of the guidelines is available on the EAU website at https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/. CONCLUSIONS These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. PATIENT SUMMARY The European Association of Urology has released updated guidelines on the classification, risk factors, diagnosis, prognostic factors, and treatment of non-muscle-invasive bladder cancer. The recommendations are based on the literature up to 2020, with emphasis on the highest level of evidence. Classification of patients as having low, intermediate, or and high risk is essential in deciding on suitable treatment. Surgical removal of the bladder should be considered for tumours that do not respond to bacillus Calmette-Guérin (BCG) treatment and tumours with the highest risk of progression.
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Affiliation(s)
- Marko Babjuk
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria.
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Otakar Capoun
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Daniel Cohen
- Department of Urology, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Eva M Compérat
- Department of Pathology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | | | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Fredrik Liedberg
- Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
| | | | - A Hugh Mostafid
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Joan Palou
- Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bas W G van Rhijn
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, Department of Urology, Sorbonne University, AP-HP, Pitié Salpétrière Hospital, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Thomas Seisen
- GRC 5 Predictive Onco-Uro, Department of Urology, Sorbonne University, AP-HP, Pitié Salpétrière Hospital, Paris, France
| | - Viktor Soukup
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
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19
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Bhindi B, Kool R, Kulkarni GS, Siemens DR, Aprikian AG, Breau RH, Brimo F, Fairey A, French C, Hanna N, Izawa JI, Lacombe L, McPherson V, Rendon RA, Shayegan B, So AI, Zlotta AR, Black PC, Kassouf W. Canadian Urological Association guideline on the management of non-muscle-invasive bladder cancer - Full-text. Can Urol Assoc J 2021; 15:E424-E460. [PMID: 33938798 PMCID: PMC8418246 DOI: 10.5489/cuaj.7367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bimal Bhindi
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ronald Kool
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Girish S. Kulkarni
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Armen G. Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Rodney H. Breau
- Division of Urology, University of Ottawa, Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Adrian Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Christopher French
- Division of Urology, Department of Surgery, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Nawar Hanna
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jonathan I. Izawa
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Louis Lacombe
- Department of Surgery, Faculty of Medicine, Université Laval, Laval, QC, Canada
| | - Victor McPherson
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | | | - Bobby Shayegan
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Alan I. So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alexandre R. Zlotta
- Division of Urology, Department of Surgery, Sinai Health System and Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Wassim Kassouf
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
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Clinical trial of high dose hyperthermic intravesical mitomycin C for intermediate and high-risk non–muscle invasive bladder cancer during BCG shortage. Urol Oncol 2021; 39:498.e13-498.e20. [DOI: 10.1016/j.urolonc.2020.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/06/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022]
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21
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Mobaraki M, Moradi H. Design of robust control strategy in drug and virus scheduling in nonlinear process of chemovirotherapy. Comput Chem Eng 2021. [DOI: 10.1016/j.compchemeng.2021.107318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Sahatsapan N, Rojanarata T, Ngawhirunpat T, Opanasopit P, Patrojanasophon P. Doxorubicin-loaded chitosan-alginate nanoparticles with dual mucoadhesive functionalities for intravesical chemotherapy. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102481] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Zang J, Ye K, Fei Y, Zhang R, Chen H, Zhuang G. Immunotherapy in the Treatment of Urothelial Bladder Cancer: Insights From Single-Cell Analysis. Front Oncol 2021; 11:696716. [PMID: 34123863 PMCID: PMC8187798 DOI: 10.3389/fonc.2021.696716] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/11/2021] [Indexed: 12/25/2022] Open
Abstract
Urothelial bladder cancer (UBC) is a global challenge of public health with limited therapeutic options. Although the emergence of cancer immunotherapy, most notably immune checkpoint inhibitors, represents a major breakthrough in the past decade, many patients still suffer from unsatisfactory clinical outcome. A thorough understanding of the fundamental cellular and molecular mechanisms responsible for antitumor immunity may lead to optimized treatment guidelines and new immunotherapeutic strategies. With technological developments and protocol refinements, single-cell approaches have become powerful tools that provide unprecedented insights into the kaleidoscopic tumor microenvironment and intricate cell-cell communications. In this review, we summarize recent applications of single-cell analysis in characterizing the UBC multicellular ecosystem, and discuss how to leverage the high-resolution information for more effective immune-based therapies.
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Affiliation(s)
- Jingyu Zang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kaiyan Ye
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Fei
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruiyun Zhang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haige Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guanglei Zhuang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Veskimae E, Subbarayan S, Campi R, Carron D, Omar MI, Yuan C, Dimitropoulos K, Van Hemelrijck M, Bryan RT, N'Dow J, Babjuk M, Alfred Witjes J, Sylvester R, MacLennan S. A Systematic Review of Outcome Reporting, Definition and Measurement Heterogeneity in Non-Muscle Invasive Bladder Cancer Effectiveness Trials of Adjuvant, Prophylactic Treatment After Transurethral Resection. Bladder Cancer 2021; 7:221-241. [PMID: 38994538 PMCID: PMC11181687 DOI: 10.3233/blc-201510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Heterogenous outcome reporting in non-muscle-invasive bladder cancer (NMIBC) effectiveness trials of adjuvant treatment after transurethral resection (TURBT) has been noted in systematic reviews (SRs). This hinders comparing results across trials, combining them in meta-analyses, and evidence-based decision-making for patients and clinicians. OBJECTIVE We aimed to systematically review the extent of reporting and definition heterogeneity. METHODS We included randomized controlled trials (RCTs) identified from SRs comparing adjuvant treatments after TURBT or TURBT alone in patients with NMIBC (with or without carcinoma in situ) published between 2000-2020. Abstracts and full texts were screened independently by two reviewers. Data were extracted by one reviewer and checked by another. RESULTS We screened 807 abstracts; from 15 SRs, 57 RCTs were included. Verbatim outcome names were coded to standard outcome names and organised using the Williamson and Clarke taxonomy. Recurrence (98%), progression (74%), treatment response (in CIS studies) (40%), and adverse events (77%) were frequently reported across studies. However, overall (33%) and cancer-specific (33%) survival, treatment completion (17%) and treatment change (37%) were less often reported. Quality of Life (3%) and economic outcomes (2%) were rarely reported. Heterogeneity was evident throughout, particularly in the definitions of progression and recurrence, and how CIS patients were handled in the analysis of studies with predominantly papillary patients, highlighting further issues with the definition of recurrence and progression vs treatment response for CIS patients. Data reporting was also inconsistent, with some trials reporting event rates at various time-points and others reporting time-to-event with or without Hazard Ratios. Adverse events were inconsistently reported. QoL data was absent in most trials. CONCLUSIONS Heterogenous outcome reporting is evident in NMIBC effectiveness trials. This has profound implications for meta-analyses, SRs and evidence-based treatment decisions. A core outcome set is required to reduce heterogeneity. PATIENT SUMMARY This systematic review found inconsistencies in outcome definitions and reporting, pointing out the urgent need for a core outcome set to help improve evidence-based treatment decisions.
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Affiliation(s)
- Erik Veskimae
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | | | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Cathy Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Konstantinos Dimitropoulos
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
- Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Mieke Van Hemelrijck
- King's College London, Faculty of Life Sciences and Medicine, Translational and Oncology Research (TOUR), London, UK
| | - Richard T Bryan
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
- Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Marek Babjuk
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Li Z, Jiang Y, Yu Y, Kang Q. Effect of COVID-19 Pandemic on Diagnosis and Treatment Delays in Urological Disease: Single-Institution Experience. Risk Manag Healthc Policy 2021; 14:895-900. [PMID: 33692641 PMCID: PMC7939494 DOI: 10.2147/rmhp.s299233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/17/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose In the background of the global pandemic, we aim to investigate the effect of COVID-19 on diagnosis and treatment delay in urology patients. Patients and Methods A total of 4919 inpatients were identified from the urological department in our institution, including 2947 and 1972 patients within 9 months before and after the outbreak (group A and group B). The baseline characteristics and residential population of different types of diseases were compared in the two groups. Patients who underwent delay of diagnosis or treatment with poor outcomes were described. Results Our result revealed a 33.1% decrease of total resident population as well as a 44.8% decline in bed utilization rate after the outbreak. Significant differences were found between group A and group B in gender (P=0.024) and patients living alone or not (P=0.026). The hospitalization rate of patients with malignancy increased significantly while that of benign patients decreased during the epidemic (P<0.001). Besides, we identified 5 cases with bladder cancer and 3 cases with prostate cancer that underwent delay of diagnosis or treatment with unfavorable consequences. Conclusion With the impact of COVID-19, delay in diagnosis or treatment of non-COVID-19 diseases is inevitable whether the medical resources allocation is effective or not. Psychological status of patients might be the major cause of postponing diagnosis or treatment. For urological patients with locally advanced tumor or rapid progression, who need long-term postoperative intervention, the delay of regular treatment could lead to inevitable progression or recurrence.
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Affiliation(s)
- Zhen Li
- Department of Urology, The Fifth People's Hospital of Dalian, Dalian, Liaoning, People's Republic of China
| | - Yu Jiang
- Department of Pediatrics, Dalian Municipal Women and Children's Medical Center, Dalian, Liaoning, People's Republic of China
| | - Yang Yu
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Qianyu Kang
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
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Grimberg DC, Shah A, Tan WP, Etienne W, Spasojevic I, Inman BA. Hyperthermia Improves Solubility of Intravesical Chemotherapeutic Agents. Bladder Cancer 2020; 6:461-470. [PMID: 36118287 PMCID: PMC9441059 DOI: 10.3233/blc-200350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/24/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Nearly 70% of all new cases of bladder cancer are non-muscle invasive disease, the treatment for which includes transurethral resection followed by intravesical therapy. Unfortunately, recurrence rates approach 50% in part due to poor intravesical drug delivery. Hyperthermia is frequently used as an adjunct to intravesical chemotherapy to improve drug delivery and response to treatment. OBJECTIVE: To assess the solubility profile of intravesical chemotherapies under varying conditions of pH and temperature. METHODS: Using microplate laser nephelometry we measured the solubility of three intravesical chemotherapy agents (mitomycin C, gemcitabine, and cisplatin) at varying physical conditions. Drugs were assessed at room temperature (23°C), body temperature (37°C), and 43°C, the temperature used for hyperthermic intravesical treatments. To account for variations in urine pH, solubility was also investigated at pH 4.00, 6.00, and 8.00. RESULTS: Heat incrementally increased the solubility of all three drugs studied. Conversely, pH largely did not impact solubility aside for gemcitabine which showed slightly reduced solubility at pH 8.00 versus 6.00 or 4.00. Mitomycin C at the commonly used 2.0 mg/mL was insoluble at room temperature, but soluble at both 37 and 43°C. CONCLUSIONS: Hyperthermia as an adjunct to intravesical treatment would improve drug solubility, and likely drug delivery as some current regimens are insoluble without heat. Improvements in solubility also allow for testing of alternative administration regimens to improve drug delivery or tolerability. Further studies are needed to confirm that improvements in solubility result in increased drug delivery.
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Affiliation(s)
- Dominic C. Grimberg
- Division of Urology, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Ankeet Shah
- Division of Urology, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Wei Phin Tan
- Division of Urology, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Wiguins Etienne
- Division of Urology, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Ivan Spasojevic
- Department of Medicine, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Brant A. Inman
- Division of Urology, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Alshyarba MH, Alamri A, Assiri AA. Economic impacts of the Bacillus Calmette-Guérin (BCG) therapy shortage and the proposed solutions for patients with non-muscle invasive bladder Cancer in Aseer Province, Saudi Arabia. J Family Med Prim Care 2020; 9:2758-2762. [PMID: 32984121 PMCID: PMC7491787 DOI: 10.4103/jfmpc.jfmpc_171_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 11/04/2022] Open
Abstract
Objective To report the magnitude, the financial and the economic impact of Bacillus Calmette-Guérin (BCG) shortage in our institute and transfer of non-muscle invasive bladder cancer (NMIBC) patients to higher centers to receive the treatment. Methods This is a retrospective study, between January 2015 and December 2017, the cases of NMIBC diagnosed at Aseer Central Hospital, Abha, Saudi Arabia were studied. Demographic features, clinical presentations, histopathological features, and the BCG therapy shortage and its economic impact were addressed. Results Over a three years study review of 62 urothelial bladder cancer, NMIBC was diagnosed in 55 (89%) patients. Forty-three (78%) patients were males and 12 (22%) patients were females. The mean age ± standard deviation (SD) (range) in this cohort was 59 ± 12 years (38-87). Gross hematuria was the main presentation in 51 (92%) patients of this cohort. Dysuria and other lower urinary tract symptoms were the presentations in 18 (32%) patients. Smoking history was positive in 33 (60%) patients and the rest 22 (40%) patients denied any form of tobacco consumptions. The BCG eligible were 46 (84%) patients of all NMIBC patients in this study. Twenty-seven (59%) patients of them received BCG in our institute. The rest 19 (41%) patients were opted to be transferred to a higher medical center to receive the BCG because of the BCG shortage in our center. The financial cost of traveling to receive the six-weeks induction BCG therapy was on average of 7200 Saudi riyals (1.745 €) for every patient. Conclusions The BCG shortage in our institute is almost approaching half of eligible BCG cases. This has had an economic impact on the health budget. Such health catastrophe could be mitigated with proper health plans of a provision of the BCG to all tertiary care centers. Alternative therapies for such cases should be considered in cases of global BCG shortage.
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Affiliation(s)
- Mishari Hm Alshyarba
- Department of Surgery (Urology Division), College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Kingdom of Saud Arabia
| | - Abdulaziz Alamri
- Department of Surgery (Urology Division), College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Kingdom of Saud Arabia
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Taskovska M, Kreft ME, Smrkolj T. Current and innovative approaches in the treatment of non-muscle invasive bladder cancer: the role of transurethral resection of bladder tumor and organoids. Radiol Oncol 2020; 54:135-143. [PMID: 32374292 PMCID: PMC7276645 DOI: 10.2478/raon-2020-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/30/2020] [Indexed: 11/20/2022] Open
Abstract
Background Bladder cancer is the 7th most common cancer in men. About 75% of all bladder cancer are non-muscle invasive (NMIBC). The golden standard for definite diagnosis and first-line treatment of NMIBC is transurethral resection of bladder tumour (TURB). Historically, the monopolar current was used first, today bipolar current is preferred by most urologists. Following TURB, depending on the tumour grade, additional intravesical chemo- or/and immunotherapy is indicated, in order to prevent recurrence and need for surgical resection. Development of new technologies, molecular and cell biology, enabled scientists to develop organoids - systems of human cells that are cultivated in the laboratory and have characteristics of the tissue from which they were harvested. In the field of urologic cancers, the organoids are used mainly for studying the course of different diseases, however, in the field of bladder cancer the data are scarce. Conclusions Different currents - monopolar and bipolar, have different effect on urothelium, that is important for oncological results and pathohistological interpretation. Specimens of bladder cancer can be used for preparation of organoids that are further used for studying carcinogenesis. Bladder organoids are step towards personalised medicine, especially for testing effectiveness of chemo-/immunotherapeutics.
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Affiliation(s)
- Milena Taskovska
- Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mateja Erdani Kreft
- Institute for Cell Biology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tomaz Smrkolj
- Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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29
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Teoh JYC, Roupret M, Shariat SF, Herrmann T. Intravesical therapy for bladder cancer in the pandemic of Covid-19. World J Urol 2020; 39:1313-1314. [PMID: 32356225 PMCID: PMC7191133 DOI: 10.1007/s00345-020-03218-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jeremy Y C Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Morgan Roupret
- Sorbonne University, GRC n°5, Predicitive onco-uro, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Charles University, Prague, Czech Republic
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.
- Department of Urology, Hanover Medical School (MHH), Hannover, Germany.
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30
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de Wit* M, M. Retz* M, Rödel C, E. Gschwend J. The Diagnosis and Treatment of Patients With Bladder Carcinoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 118:arztebl.m2021.0013. [PMID: 33759759 PMCID: PMC8220031 DOI: 10.3238/arztebl.m2021.0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND In Germany, bladder carcinoma accounts for 3-4 % of all malignant tumors. New study findings in the fields of endoscopy, surgery, and systemic therapy have led to multimodal treatment approaches for bladder cancer that can prolong overall survival and improve the affected patients' quality of life. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to the German Clinical Practice Guideline on the Early Detection, Diagnosis, Treatment, and Continuing Care of Bladder Carcinoma, along with data available on the websites of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA). The bladder carcinoma guideline of the Onkopedia guidelines program was used as well. RESULTS 75% of all urothelial carcinomas are diagnosed in the non-muscle-invasive stage. These carcinomas should be resected via the endoscopic transurethral approach whenever possible. Next, depending on the patient's risk profile, intravesical therapy may be needed. Patients with carcinoma in the muscle-invasive stage should be given multimodal treatment, including radical cystectomy with urinary diversion and perioperative systemic therapy; alternatively, bladder-preserving chemoradiotherapy can be offered in selected cases. For patients with metastatic bladder carcinoma, immunotherapy with checkpoint inhibitors has become well established for first- and second-line therapy alongside classic cytostatic treatment and has been shown to prolong patients' lives significantly. The administration of checkpoint inhibitors can prolong the overall survival of patients with metastases to 15-17 months. CONCLUSION The treatment of bladder carcinoma in all stages calls for interdisciplinary collaboration to ensure the provision of effective, individual multimodal treatment.
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Affiliation(s)
- Maike de Wit*
- * These two authors share first authorship
- Department of Hematology, Oncology and Palliative Medicine, Vivantes Neukölln Hospital Berlin
| | - Margitta M. Retz*
- * These two authors share first authorship
- Department of Urology Klinikum rechts der Isarder Technical University Munich (TUM)
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt am Main
| | - Jürgen E. Gschwend
- Department of Urology Klinikum rechts der Isarder Technical University Munich (TUM)
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31
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Wroclawski ML, Schutz FA, Cha JD, Soares A. Alternative Therapies to Bacillus Calmette-Guérin Shortage for Nonmuscle Invasive Bladder Cancer in Brazil and Other Underdeveloped Countries: Management Considerations. J Glob Oncol 2020; 5:1-9. [PMID: 31454284 PMCID: PMC6776038 DOI: 10.1200/jgo.19.00112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Bacillus Calmette-Guérin (BCG) plays a cornerstone role in
the management of nonmuscle invasive urothelial carcinoma of the bladder.
However, there has been a worldwide intermittent BCG shortage in recent years
that may affect the care of patients with bladder cancer and pose difficult
clinical decisions to urologists and clinical oncologists. This literature
review aims to clarify alternatives to BCG during a shortage and propose
measures to replace BCG, mainly in Brazil and probably in other low- and
middle-income countries, where not all studied and commonly suggested treatments
are available.
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Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Latin American Cooperative Oncology Group - Genitourinary, Porto Alegre, Brazil
| | - Fabio A Schutz
- BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Latin American Cooperative Oncology Group - Genitourinary, Porto Alegre, Brazil
| | - Jonathan Doyun Cha
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Andrey Soares
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Centro Paulista de Oncologia, São Paulo, Brazil.,Latin American Cooperative Oncology Group - Genitourinary, Porto Alegre, Brazil
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Xu S, Tan S, Wu T, Gu J, Xu L, Che X. The value of transurethral thulium laser en bloc resection combined with a single immediate postoperative intravesical instillation of pirarubicin in primary non-muscle-invasive bladder cancer. Lasers Med Sci 2020; 35:1695-1701. [PMID: 31970565 DOI: 10.1007/s10103-020-02960-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 01/10/2020] [Indexed: 01/07/2023]
Abstract
The objective of this study was to evaluate which patients might benefit from a single immediate postoperative intravesical instillation (SII) compared to maintenance intravesical instillations (MII) in primary non-muscle-invasive bladder cancer (NMIBC) after transurethral en bloc resection of bladder tumors (ERBT). A total of 141 patients with primary NMIBC who underwent ERBT with thulium laser between January 2012 and May 2016 were retrospectively enrolled. All the patients were categorized into two groups based on the duration of postoperative intravesical instillation of pirarubicin (THP): single intravesical instillation (SII) group, patients received a single immediate postoperative intravesical instillation of THP (30 mg), and maintenance intravesical instillations (MII) group, patients received a 1-year MII of THP (30 mg). Prognosis and recurrence data of each group were analyzed. One hundred and four (73.8%) patients received MII, and other 37 (26.2%) patients received SII. There was no significant difference in recurrence-free survival (RFS) between the two groups (P = 0.105). Following recurrence risk-stratified analysis, patients with high recurrence risk who accepted SII had a significantly lower RFS rate than those who received MII (P = 0.027). However, there were no significant differences in RFS rate between the two groups in patients with low and intermediate recurrence risk. In the multivariate analysis, the number of tumors was found to be an independent prognostic factor for RFS in NMIBC patients [hazard ratio, 5.665; 95% confidence interval (CI), 2.577-12.454; P < 0.001]. SII seems not to be inferior to MII in patients with initial low-risk and intermediate-risk NMIBC after ERBT.
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Affiliation(s)
- Sheng Xu
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Road, Longhua District, Haikou, 570311, China
| | - Shaoying Tan
- Department of Nursing, Haikou Fourth People's Hospital, No. 65, Yehai Road, Qiongshan District, Haikou, 571100, China
| | - Tingming Wu
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Road, Longhua District, Haikou, 570311, China
| | - Jun Gu
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Road, Longhua District, Haikou, 570311, China
| | - Lei Xu
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Road, Longhua District, Haikou, 570311, China
| | - Xianping Che
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Road, Longhua District, Haikou, 570311, China.
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Huang Y, Cen J, Liu Z, Wei J, Chen Z, Feng Z, Lu J, Fang Y, Zhou F, Luo J, Mo C, Chen W. A Comparison of Different Prophylactic Intravesical Chemotherapy Regimens for Bladder Cancer Recurrence After Nephroureterectomy for Primary Upper Tract Urothelial Carcinomas: A Retrospective 2-center Study. Technol Cancer Res Treat 2020; 18:1533033819844483. [PMID: 30987527 PMCID: PMC6469286 DOI: 10.1177/1533033819844483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Prophylactic intravesical chemotherapy can decrease bladder cancer recurrence rate after
nephroureterectomy for upper tract urothelial carcinoma. We aimed to compare the effect of
different prophylactic intravesical chemotherapy regimens in bladder recurrence-free
survival. From 2000 to 2016, a total of 270 patients treated with radical
nephroureterectomy at both institutions were enrolled. Patients were divided into 3
groups: multiple-instillation group, single-instillation group, and no-instillation group.
Univariable and multivariable analyses with Cox regression methods were performed to
calculate hazard ratios for bladder recurrence using clinicopathologic data, including our
different instillation strategies. Sixty-three (23.3%) of 270 patients had subsequent
intravesical recurrence. Significantly fewer patients in both the instillation groups had
a recurrence compared to in the no-instillation group (13.1% vs 25.4% vs 41.5%,
P = .001). Furthermore, there was a significant difference between both
the instillation groups (P = .016). In different subsets of patients with
upper tract urothelial carcinoma, intravesical chemotherapy, either multiple or single
instillation, was a protective factor of bladder recurrence in pT2-4 (P =
.002) and high grade (P < .0001). Importantly, Kaplan-Meier curves of
bladder recurrence-free survival rate were increased observably in multiple-instillation
group compared to that in single-instillation group (P = .053 in pT2-4
subgroup; P = .048 in high-grade subgroup, respectively). On
multivariable analysis, intravesical chemotherapy (P < .001),
especially multiple instillations (hazard ratio 0.230; 95% confidence interval
0.110-0.479), was identified an independent predictor of bladder recurrence-free survival.
In conclusion, prophylactic intravesical chemotherapy effectively prevents bladder
recurrence after nephroureterectomy, especially with multiple instillations, in patients
with invasive upper tract urothelial carcinoma or at high-grade status.
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Affiliation(s)
- Yong Huang
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,2 The Department of Emergency, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junjie Cen
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuowei Liu
- 3 Department of Urology, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Jinhuan Wei
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenhua Chen
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zihao Feng
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Lu
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong Fang
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fangjian Zhou
- 3 Department of Urology, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Junhang Luo
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chengqiang Mo
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- 1 The Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Babjuk M, Burger M, Compérat EM, Gontero P, Mostafid AH, Palou J, van Rhijn BWG, Rouprêt M, Shariat SF, Sylvester R, Zigeuner R, Capoun O, Cohen D, Escrig JLD, Hernández V, Peyronnet B, Seisen T, Soukup V. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ) - 2019 Update. Eur Urol 2019; 76:639-657. [PMID: 31443960 DOI: 10.1016/j.eururo.2019.08.016] [Citation(s) in RCA: 836] [Impact Index Per Article: 167.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022]
Abstract
CONTEXT This overview presents the updated European Association of Urology (EAU) guidelines for non-muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ (CIS). OBJECTIVE To provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation and recommendations. EVIDENCE ACQUISITION A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines has been performed annually since the last published version in 2017. Databases covered by the search included Medline, EMBASE, and the Cochrane Libraries. Previous guidelines were updated, and the level of evidence and grade of recommendation were assigned. EVIDENCE SYNTHESIS Tumours staged as Ta, T1, and/or CIS are grouped under the heading of NMIBC. Diagnosis depends on cystoscopy and histological evaluation of the tissue obtained by transurethral resection (TURB) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TURB is essential for the patient's prognosis and correct diagnosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a T1 tumour is detected, a second TURB should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the European Organisation for Research and Treatment of Cancer (EORTC) scoring system. Stratification of patients into low-, intermediate-, and high-risk groups is pivotal to the recommendation of adjuvant treatment. In patients with tumours presumed to be at a low risk and in those presumed to be at an intermediate risk with a low previous recurrence rate and an expected EORTC recurrence score of <5, one immediate chemotherapy instillation is recommended. Patients with intermediate-risk tumours should receive 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at the highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-unresponsive tumours. The extended version of the guidelines is available at the EAU website: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/. CONCLUSIONS These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. PATIENT SUMMARY The European Association of Urology Non-muscle-invasive Bladder Cancer (NMIBC) Panel has released an updated version of their guidelines, which contains information on classification, risk factors, diagnosis, prognostic factors, and treatment of NMIBC. The recommendations are based on the current literature (until the end of 2018), with emphasis on high-level data from randomised clinical trials and meta-analyses. Stratification of patients into low-, intermediate-, and high-risk groups is essential for deciding appropriate use of adjuvant intravesical chemotherapy or bacillus Calmette-Guérin (BCG) instillations. Surgical removal of the bladder should be considered in case of BCG-unresponsive tumours or in NMIBCs with the highest risk of progression.
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Affiliation(s)
- Marko Babjuk
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria.
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Eva M Compérat
- Department of Pathology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UPMC Paris VI, Paris, France
| | - Paolo Gontero
- Division of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy
| | - A Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bas W G van Rhijn
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany; Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Morgan Rouprêt
- Urology Department, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Richard Sylvester
- European Association of Urology Guidelines Office, Brussels, Belgium
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Otakar Capoun
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Daniel Cohen
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | | | - Virginia Hernández
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Thomas Seisen
- Urology Department, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Viktor Soukup
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Early-Invasive Urothelial Bladder Carcinoma and Instillation Treatment of Non-muscle-Invasive Bladder Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Otto W, Burger M, Breyer J. Early-Invasive Urothelial Bladder Carcinoma and Instillation Treatment of Non-muscle-Invasive Bladder Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42603-7_20-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Liu Y, Wang R, Hou J, Sun B, Zhu B, Qiao Z, Su Y, Zhu X. Paclitaxel/Chitosan Nanosupensions Provide Enhanced Intravesical Bladder Cancer Therapy with Sustained and Prolonged Delivery of Paclitaxel. ACS APPLIED BIO MATERIALS 2018; 1:1992-2001. [DOI: 10.1021/acsabm.8b00501] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Yongjia Liu
- School of Chemistry and Chemical Engineering, Instrumental Analysis Center, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People’s Hospital, School of Medicine, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, 200240 Shanghai, China
| | - Ruibin Wang
- School of Chemistry and Chemical Engineering, Instrumental Analysis Center, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People’s Hospital, School of Medicine, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, 200240 Shanghai, China
| | - Jingwen Hou
- School of Chemistry and Chemical Engineering, Instrumental Analysis Center, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People’s Hospital, School of Medicine, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, 200240 Shanghai, China
| | - Binbin Sun
- School of Chemistry and Chemical Engineering, Instrumental Analysis Center, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People’s Hospital, School of Medicine, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, 200240 Shanghai, China
| | - Bangshang Zhu
- School of Chemistry and Chemical Engineering, Instrumental Analysis Center, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People’s Hospital, School of Medicine, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, 200240 Shanghai, China
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Donghua University, 201620 Shanghai, China
| | - Zhiguang Qiao
- School of Chemistry and Chemical Engineering, Instrumental Analysis Center, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People’s Hospital, School of Medicine, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, 200240 Shanghai, China
| | - Yue Su
- School of Chemistry and Chemical Engineering, Instrumental Analysis Center, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People’s Hospital, School of Medicine, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, 200240 Shanghai, China
| | - Xinyuan Zhu
- School of Chemistry and Chemical Engineering, Instrumental Analysis Center, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People’s Hospital, School of Medicine, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, 200240 Shanghai, China
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What to do during Bacillus Calmette–Guérin shortage? Valid strategies based on evidence. Curr Opin Urol 2018; 28:570-576. [DOI: 10.1097/mou.0000000000000544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Naya Y, Mikami K, Takaha N, Inoue Y, Fujihara A, Kanazawa M, Nakanishi H, Miyashita H, Ukimura O. Randomized study of intravesical pirarubicin chemotherapy with low and intermediate-risk nonmuscle-invasive bladder cancer in Japan: Comparison of a single immediate postoperative intravesical instillation with short-term adjuvant intravesical instillations after transurethral resection. Medicine (Baltimore) 2018; 97:e12740. [PMID: 30334959 PMCID: PMC6211924 DOI: 10.1097/md.0000000000012740] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/15/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the efficacy, defined by the 3-year tumor recurrence-free survival rate, of intravesical chemotherapy using pirarubicin (THP) in patients with low or intermediate-risk nonmuscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS Between October 2010 and January 2015, 206 patients were enrolled, and finally 113 were randomized to receive either a single immediate postoperative intravesical instillation of THP (30 mg) (Group A), or 8 additional weekly intravesical instillations of THP (30 mg) after a single postoperative instillation (Group B). The patients were examined by performing cystoscopy and urine cytology every 3 months after transurethral resection to determine bladder tumor recurrence. The primary endpoint was 3-year-recurrence-free survival rate. RESULTS All 113 patients were bacillus Calmette-Guérin (BCG)-naïve. The 3-year recurrence free survival rate was 63.7% for Group A and 85.3% for Group B (log-rank test, P = .0070). In patients with intermediate recurrence risk, the 3-year recurrence-free survival rate was 63.4% in Group A and 86.1% in Group B (log-rank test, P = .0036). Cox regression analysis revealed that only additional instillation of THP was a significant independent factor for recurrence-free rate in patients with intermediate risk. No patient with progression was noted during this period. Frequent adverse effects (AEs) were frequent urination and micturition pain, and no severe AEs (Grade 3 or more) occurred. CONCLUSION Additional instillation of THP (30 mg) weekly for 8 weeks reduced the risk of tumor recurrence without severe AEs in BCG-naïve NMIBC patients with intermediate risk.
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Affiliation(s)
- Yoshio Naya
- Department of Urology, Meiji University of Integrative Medicine, Nantan
- Department Urology, Nagahama City Kohoku Hospital, Nagahama
| | - Kazuya Mikami
- Department of Urology, Kyoto First Red-Cross Hospital
| | - Natsuki Takaha
- Department of Urology, Meiji University of Integrative Medicine, Nantan
| | - Yuuta Inoue
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto
| | - Motohiro Kanazawa
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto
| | | | - Hiroaki Miyashita
- Department of Urology, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto
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Tabayoyong WB, Kamat AM, O'Donnell MA, McKiernan JM, Ray-Zack MD, Palou J, Brausi M, Black PC, Williams SB. Systematic Review on the Utilization of Maintenance Intravesical Chemotherapy in the Management of Non-muscle-invasive Bladder Cancer. Eur Urol Focus 2018; 4:512-521. [PMID: 30190111 DOI: 10.1016/j.euf.2018.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/02/2018] [Accepted: 08/23/2018] [Indexed: 11/28/2022]
Abstract
CONTEXT Current guidelines remain ill-defined regarding the optimal intravesical chemotherapy type and regimen for the treatment of non-muscle-invasive bladder cancer (NMIBC). Although maintenance therapy is a standard part of bacillus Calmette-Guerin (BCG) therapy, its role in the context of chemotherapy remains debatable. OBJECTIVE We reviewed the literature regarding the utilization of intravesical maintenance chemotherapy in the treatment of NMIBC to determine its impact on recurrence, progression, and survival. EVIDENCE ACQUISITION A systematic search was conducted using Ovid and Medline according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2018 reporting on the utilization of maintenance intravesical chemotherapy. Only randomized controlled trials (RCTs) that included a comparison between an induction regimen and an induction plus maintenance regimen were included. EVIDENCE SYNTHESIS Sixteen RCTs were included in the final analysis. The most commonly studied intravesical chemotherapy agents used in maintenance regimens were epirubicin, doxorubicin, and mitomycin C. Several maintenance schedules were utilized, some as short as 3mo and others as long as 3 yr, while the most common maintenance regimen utilized was monthly instillation for 1 yr. Of the 16 trials, 13 reported no significant improvement in recurrence for patients receiving maintenance compared with no maintenance, and none of the trials demonstrated a significant impact on progression or survival. CONCLUSIONS Intermediate length maintenance regimens lasting 7-12mo were the most common maintenance regimens utilized. There was considerable heterogeneity between trial design and duration of follow-up, making direct comparisons for recurrence, progression, and survival outcomes between trials challenging. Although maintenance intravesical chemotherapy is suggested as a treatment option for patients with NMIBC by some guidelines, the majority of evidence suggested that it provided no significant advantage over induction therapy alone with respect to recurrence, progression, or survival. PATIENT SUMMARY In this review, we reviewed prior clinical trials to determine whether prolonged intravesical chemotherapy ("maintenance therapy") improved the rates of recurrence, progression, and survival. Where differences were found in favor of maintenance therapy, there was no statistical significance demonstrated, possibly due to the underpowered nature of the study design. While there was no consensus on an optimal agent or maintenance schedule, we found no evidence to suggest that maintenance therapy would improve recurrence, progression, or survival.
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Affiliation(s)
- William B Tabayoyong
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Mohamed D Ray-Zack
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Joan Palou
- Department of Urology, Fundacio Puigvert, Barcelona, Spain
| | - Maurizio Brausi
- Department of Urology, Azienda Unita Sanitaria Locale Modena, Modena, Italy
| | - Peter C Black
- Department of Urologic Sciences, The University of British Columbia, Vancouver, Canada
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA.
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Lodewijk I, Dueñas M, Rubio C, Munera-Maravilla E, Segovia C, Bernardini A, Teijeira A, Paramio JM, Suárez-Cabrera C. Liquid Biopsy Biomarkers in Bladder Cancer: A Current Need for Patient Diagnosis and Monitoring. Int J Mol Sci 2018; 19:E2514. [PMID: 30149597 PMCID: PMC6163729 DOI: 10.3390/ijms19092514] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 02/08/2023] Open
Abstract
Bladder Cancer (BC) represents a clinical and social challenge due to its high incidence and recurrence rates, as well as the limited advances in effective disease management. Currently, a combination of cytology and cystoscopy is the routinely used methodology for diagnosis, prognosis and disease surveillance. However, both the poor sensitivity of cytology tests as well as the high invasiveness and big variation in tumour stage and grade interpretation using cystoscopy, emphasizes the urgent need for improvements in BC clinical guidance. Liquid biopsy represents a new non-invasive approach that has been extensively studied over the last decade and holds great promise. Even though its clinical use is still compromised, multiple studies have recently focused on the potential application of biomarkers in liquid biopsies for BC, including circulating tumour cells and DNA, RNAs, proteins and peptides, metabolites and extracellular vesicles. In this review, we summarize the present knowledge on the different types of biomarkers, their potential use in liquid biopsy and clinical applications in BC.
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Affiliation(s)
- Iris Lodewijk
- Molecular Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense nº 40, 28040 Madrid, Spain.
- Biomedical Research Institute I+12, University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain.
| | - Marta Dueñas
- Molecular Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense nº 40, 28040 Madrid, Spain.
- Biomedical Research Institute I+12, University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain.
| | - Carolina Rubio
- Molecular Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense nº 40, 28040 Madrid, Spain.
- Biomedical Research Institute I+12, University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain.
| | - Ester Munera-Maravilla
- Molecular Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense nº 40, 28040 Madrid, Spain.
- Biomedical Research Institute I+12, University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain.
| | - Cristina Segovia
- Molecular Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense nº 40, 28040 Madrid, Spain.
- Biomedical Research Institute I+12, University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain.
| | - Alejandra Bernardini
- Molecular Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense nº 40, 28040 Madrid, Spain.
- Biomedical Research Institute I+12, University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain.
| | - Alicia Teijeira
- Molecular Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense nº 40, 28040 Madrid, Spain.
| | - Jesús M Paramio
- Molecular Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense nº 40, 28040 Madrid, Spain.
- Biomedical Research Institute I+12, University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain.
| | - Cristian Suárez-Cabrera
- Molecular Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense nº 40, 28040 Madrid, Spain.
- Biomedical Research Institute I+12, University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain.
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Monteiro LL, Witjes JA, Agarwal PK, Anderson CB, Bivalacqua TJ, Bochner BH, Boormans JL, Chang SS, Domínguez-Escrig JL, McKiernan JM, Dinney C, Godoy G, Kulkarni GS, Mariappan P, O'Donnell MA, Rentsch CA, Shah JB, Solsona E, Svatek RS, van der Heijden AG, van Valenberg FJP, Kassouf W. ICUD-SIU International Consultation on Bladder Cancer 2017: management of non-muscle invasive bladder cancer. World J Urol 2018; 37:51-60. [PMID: 30109483 DOI: 10.1007/s00345-018-2438-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/06/2018] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To provide a summary of the Third International Consultation on Bladder Cancer recommendations for the management of non-muscle invasive bladder cancer (NMIBC). METHODS A detailed review of the literature was performed focusing on original articles for the management of NMIBC. An international committee assessed and graded the articles based on the Oxford Centre for Evidence-based Medicine system. The entire spectrum of NMIBC was covered such as prognostic factors of recurrence and progression, risk stratification, staging, management of positive urine cytology with negative white light cystoscopy, indications of bladder and prostatic urethral biopsies, management of Ta low grade (LG) and high risk tumors (Ta high grade [HG], T1, carcinoma in situ [CIS]), impact of BCG strain and host on outcomes, management of complications of intravesical therapy, role of alternative therapies, indications for early cystectomy, surveillance strategies, and new treatments. The working group provides several recommendations on the management of NMIBC. RESULTS Recommendations were summarized with regard to staging; management of primary and recurrent LG Ta and high risk disease, positive urine cytology with negative white light cystoscopy and prostatic urethral involvement; indications for timely cystectomy; and surveillance strategies. CONCLUSION NMIBC remains a common and challenging malignancy to manage. Accurate staging, grading, and risk stratification are critical determinants of the management and outcomes of these patients. Current tools for risk stratification are limited but informative, and should be used in clinical practice when determining diagnosis, surveillance, and treatment of NMIBC.
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Affiliation(s)
- Leonardo L Monteiro
- Division of Urology, McGill University Health Center-Glen Site, 1001 Decarie Blvd, Montreal, QC, H3A 3J1, Canada
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Piyush K Agarwal
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | | | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sam S Chang
- Ingram Cancer Center, Vanderbilt University, Tennessee, USA
| | | | | | - Colin Dinney
- Department of Urology, MD Anderson Cancer Center, Houston, USA
| | - Guilherme Godoy
- Scott Department of Urology, Baylor College of Medicine, Houston, USA
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | | | | | | | - Jay B Shah
- Department of Urology, Stanford University School of Medicine, Stanford, USA
| | - Eduardo Solsona
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Robert S Svatek
- Department of Urology, Division of Urologic Oncology, The University of Texas Health San Antonio, San Antonio, USA
| | | | | | - Wassim Kassouf
- Division of Urology, McGill University Health Center-Glen Site, 1001 Decarie Blvd, Montreal, QC, H3A 3J1, Canada.
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Patient Compliance With Maintenance Intravesical Therapy for Nonmuscle Invasive Bladder Cancer. Urology 2018; 118:107-113. [DOI: 10.1016/j.urology.2018.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
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Babjuk M, Burger M, Compérat EM, Gontero P, Mostafid HA, Palou J, van Rhijn BWG, Rouprêt M, Shariat SF, Sylvester R, Zigeuner R, Capoun O, Cohen D, Dominguez-Escrig JL, Hernández V, Peyronnet B, Seisen T, Soukup V. Indication for a Single Postoperative Instillation of Chemotherapy in Non-muscle-invasive Bladder Cancer: What Factors Should Be Considered? Eur Urol Focus 2018; 4:525-528. [PMID: 30061076 DOI: 10.1016/j.euf.2018.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/08/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
An early single instillation of intravesical chemotherapy (SICI) used immediately after transurethral resection of the bladder (TURB) can significantly reduce the recurrence rate in selected patients with non-muscle-invasive bladder cancer (NMIBC). SICI should be used in patients with low-risk and with selected intermediate-risk tumours, in particular for multiple primary small papillary tumours, single primary papillary tumours >3cm, and single recurrent papillary tumours recurring >1yr after the previous resection. The available data do not support any recommendation to reduce the role of SICI in patients after fluorescence cystoscopy-guided TURB or en bloc TURB. SICI can even provide some benefit in patients with intermediate-risk tumours subsequently treated with further instillations. During instillation, contraindications should be taken into account and safety measures should be applied. PATIENT SUMMARY: An early single instillation of intravesical chemotherapy immediately after transurethral resection of the bladder can significantly reduce the recurrence rate in selected patients with non-muscle-invasive bladder cancer. It should be used in patients with low-risk and selected intermediate-risk tumours.
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Affiliation(s)
- Marko Babjuk
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic; Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Eva M Compérat
- Department of Pathology, Hôpital Tenon, AP-HP, Sorbonne University, Paris, France
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Hugh A Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Bas W G van Rhijn
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Morgan Rouprêt
- Department of Urology, Hôpital La Pitié-Salpétrière, AP-HP, Sorbonne University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic; Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Richard Sylvester
- European Association of Urology Guidelines Office, Brussels, Belgium
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Otakar Capoun
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Daniel Cohen
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Urology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | | | - Virginia Hernández
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Thomas Seisen
- Department of Urology, Hôpital La Pitié-Salpétrière, AP-HP, Sorbonne University, Paris, France
| | - Viktor Soukup
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Mekayten M, Yutkin V, Duvdevani M, Pode D, Hidas G, Landau EH, Youssef F, Gofrit ON. High frequency of bladder cancer after nephroureterectomy: justification for adjuvant intravesical treatment? Res Rep Urol 2018; 10:33-38. [PMID: 29872646 PMCID: PMC5973432 DOI: 10.2147/rru.s164166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Bladder recurrence after nephroureterectomy (NU) is common. However, there is no acceptable policy of adjuvant intravesical treatment after NU. Objective To assess the rate of bladder recurrence following NU and to identify the high-risk subgroups that may become candidates for adjuvant intravesical therapy after NU. Patients and methods Ninety-one patients (mean age 66.4 years) underwent NU. High-grade (HG) tumors were found in 63 patients and low-grade (LG) tumors in 28. Median follow-up was 72 months. The risk of bladder recurrence was assessed by uni- and multivariate analyses of patient and tumor characteristics. Results Bladder recurrence developed in 38 patients (41.8%) after a median period of 11 months. Among these, 25 patients with HG upper tract urothelial carcinoma (39.7%) and 13 patients with LG upper tract urothelial carcinoma (46.4%) developed recurrence. HG bladder recurrence developed in 24 patients (63.2%) and LG recurrence developed in 14 patients (36.8%). Stages pTa, pT1, pT2, or higher bladder recurrence developed in 26 (68.4%), 7 (18.4%), and 4 patients (10.5%), respectively, and pure pTis developed in 1 patient. On uni- and multivariate analyses, the risk of bladder recurrence was independent of any clinicopathologic characteristics. Conclusion High rate and short time interval of bladder recurrence after NU were found, with no specific subgroup of patients with increased risk. These findings support prescribing adjuvant intravesical therapy to all patients after NU.
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Affiliation(s)
- Matan Mekayten
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ezekiel H Landau
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Fadi Youssef
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Crijnen J, De Reijke TM. Emerging intravesical drugs for the treatment of non muscle-invasive bladder cancer. Expert Opin Emerg Drugs 2018; 23:135-147. [PMID: 29730950 DOI: 10.1080/14728214.2018.1474201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Bladder cancer (BC) is a severe health burden: and has high recurrence and progression rates. Standard treatment starts with TURB followed by intravesical chemotherapy with Mitomycin C or immunotherapy with BCG. However, successful management still remains a challenge, because approximately 30% of patients have recurrence or progression within 5 years, and treatment has considerable side effects. Anticipating on the upcoming BCG shortage emphasizes, moreover, the necessity to develop and study novel treatments. This review explores emerging and novel salvage treatments as well as approaches of current treatments with decrease side-effects for non muscle-invasive bladder cancer (NMIBC). Areas covered: In this review, the authors provide an overview of the novel and emerging therapies for NMIBC. They also provide the currently available data and ongoing trials. Expert opinion: Key findings in the field of research on emerging intravesical drugs for the treatment of NMIBC are the promising results for device assisted treatments, treatment with intravesical immunotherapy, and treatments to expedite the immunotherapy checkpoint inhibitors. Other novel therapies are still in an experimental stage and have to make the transition towards the clinical setting to determine the benefit in terms of reduced side-effects, recurrence and progression rates.
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Affiliation(s)
- Jasper Crijnen
- a Department of Urology , Academic Medical Center , Amsterdam , The Netherlands
| | - Theo M De Reijke
- a Department of Urology , Academic Medical Center , Amsterdam , The Netherlands
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Oosterlinck W, Decaestecker K. Editorial on the value of an immediate intravesical instillation of mitomycin C in patients with non-muscle-invasive bladder cancer. Transl Androl Urol 2018; 7:S135-S137. [PMID: 29644182 PMCID: PMC5881219 DOI: 10.21037/tau.2017.09.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Miao T, Wang J, Zeng Y, Liu G, Chen X. Polysaccharide-Based Controlled Release Systems for Therapeutics Delivery and Tissue Engineering: From Bench to Bedside. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2018; 5:1700513. [PMID: 29721408 PMCID: PMC5908359 DOI: 10.1002/advs.201700513] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/19/2017] [Indexed: 05/08/2023]
Abstract
Polysaccharides or polymeric carbohydrate molecules are long chains of monosaccharides that are linked by glycosidic bonds. The naturally based structural materials are widely applied in biomedical applications. This article covers four different types of polysaccharides (i.e., alginate, chitosan, hyaluronic acid, and dextran) and emphasizes their chemical modification, preparation approaches, preclinical studies, and clinical translations. Different cargo fabrication techniques are also presented in the third section. Recent progresses in preclinical applications are then discussed, including tissue engineering and treatment of diseases in both therapeutic and monitoring aspects. Finally, clinical translational studies with ongoing clinical trials are summarized and reviewed. The promise of new development in nanotechnology and polysaccharide chemistry helps clinical translation of polysaccharide-based drug delivery systems.
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Affiliation(s)
- Tianxin Miao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
- School of Chemical & Biomolecular EngineeringGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Junqing Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
- Collaborative Innovation Center of Guangxi Biological Medicine and theMedical and Scientific Research CenterGuangxi Medical UniversityNanning530021China
| | - Yun Zeng
- Department of PharmacologyXiamen Medical CollegeXiamen361008China
| | - Gang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
- State Key Laboratory of Cellular Stress BiologyInnovation Center for Cell BiologySchool of Life SciencesXiamen UniversityXiamen361102China
- State Key Laboratory of Physical Chemistry of Solid Surfaces and The MOE Key Laboratory of Spectrochemical Analysis & InstrumentationCollege of Chemistry and Chemical EngineeringXiamen UniversityXiamen361005China
| | - Xiaoyuan Chen
- Laboratory of Molecular Imaging and NanomedicineNational Institute of Biomedical Imaging and BioengineeringNational Institutes of HealthBethesdaMD20892USA
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Oosterlinck W, Decaestecker K. Update on early instillation of chemotherapy after transurethral resection of non-muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2018. [PMID: 29528758 DOI: 10.1080/14737140.2018.1451748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Non-muscle-invasive bladder cancer (NMIBC) is a highly recurrent disease. Early bladder chemotherapy instillation (EBCI) after transurethral resection (TURB) is an efficient way to diminish recurrence. However, this method is often challenged. Areas covered: There was a recent publication of a large meta-analysis with the original patient data and the largest study ever on EBCI. Both brought new evidence on EBCI. Also the results of the 2 trials of EBCI with apaziquone appeared. EBCI is discussed among other methods to decrease recurrence. Expert commentary: EBCI obtains a 35% relative reduction of recurrence with the best results in low risk tumors. However, tumors with an EORTC recurrence score of 5 or more do not respond. It should be given within a few hours after TURB. Mitomycin C and epirubicin have been most widely used with no difference in response. Intensive rinsing of the bladder is also able to reduce recurrence rates by about 21%. A rare, but major problem and reason for not using EBCI is the possible extravasation of the drug after TURB. Apaziquone is rapidly inactivated in tissue and blood and is therefore ideal for local use. Two phase III trials however obtained only a modest result.
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Unda-Urzaiz M, Fernandez-Gomez J, Cozar-Olmo J, Juárez A, Palou J, Martínez-Piñeiro L. Update on the role of endovesical chemotherapy in nonmuscle-invasive bladder cancer. Actas Urol Esp 2018; 42:73-76. [PMID: 29129339 DOI: 10.1016/j.acuro.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
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