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Jackson-Spence F, Ackerman C, Jones R, Toms C, Jovaisaite A, Young M, Hussain S, Protheroe A, Birtle A, Chakraborti P, Huddart R, Jagdev S, Bahl A, Sundar S, Crabb S, Powles T, Szabados B. Biomarkers associated with survival in patients with platinum-refractory urothelial carcinoma treated with paclitaxel. Urol Oncol 2024:S1078-1439(24)00491-5. [PMID: 39025719 DOI: 10.1016/j.urolonc.2024.05.015] [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: 09/15/2023] [Revised: 05/18/2024] [Accepted: 05/19/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Taxane- based chemotherapy is widely used in patients with platinum- and immunotherapy refractory, metastatic urothelial carcinoma (mUC). Outcomes are poor and biomarkers associated with outcome are lacking. We aim to identify cancer hallmarks associated with survival in patients receiving paclitaxel. METHODS Whole-transcriptome profiles were generated for a subset of patients enrolled in a randomised phase II study investigating paclitaxel and pazopanib in platinum refractory mUC (PLUTO, EudraCT 2011-001841-34). Estimates of gene expression were calculated and input into the Almac proprietary analysis pipeline and signature scores were calculated using ClaraT V3.0.0. Ten key gene signatures were assessed: Immuno-Oncology, Epithelial to Mesenchymal Transition, Angiogenesis, Proliferation, Cell Death, Genome Instability, Energetics, Inflammation, Immortality and Evading Growth. Hazard ratios were calculated using Cox regression model and Kaplan-Meier methods were used to estimate progression free survival (PFS) and overall survival (OS). RESULTS 38 and 45 patients treated with paclitaxel or pazopanib were included. Patients with high genome instability expression treated with paclitaxel had significantly improved survival with a HR of 0.29 (95% CI: 0.14-0.61, p=0.001) and HR 0.34 (95% CI: 0.17-0.69, p=0.003) for PFS and OS, respectively. Similarly, patients with high evading growth suppressor expression treated with paclitaxel had improved PFS and OS with a HR of 0.35 (95% CI: 0.19-0.77, p=0.007) and HR 0.46 (95% CI: 0.23-0.91, p=0.026), respectively. No other gene signatures had significant impact on outcome. In both paclitaxel and pazopanib cohorts, angiogenesis activation was associated with worse PFS and OS, and VEGF targeted therapy did not improve outcomes. CONCLUSION High Genome-instability and Evading-growth suppressor biologies are associated with improved survival in patients with platinum refractory mUC receiving paclitaxel. These may refine mUC risk stratification and guide treatment decision in the future.
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Affiliation(s)
| | - Charlotte Ackerman
- Department of Genitourinary Oncology, Barts Cancer Institute, QMUL, London, UK
| | - Robert Jones
- Department of Genitourinary Oncology, University of Glasgow, Glasgow, Scotland, UK
| | - Charlotte Toms
- Department of Genitourinary Oncology, Barts Cancer Institute, QMUL, London, UK
| | - Agne Jovaisaite
- Department of Genitourinary Oncology, Barts Cancer Institute, QMUL, London, UK
| | - Matthew Young
- Department of Genitourinary Oncology, Barts Cancer Institute, QMUL, London, UK
| | - Syed Hussain
- Department of Genitourinary Oncology, University of Liverpool, Liverpool, UK
| | - Andrew Protheroe
- Department of Genitourinary Oncology, Churchill Hospital, Oxford, UK
| | - Alison Birtle
- Department of Genitourinary Oncology, Preston Hospital, Preston, UK
| | - Prabir Chakraborti
- Department of Genitourinary Oncology, Derby Hospitals NHS Foundation trust, Derby, UK
| | - Robert Huddart
- Department of Genitourinary Oncology, Institute of Cancer Research, Sutton, UK
| | - Santinder Jagdev
- Department of Genitourinary Oncology, St James's University Hospital, Leeds, UK
| | - Amit Bahl
- Department of Genitourinary Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - Santhanam Sundar
- Department of Genitourinary Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Simon Crabb
- Department of Genitourinary Oncology, University of Southampton, Southampton UK
| | - Thomas Powles
- Department of Genitourinary Oncology, Barts Cancer Institute, QMUL, London, UK.
| | - Bernadett Szabados
- Department of Genitourinary Oncology, Barts Cancer Institute, QMUL, London, UK
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Mansinho A, Cruz A, Marconi L, Pinto C, Augusto I. Avelumab as First-Line Maintenance Treatment in Locally Advanced or Metastatic Urothelial Carcinoma. Adv Ther 2023; 40:4134-4150. [PMID: 37608243 DOI: 10.1007/s12325-023-02624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023]
Abstract
This work provides a summary of guideline recommendations and an expert position on the use of maintenance avelumab therapy based on a review of current international clinical practice guidelines for locally advanced or metastatic urothelial carcinoma (UC). A PubMed literature search was conducted in March 2022 (updated in July 2023) to identify guidelines for locally advanced or metastatic UC. An expert panel (four oncologists and one urologist) reviewed the guidelines and clinical evidence, and discussed practical questions regarding the use of avelumab maintenance therapy in this clinical setting. The National Comprehensive Cancer Network, European Association of Urology and European Society for Medical Oncology guidelines recommend first-line cisplatin-containing chemotherapy for cisplatin-eligible patients, carboplatin-gemcitabine for cisplatin-ineligible patients who are fit for carboplatin, or immunotherapy with programmed death ligand-1 (PD-L1) inhibitors (e.g. atezolizumab) in platinum-ineligible patients. Maintenance avelumab is recommended in patients with response/stable disease following chemotherapy (regardless of PD-L1 status). In patients who relapse after/during chemotherapy, options include immunotherapy, erdafitinib [in those with fibroblast growth factor receptor (FGFR) mutations], enfortumab vedotin or further chemotherapy. The expert panel provided the following practical guidance: (1) consider maintenance avelumab in all eligible patients; (2) continue avelumab until disease progression/unacceptable toxicity; (3) ideally, administer six cycles of platinum-based chemotherapy prior to maintenance avelumab; (4) perform radiological evaluation after four chemotherapy cycles and prior to maintenance avelumab; (5) carboplatin-gemcitabine followed by maintenance avelumab is preferred in cisplatin-ineligible patients (regardless of PD-L1 expression), but consider first-line immunotherapy in PD-L1-positive patients and platinum-ineligible patients (regardless of PD-L1 status); and (6) for patients who relapse on avelumab, second-line options include enfortumab vedotin, FGFR inhibitors (in those with FGFR mutations) or clinical trial inclusion. In conclusion, avelumab maintenance therapy is recommended following platinum-based chemotherapy in all eligible patients with locally advanced or metastatic UC, continued until disease progression or unacceptable toxicity.
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Affiliation(s)
- André Mansinho
- Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
- Faculdade de Medicina, Instituto de Medicina Molecular-João Lobo Antunes, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Andreia Cruz
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - Lorenzo Marconi
- Centro Hospitalar Universitario de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Cidália Pinto
- Centro Hospitalar Universitário do Algarve- Hospital de Faro, Rua Leão Penedo, 8000-386, Faro, Portugal
| | - Isabel Augusto
- Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-100, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-100, Porto, Portugal
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Response of Patients with Taxane-Refractory Advanced Urothelial Cancer to Enfortumab Vedotin, a Microtubule-Disrupting Agent. Case Rep Urol 2023; 2023:1024239. [PMID: 36691441 PMCID: PMC9867573 DOI: 10.1155/2023/1024239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Enfortumab vedotin (EV), a nectin-4-directed antibody conjugated to monomethyl auristatin E (MMAE), has been approved for patients with advanced urothelial carcinoma (aUC) previously treated with platinum-based chemotherapy and immune inhibitors. Taxane agents and MMAE share antitumor mechanisms through microtubule disruption, thus raising a notable concern regarding cross-resistance between these drugs. This case report describes two patients with taxane-based chemotherapy-refractory aUC who responded well to EV. A 71-year-old man (case 1) with pT3N0M0 renal pelvic UC showed a partial response to EV in metastatic lesions of the bilateral lungs and right pelvic lymph nodes after three cycles of paclitaxel plus gemcitabine chemotherapy. A 53-year-old man (case 2) with cT3bN2M0 bladder UC underwent platinum-based neoadjuvant chemotherapy and the following radial cystectomy (ypTis ypN0). He developed bilateral lung metastases and showed a complete response to EV in the metastatic lesions after 20 cycles of paclitaxel plus nedaplatin chemotherapy. Our experience of two cases demonstrated that tumor response to EV can be expected in patients with taxane-refractory aUC.
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Yamada T, Nakane K, Enomoto T, Tomioka M, Taniguchi T, Ishida T, Ozawa K, Takagi K, Ito H, Takeuchi S, Kawase M, Kawase K, Kato D, Takai M, Iinuma K, Yokoi S, Nakano M, Koie T. Oncological Outcomes in Patients with Metastatic Urothelial Carcinoma after Discontinuing Pembrolizumab as a Second-Line Treatment: A Retrospective Multicenter Real-World Cohort Study. Biomedicines 2022; 10:biomedicines10092243. [PMID: 36140344 PMCID: PMC9496337 DOI: 10.3390/biomedicines10092243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
The treatment options are currently limited, and the oncological outcomes remain unclear, for patients with metastatic urothelial carcinoma (mUC) with or without third-line systemic therapy. We aimed to evaluate the oncological outcomes in real-world daily clinical practice after platinum-based chemotherapy followed by pembrolizumab for mUC. This retrospective, multicenter cohort study included patients with mUC who received second-line pembrolizumab in Japan. The patients were divided into the treatment group (those who received third-line treatment) and the BSC group (those who did not receive other treatments). The primary endpoint of this study was to evaluate the oncological outcomes. Of 126 patients enrolled in this study, 40 received third-line therapy. The median follow-up period was 8.0 months. The median overall survival (OS) times were nine months in the BSC group and 17 months in the treatment group (p < 0.001). The median progression-free survival (PFS) times were 4 months in the BSC group and 14 months in the treatment group (p < 0.001). In the multivariate analysis, performance status and liver metastasis were significantly associated with OS. Third-line therapy may have clinical potential advantages for improving the oncological outcomes in patients with mUC.
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Affiliation(s)
- Toyohiro Yamada
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Torai Enomoto
- Department of Urology, Matsunami General Hospital, Hashima-gun 5016062, Japan
| | - Masayuki Tomioka
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama 5068550, Japan
- Department of Urology, Chuno Kosei Hospital, Seki 5013802, Japan
| | - Tomoki Taniguchi
- Department of Urology, Chuno Kosei Hospital, Seki 5013802, Japan
- Department of Urology, Ogaki Municipal Hospital, Ogaki 5038502, Japan
| | - Takashi Ishida
- Department of Urology, Gifu Municipal Hospital, Gifu 5008513, Japan
| | - Kaori Ozawa
- Department of Urology, Ogaki Municipal Hospital, Ogaki 5038502, Japan
| | - Kimiaki Takagi
- Department of Urology, Daiyukai Daiichi Hospital, Ichinomiya 4918551, Japan
| | - Hiroki Ito
- Department of Urology, Toyota Memorial Hospital, Toyota 4718513, Japan
| | - Shinichi Takeuchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Shigeaki Yokoi
- Department of Urology, Central Japan International Medical Center, Minokamo 5058510, Japan
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, Gifu 5008717, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
- Correspondence: ; Tel.: +81-582306000
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Hong J, Sung HH, Jeong BC, Park SH. Subsequent Systemic Therapy following Platinum and Immune Checkpoint Inhibitors in Metastatic Urothelial Carcinoma. Biomedicines 2022; 10:biomedicines10082005. [PMID: 36009553 PMCID: PMC9405748 DOI: 10.3390/biomedicines10082005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
Treatment of metastatic urothelial carcinoma (mUC) after failure with platinum-based chemotherapy and immune checkpoint inhibitors (ICIs) remains controversial. To explore the role of subsequent systemic therapy, medical records from 436 patients who were consecutively treated with chemotherapy for mUC between May 2017 and April 2021 were collected from a single-center cancer registry. The primary endpoint was overall survival (OS), and progression-free survival (PFS) and response rate (RR) were also assessed. Among the 318 patients who failed both platinum and ICIs, subsequent therapy was delivered to 166 (52%) patients: taxanes (n = 56), platinum rechallenge (n = 46), pemetrexed (n = 39), and clinical trials (n = 25). Objective responses to third-line therapy were noted in 50 patients (RR, 30%; 95% CI, 23–37%). The patients who were enrolled in clinical trials and treated with platinum rechallenge were significantly more likely to respond than those treated with taxanes or pemetrexed. The median PFS and OS were 3.5 months (95% CI, 2.9–4.2 months) and 9.5 months (95% CI, 8.1–11.0 months), respectively. Similar to RR, PFS and OS were longer for the patients who were enrolled in clinical trials. Based on multivariate analyses, good performance status and enrollment in clinical trials are associated with benefits from subsequent therapy for pretreated mUC.
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Affiliation(s)
- Joohyun Hong
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Se Hoon Park
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence:
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Nishimura N, Miyake M, Shimizu T, Tachibana A, Tanaka N, Fujimoto K. Efficacy of pembrolizumab rechallenge for metastatic urothelial carcinoma. IJU Case Rep 2022; 5:338-341. [PMID: 36090940 PMCID: PMC9436659 DOI: 10.1002/iju5.12474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Before the approval of enfortumab vedotin, no standard treatment was available as the salvage treatment for patients with metastatic urothelial carcinoma who had failed second‐line or later pembrolizumab. Pembrolizumab rechallenge is one of the options for these patients, but there is limited evidence on the effectiveness of pembrolizumab rechallenge. We report three patients with metastatic urothelial carcinoma treated with pembrolizumab rechallenge and discuss rechallenge of immune checkpoint inhibitors in other malignancies. Case presentation This study included three cases treated with pembrolizumab rechallenge with the age of 54 (Case 1), 78 (Case 2), and 67 (Case 3) years old. A complete response to the prior pembrolizumab was observed only in Case 1. However, no patients responded to the pembrolizumab rechallenge. Conclusion Pembrolizumab rechallenge is not recommended in the current clinical setting of metastatic urothelial carcinoma, even for patients who showed complete response to the prior pembrolizumab.
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Affiliation(s)
| | - Makito Miyake
- Department of Urology Nara Medical University Kashihara Nara Japan
| | - Takuto Shimizu
- Department of Urology Saiseikai Chuwa Hospital Sakurai Nara Japan
| | - Akira Tachibana
- Department of Urology Gokeikai Osaka Kansei Hospital Yodogawaku Osaka Japan
| | - Nobumichi Tanaka
- Department of Urology Nara Medical University Kashihara Nara Japan
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Koguchi D, Matsumoto K, Ikeda M, Taoka Y, Hirayama T, Murakami Y, Utsunomiya T, Matsuda D, Okuno N, Irie A, Iwamura M. Impact of salvage cytotoxic chemotherapy on prognosis in patients with recurrence after radical cystectomy: a multi-institutional retrospective study. BMC Urol 2022; 22:75. [PMID: 35549909 PMCID: PMC9103293 DOI: 10.1186/s12894-022-01026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background In patients experiencing disease recurrence after radical cystectomy (RC) for bladder cancer, data about the impact of clinicopathologic factors, including salvage treatment using cytotoxic chemotherapy, on the survival are scarce. We investigated the prognostic value of clinicopathologic factors and the treatment effect of salvage cytotoxic chemotherapy (SC) in such patients. Methods In this retrospective study, we evaluated the clinical data for 86 patients who experienced recurrence after RC. Administration of SC or of best supportive care (BSC) was determined in consultation with the urologist in charge and in accordance with each patient’s performance status, wishes for treatment, and renal function. Statistical analyses explored for prognostic factors and evaluated the treatment effect of SC compared with BSC in terms of cancer-specific survival (CSS). Results Multivariate analyses showed that liver metastasis after RC (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.17 to 3.85; P = 0.01) and locally advanced disease at RC (HR 1.92; 95% CI 1.06 to 3.46; P = 0.03) are independent risk factors for worse CSS in patients experiencing recurrence after RC. In a risk stratification model, patients were assigned to one of two groups based on liver metastasis and locally advanced stage. In the high-risk group, which included 68 patients with 1–2 risk factors, CSS was significantly better for patients receiving SC than for those receiving BSC (median survival duration: 9.4 months vs. 2.4 months, P = 0.005). The therapeutic effect of SC was not related to a history of adjuvant chemotherapy. Conclusions The present study indicated the potential value of 1st-line SC in patients experiencing recurrence after RC even with advanced features, such as liver metastasis after RC and locally advanced disease at RC.
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Affiliation(s)
- Dai Koguchi
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku Sagamihara, Kanagawa, 252-0374, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku Sagamihara, Kanagawa, 252-0374, Japan.
| | - Masaomi Ikeda
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku Sagamihara, Kanagawa, 252-0374, Japan
| | - Yoshinori Taoka
- Department of Urology, Kitasato University Medical Center, Saitama, Japan
| | - Takahiro Hirayama
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Yasukiyo Murakami
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Takuji Utsunomiya
- Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, Kanagawa, Japan
| | | | - Norihiko Okuno
- Department of Urology, National Hospital Organization Sagamihara Hospital, Kanagawa, Japan
| | - Akira Irie
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku Sagamihara, Kanagawa, 252-0374, Japan
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Bellmunt J, Valderrama BP, Puente J, Grande E, Bolós MV, Lainez N, Vázquez S, Maroto P, Climent MÁ, del Muro XG, Arranz JÁ, Durán I. Recent Therapeutic Advances in Urothelial Carcinoma: A Paradigm Shift in Disease Management. Crit Rev Oncol Hematol 2022; 174:103683. [DOI: 10.1016/j.critrevonc.2022.103683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/13/2022] Open
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Powles T, Bellmunt J, Comperat E, De Santis M, Huddart R, Loriot Y, Necchi A, Valderrama BP, Ravaud A, Shariat SF, Szabados B, van der Heijden MS, Gillessen S. Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:244-258. [PMID: 34861372 DOI: 10.1016/j.annonc.2021.11.012] [Citation(s) in RCA: 205] [Impact Index Per Article: 102.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- T Powles
- Barts Cancer Centre, Barts Health NHS Trust, Queen Mary University of London, London, UK
| | - J Bellmunt
- Beth Israel Deaconess Medical Centre-IMIM Lab, Harvard Medical School, Boston, USA
| | - E Comperat
- L'Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - M De Santis
- Department of Urology, Charité Universitätsmedizin, Berlin, Germany
| | - R Huddart
- Royal Marsden Hospital, Institute of Cancer Research, London, UK
| | - Y Loriot
- Département de Médecine Oncologique, Université Paris-Saclay and Gustave Roussy, Villejuif, France
| | - A Necchi
- Vita-Salute San Raffaele University, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - A Ravaud
- Hôpital Saint-André CHU, Bordeaux, France; Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France
| | - S F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - B Szabados
- Barts Cancer Centre, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - M S van der Heijden
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - S Gillessen
- Oncology Institute of Southern Switzerland (IOSI), EOC, Lugano, Switzerland
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10
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Ozaki K, Hatakeyama S, Tanaka T, Noro D, Tokui N, Horiguchi H, Okuyama Y, Fujita N, Okamoto T, Okamoto A, Suzuki Y, Yamamoto H, Yoneyama T, Hashimoto Y, Ohyama C. The impact of eligibility for maintenance immunotherapy on prognosis in patients with unresectable or metastatic urothelial carcinoma. BJUI COMPASS 2021; 3:139-145. [PMID: 35474727 PMCID: PMC8988805 DOI: 10.1002/bco2.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kai Ozaki
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Shingo Hatakeyama
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Toshikazu Tanaka
- Department of Urology Aomori Prefectural Central Hospital Aomori Japan
| | - Daisuke Noro
- Department of Urology Mutsu General Hospital Mutsu Japan
| | - Noriko Tokui
- Department of Urology Odate Municipal Hospital Odate Japan
| | - Hirotaka Horiguchi
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Yoshiharu Okuyama
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Naoki Fujita
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Teppei Okamoto
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Akiko Okamoto
- Department of Urology Oyokyo Kidney Research Institute Hirosaki Japan
| | | | - Hayato Yamamoto
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Yasuhiro Hashimoto
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Chikara Ohyama
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
- Department of Urology Aomori City Hospital Aomori Japan
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11
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[Systemic treatment of bladder cancer]. Urologe A 2021; 60:1167-1174. [PMID: 34043031 DOI: 10.1007/s00120-021-01535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Cisplatin-based chemotherapy regimens represent the standard of care in patients with locally advanced or metastatic urothelial carcinoma of the bladder. However, many patients are ineligible for cisplatin due to comorbidities or performance status. Immunotherapy with checkpoint inhibitors (CPI) has become a well-established treatment alternative in metastatic bladder cancer. The following review discusses current literature and guideline recommendations based on two case studies, in order to provide practical know-how about therapy sequences and treatment processes.
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12
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Nadal R, Clara JA, Valderrama BP, Bellmunt J. Current Therapy for Metastatic Urothelial Carcinoma. Hematol Oncol Clin North Am 2021; 35:469-493. [PMID: 33958146 DOI: 10.1016/j.hoc.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Urothelial carcinoma (UC) is a highly lethal malignancy in the metastatic state. Platinum-based chemotherapy regimens have been the backbone treatment for patients with advanced UC in the first-line setting. However, a large subset of patients are suboptimal candidates for these combinations owing to poor renal function and/or other comorbidities. Patients who are unable to tolerate or who progress after frontline platinum chemotherapy face a poor outcome. Recent insights into UC biology and immunology are being translated into new therapies for metastatic UC (mUC) including immune checkpoint inhibitors (ICIs), erdafitinib, a FGFR inhibitor, and antibody drug conjugates (ADC) such enfortumab vedotin.
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Affiliation(s)
- Rosa Nadal
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, 10 Center Drive, Room 3E-5330, Bethesda, MD 20892, USA
| | - Joseph A Clara
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, 10 Center Drive, Room 3E-5330, Bethesda, MD 20892, USA
| | - Begoña P Valderrama
- Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot, s/n, Sevilla 41001, Spain
| | - Joaquim Bellmunt
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, KS 118, Boston, MA 02215, USA.
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13
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Montazeri K, Sonpavde G. Salvage systemic therapy for metastatic urothelial carcinoma: an unmet clinical need. Expert Rev Anticancer Ther 2020; 21:299-313. [PMID: 33249937 DOI: 10.1080/14737140.2021.1855981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Metastatic urothelial carcinoma (mUC) remains a fatal malignancy, despite the recent addition of immune check point inhibitors (ICIs), an FGFR inhibitor and an antibody-drug conjugate (ADC) to the therapeutic armamentarium. The survival rates are particularly dismal after first-line treatment failure, entailing an urgent need for more effective therapies. Advances in understanding biomarkers and identifying targetable molecules have broadened the pathways under investigation in mUC. AREAS COVERED This review summarizes mUC salvage therapy options, including chemotherapy, ICI, and novel promising agents, including targeted therapies, ADCs, cytotoxic agents and vaccines. For the literature review, a PubMed search and relevant data presented at international conferences were used. EXPERT OPINION The approval of ICIs, FGFR inhibitor erdafitinib and ADC enfortumab vedotin in the salvage setting has transformed the mUC landscape. Yet there are additional promising agents currently under study. Toxicities are observed with ADCs and FGFR inhibitors, but appear manageable in most patients. The molecular heterogeneity and complex tumor biology are challenging barriers for progress in the therapy of mUC. Advances in molecular profiling, defining validated predictive markers, rational combinations of agents and therapeutically actionable targets will help develop personalized compounds with higher efficacy and less toxicity with hopes to improve outcomes for mUC.
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Affiliation(s)
| | - Guru Sonpavde
- Dana Farber Cancer Institute, Harvard Medical School, Boston, USA
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14
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Walunj D, Egarmina K, Tuchinsky H, Shpilberg O, Hershkovitz-Rokah O, Grynszpan F, Gellerman G. Expedient synthesis and anticancer evaluation of dual-action 9-anilinoacridine methyl triazene chimeras. Chem Biol Drug Des 2020; 97:237-252. [PMID: 32772433 DOI: 10.1111/cbdd.13776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/20/2020] [Accepted: 08/01/2020] [Indexed: 12/20/2022]
Abstract
The efficient synthesis of molecular hybrids including a DNA-intercalating 9-anilinoacridine (9-AnA) core and a methyl triazene DNA-methylating moiety is described. Nucleophilic aromatic substitution (SN Ar) and electrophilic aromatic substitution (EAS) reactions using readily accessible starting materials provide a quick entry to novel bifunctional anticancer molecules. The chimeras were evaluated for their anticancer activity. Chimera 7b presented the highest antitumor activity at low micromolar IC50 values in antiproliferative assays performed with various cancer cell lines. In comparison, compound 7b outperformed DNA-intercalating drugs like amsacrine and AHMA. Mechanistic studies of chimera 7b suggest a dual mechanism of action: methylation of the DNA-repairing protein MGMT associated with the triazene structural portion and Topo II inhibition by intercalation of the acridine core.
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Affiliation(s)
- Dipak Walunj
- Department of Chemical Sciences, Ariel University, Ariel, Israel
| | - Katarina Egarmina
- Institute of Hematology, Assuta Medical Centers, Tel Aviv, Israel.,Translational Research Lab, Assuta Medical Centers, Tel Aviv, Israel.,Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Helena Tuchinsky
- Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Ofer Shpilberg
- Institute of Hematology, Assuta Medical Centers, Tel Aviv, Israel.,Translational Research Lab, Assuta Medical Centers, Tel Aviv, Israel
| | - Oshrat Hershkovitz-Rokah
- Institute of Hematology, Assuta Medical Centers, Tel Aviv, Israel.,Translational Research Lab, Assuta Medical Centers, Tel Aviv, Israel.,Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Flavio Grynszpan
- Department of Chemical Sciences, Ariel University, Ariel, Israel
| | - Gary Gellerman
- Department of Chemical Sciences, Ariel University, Ariel, Israel
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15
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Wu CG, Chiovaro F, Curioni-Fontecedro A, Casanova R, Soltermann A. In vitro cell culture of patient derived malignant pleural and peritoneal effusions for personalised drug screening. J Transl Med 2020; 18:163. [PMID: 32276643 PMCID: PMC7149866 DOI: 10.1186/s12967-020-02331-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/04/2020] [Indexed: 12/29/2022] Open
Abstract
Background Malignant serous effusion (MSE) denotes a manifestation of metastatic disease with typical high concentrations of both cancer and immune cells, making them an ideal resource for in vitro cytologic studies. Hence, the aim of the study was to investigate the features of 2D and 3D MSE culture systems as well as their feasibilities for in vitro drug screening. Methods Pleural and peritoneal effusions from 8 patients were collected and processed for 2D monolayer and 3D hanging drop cell culture into GravityPLUS™ plates. Representative markers for cell components, proliferation rate and tumour classification were investigated by immunohistochemistry, followed by absolute quantification using a digitalised image analysis approach. Further, we implemented another 3D cell culture model based on a low attachment method for in vitro drug sensitivity testing of carboplatin, pemetrexed and pembrolizumab for 5 patients. Results Monolayer cell culture was favourable for the growth of mesothelial cells, while hanging drop culture in GravityPLUS™ plates showed better ability for preserving cancer cells, inducing positive diagnostic markers expression and restraining the growth of mesothelial cells. For in vitro drug testing, MSE from five patients presented various drug sensitivities, and one case showed strong response to PD-1 checkpoint inhibition (pembrolizumab). For some patients, the application of combinatorial drugs had better therapeutic responses compared to monotherapy. Conclusions Digitalised quantification of data offers a better understanding of different MSE culture models. More importantly, the proposed platforms are practical and amenable for performing in vitro chemo-/immunotherapeutic drug testing by using routine cytologic MSE in a personalised manner. Next to cell blocks, our work demonstrates the prognostic and predictive value of cytologic effusion samples.
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Affiliation(s)
- Cheng-Guang Wu
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland. .,University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland.
| | | | - Alessandra Curioni-Fontecedro
- Department of Medical Oncology and Haematology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ruben Casanova
- University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland
| | - Alex Soltermann
- ADMED Pathology, Rue de la Maladière 45, 2000, Neuchâtel, Switzerland
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16
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Abe T, Minami K, Harabayashi T, Sazawa A, Chiba H, Kikuchi H, Miyata H, Matsumoto R, Osawa T, Maruyama S, Ishizaki J, Mochizuki T, Chiba S, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Murai S, Shinohara N. Outcome of maintenance systemic chemotherapy with drug-free interval for metastatic urothelial carcinoma. Jpn J Clin Oncol 2020; 49:965-971. [PMID: 31187865 PMCID: PMC6886465 DOI: 10.1093/jjco/hyz084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Aiming to achieve long-term disease control, maintenance systemic chemotherapy (MSC) with a 1-3-month drug-free interval is continued in selected patients. We report our experience of MSC for metastatic urothelial carcinoma (UC). METHODS Of 228 metastatic UC patients treated with systemic chemotherapy, 40 (17.5%, 40/228) had continuously undergone MSC. Data on the regimen, cycle number, and reason for the discontinuation of MSC were also collected. We analyzed OS from the initiation of MSC until death or the last follow-up, using the log-rank test to assess the significance of differences. RESULTS The median number of cycles of chemotherapy was 6, and the responses were CR in 6, PR in 20, SD in 13, and PD in 1 before MSC. Gemcitabine plus CDDP or carboplatin was mainly performed as MSC (70%, 28/40). MSC was repeated quarterly in 30 (75%, 30/40), every two months in 8 (20%, 8/40), and with other intervals in 2 (5%, 2/40). Overall, a median of 3.5 cycles (range: 1-29) of MSC was performed. The reason for the discontinuation of MSC was PD in 24 (60%, 24/40), favorable disease control in 9 (22.5%, 9/40), and myelosuppression in 3 (7.5%, 3/40), and for other reasons in 2 (5%, 2/40). MSC was ongoing in 2 (5%, 2/40). The median OS was 27 months from the initiation of MSC. PS0 (P = 0.0169), the absence of lung metastasis (P = 0.0387), and resection of the primary site (P = 0.0495) were associated with long-term survival after MSC. CONCLUSIONS In selected patients, long-term systemic chemotherapy could be performed with a drug-free interval. Our maintenance strategy with cytotoxic drugs may become one of the treatment options for long-term disease control.
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Affiliation(s)
- T Abe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - K Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - T Harabayashi
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - A Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - H Chiba
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - H Kikuchi
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - H Miyata
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - R Matsumoto
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - T Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - S Maruyama
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - J Ishizaki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - T Mochizuki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - S Chiba
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - T Akino
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - M Murakumo
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - N Miyajima
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - K Tsuchiya
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - S Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - N Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Han W, Shi L, Xie B, Wan J, Ren L, Wang Y, Chen X, Wang H. Supramolecular Engineering of Molecular Inhibitors in an Adaptive Cytotoxic Nanoparticle for Synergistic Cancer Therapy. ACS APPLIED MATERIALS & INTERFACES 2020; 12:1707-1720. [PMID: 31816241 DOI: 10.1021/acsami.9b20178] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Combinatorial regimens that rationally pair molecular inhibitors with standard cytotoxic chemotherapeutics are used to improve therapeutic outcomes. Simultaneously engineering these therapies within a single nanocarrier that spans cytotoxic, antiangiogenic, and anti-invasive mechanisms and that enables the delivery of unique drug combinations remains a technical challenge. In this study, we developed a simple and broadly applicable strategy in which ultrastable cytotoxic nanoparticles with an established excellent antitumor efficacy and π-rich inner core structure supramolecularly stabilized the antiangiogenic molecular inhibitor apatinib to create a synergistic drug delivery system (termed sTKI-pSN38). This small-sized nanoparticle accomplished the sequential release of both encapsulated drugs to exert antimetastatic, antivascular, and cytotoxic activities simultaneously. In xenograft models of hepatocellular carcinoma, a single intravenous administration of sTKI-pSN38 elicited robust and durable tumor reduction and suppressed metastasis to lymph nodes. Interestingly, sTKI-pSN38 treatment alleviated intratumoral hypoxia, which could contribute to impaired tumor metastasis and reduced drug resistance. Collectively, this nanotherapeutic platform offers a new strategy for cancer therapy by simply engineering a drug cocktail in conventional nanoparticles and by enabling the spatiotemporal modulation of drug release to enhance the synergy of the combined drugs.
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Affiliation(s)
- Weidong Han
- Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine , Zhejiang University , Hangzhou , 310016 , PR China
| | - Linlin Shi
- Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine , Zhejiang University , Hangzhou , 310016 , PR China
| | - Binbin Xie
- Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine , Zhejiang University , Hangzhou , 310016 , PR China
| | - Jianqin Wan
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , 310003 , PR China
| | - Lulu Ren
- Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine , Zhejiang University , Hangzhou , 310016 , PR China
| | - Yuchen Wang
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , 310003 , PR China
| | - Xiaona Chen
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , 310003 , PR China
| | - Hangxiang Wang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine , Zhejiang University , Hangzhou , 310016 , PR China
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18
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Seisen T, Jamzadeh A, Leow JJ, Rouprêt M, Cole AP, Lipsitz SR, Kibel AS, Nguyen PL, Sun M, Menon M, Bellmunt J, Choueiri TK, Trinh QD. Adjuvant Chemotherapy vs Observation for Patients With Adverse Pathologic Features at Radical Cystectomy Previously Treated With Neoadjuvant Chemotherapy. JAMA Oncol 2019; 4:225-229. [PMID: 28837718 DOI: 10.1001/jamaoncol.2017.2374] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Despite existing evidence of a benefit associated with cisplatin-based adjuvant chemotherapy (AC) after radical cystectomy (RC) for chemotherapy-naive patients with pT3/T4 and/or pN+ urothelial carcinoma of the bladder (UCB), to our knowledge, no studies have addressed the effectiveness of AC in those who received neoadjuvant chemotherapy (NAC) before surgery. Objective To assess the comparative effectiveness of AC vs observation for patients with pT3/T4 and/or pN+ UCB previously treated with NAC and RC. Design, Setting, and Participants This observational cohort study used the National Cancer Data Base (January 1, 2006, through December 31, 2012) to identify individuals who received NAC and RC followed by AC or observation for pT3/T4 and/or pN+ UCB. Main Outcomes and Measures After multiple imputation was used to handle missing data, inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier and Cox proportional hazards regression analyses were performed with a 6-month conditional landmark to compare overall survival (OS) among patients who received NAC and RC followed by AC vs observation. In addition, exploratory analyses were conducted to examine the heterogeneity of the treatment effect according to age (continuous), sex (female vs male), Charlson comorbidity index (≥1 vs 0), pT/N stage (pT3/T4N0 vs pTanyN+), and surgical margin status (positive vs negative) by testing interaction terms within the IPTW-adjusted Cox proportional hazards regression model. Results Of the 788 patients with pT3/T4 and/or pN+ UCB (mean [SD] age, 65.3 [9.4] years; 603 [76.5%] male and 185 [23.5%] female), 184 (23.4%) received NAC and RC followed by AC and 604 (76.6%) received NAC and RC followed by observation. The 6-month conditional landmark, IPTW-adjusted Kaplan-Meier curves showed that median OS was significantly longer for NAC and RC followed by AC (29.9 months; interquartile range, 15.1-85.4 months) vs NAC and RC followed by observation (24.2 months; interquartile range, 12.9-58.9 months) (P = .046). The 5-year IPTW-adjusted rates of OS were 36.8% for NAC and RC followed by AC vs 24.7% for NAC and RC followed by observation. In the IPTW-adjusted Cox proportional hazards regression analysis, NAC and RC followed by AC was associated with a significant OS benefit (hazard ratio, 0.78; 95% CI, 0.61-0.99; P = .046). Interaction term analyses indicated that the OS benefit of NAC and RC followed by AC decreased significantly with age (hazard ratio, 0.97; 95% CI, 0.95-0.99; P = .02), whereas no significant interaction was observed with sex (P = .82), Charlson comorbidity index (P = .51), pT/N stage (P = .95), and surgical margin status (P = .29). Conclusions and Relevance This study found that AC after NAC and RC may be associated with an OS benefit for patients with pT3/T4 and/or pN+ UCB. The present findings should be considered as preliminary evidence to conduct a randomized clinical trial to address this association.
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Affiliation(s)
- Thomas Seisen
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Asha Jamzadeh
- Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Jeffrey J Leow
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Morgan Rouprêt
- Department of Urology, Pitié Salpétrière Hospital, Assistance Publique des Hôpitaux de Paris, Pierre and Marie Curie University, Paris, France
| | - Alexander P Cole
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam S Kibel
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maxine Sun
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mani Menon
- Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Joaquim Bellmunt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Nivolumab in patients with unresectable locally advanced or metastatic urothelial carcinoma: CheckMate 275 2-year global and Japanese patient population analyses. Int J Clin Oncol 2019; 24:1089-1098. [PMID: 31218529 DOI: 10.1007/s10147-019-01450-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nivolumab has demonstrated antitumor activity and manageable safety in the single-arm, phase II CheckMate 275 study in patients with unresectable locally advanced or metastatic platinum-resistant urothelial carcinoma. We report updated results of the global population and a subanalysis of Japanese patients from this study. METHODS Patients received nivolumab 3 mg/kg intravenously every 2 weeks until progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) confirmed by blinded independent review committee (BIRC) per Response Evaluation Criteria in Solid Tumors v1.1. Secondary endpoints included progression-free survival (PFS) by BIRC and overall survival (OS). Safety was also reported. The minimum follow-up was 21 months. RESULTS Overall, 270 patients were treated with nivolumab globally; 23 patients were Japanese. In the global and Japanese populations, respectively, ORR per BIRC was 20.4% and 21.7%; median PFS was 1.9 (95% confidence interval [CI] 1.9-2.3) and 3.8 months (95% CI 1.9-7.2); and median OS was 8.6 (95% CI 6.1-11.3) and 21.0 months (95% CI 7.2-not reached). The most common any grade treatment-related adverse events were fatigue (18.1%) and diarrhea (12.2%) in the global population; the most common in the Japanese population were diarrhea (26.1%) and pyrexia (13.0%). Grade 3 or 4 treatment-related adverse events occurred in 61 (22.6%) and seven (30.4%) of the global and Japanese patients, respectively. CONCLUSIONS Nivolumab continues to show antitumor activity and survival in the global population of CheckMate 275. Meaningful clinical benefit was also observed in Japanese patients. No new safety signals were identified.
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20
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Tsang ES, Forbes C, Chi KN, Eigl BJ, Parimi S. Second-line systemic therapies for metastatic urothelial carcinoma: a population-based cohort analysis. ACTA ACUST UNITED AC 2019; 26:e260-e265. [PMID: 31043835 DOI: 10.3747/co.26.4070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Patients with urothelial carcinoma (uc) have a poor prognosis after progression on first-line cisplatin-based chemotherapy. Real-world data about second-line cytotoxic therapies are limited. We sought to characterize patients with metastatic uc who receive more than 1 line of systemic therapy and to describe their treatments and outcomes. Methods Using BC Cancer's pharmacy database, we identified patients with documented metastatic uc who had received more than 1 line of systemic therapy. A retrospective chart review was then performed to collect clinicopathologic, treatment, and outcomes data. Results The 51 included patients, of whom 42 were men (82%), had a median age of 65 years (range: 38-81 years). Sites of metastasis included lymph nodes (n = 30), bone (n = 7), lung (n = 9), and peritoneum (n = 2). Second-line chemotherapy regimens included gemcitabine-cisplatin [gc (n = 14)], paclitaxel (n = 24), docetaxel (n = 12), and an oral topoisomerase i inhibitor (n = 1). Median time to progression (ttp) and overall survival (os) were 2.0 and 6.83 months respectively. Compared with patients who received a different agent, patients who had experienced a prior response to first-line gc and who were re-challenged with second-line gc had a better median ttp (11.0 months vs. 6.0 months, p = 0.02) and survived longer (4.0 months vs. 1.0 months, p = 0.02). No differences in os between non-gc regimens were evident. Conclusions In patients with metastatic uc, overall outcomes remain poor, but compared with patients receiving other agents, the subgroup of patients re-challenged with second-line gc demonstrated improved ttp. Conventional chemotherapy regimens provide only modest benefits in the second-line setting and have largely been replaced with immunotherapy.
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Affiliation(s)
- E S Tsang
- Division of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC
| | - C Forbes
- Department of Urology, University of British Columbia, Vancouver, BC
| | - K N Chi
- Division of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC
| | - B J Eigl
- Division of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC
| | - S Parimi
- Division of Medical Oncology, BC Cancer-Vancouver Island Centre, Victoria, BC
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Histone Deacetylase Inhibitor, Trichostatin A, Synergistically Enhances Paclitaxel-Induced Cytotoxicity in Urothelial Carcinoma Cells by Suppressing the ERK Pathway. Int J Mol Sci 2019; 20:ijms20051162. [PMID: 30866433 PMCID: PMC6429437 DOI: 10.3390/ijms20051162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/22/2019] [Accepted: 03/03/2019] [Indexed: 11/16/2022] Open
Abstract
Trichostatin A (TSA), an antifungal antibiotic derived from Streptomyces, inhibits mammalian histone deacetylases, and especially, selectively inhibits class I and II histone deacetylase (HDAC) families of enzymes. TSA reportedly elicits an antiproliferative response in multifarious tumors. This study investigated the antitumor effects of TSA alone and in combination with paclitaxel when applied to two high-grade urothelial carcinoma (UC) cell lines (BFTC-905 and BFTC-909). Fluorescence-activated cell sorting, flow cytometry, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium assay were used to assess TSA's cytotoxicity and effects on apoptosis induction. TSA induced synergistic cytotoxicity, when combined with paclitaxel (combination index < 1), resulted in concomitant suppression of paclitaxel-induced activation of phospho-extracellular signal-regulated kinase (ERK) 1/2. A xenograft nude mouse model confirmed that TSA enhances the antitumor effects of paclitaxel. These findings demonstrate that the administration of TSA in combination with paclitaxel elicits a synergistic cytotoxic response. The results of this study indicate that the chemoresistance of UC could be circumvented by combining HDAC inhibitors to target the ERK pathway.
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22
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Lorch A, Niegisch G. Metastatic Bladder Cancer Disease and Its Treatment. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_26] [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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Bianconi M, Cimadamore A, Faloppi L, Scartozzi M, Santoni M, Lopez-Beltran A, Cheng L, Scarpelli M, Montironi R. Contemporary best practice in the management of urothelial carcinomas of the renal pelvis and ureter. Ther Adv Urol 2019; 11:1756287218815372. [PMID: 30671136 PMCID: PMC6329040 DOI: 10.1177/1756287218815372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022] Open
Abstract
Upper tract urothelial carcinoma (UTUC) accounts for 5% of urothelial carcinomas (UCs), the estimated annual incidence being 1-2 cases per 100,000 inhabitants. Similarly to bladder UC, divergent differentiations and histologic variants confer an adverse risk factor in comparison with pure UTUC. Molecular and genomic characterization studies on UTUC have shown changes occurring at differing frequencies from bladder cancer, with unique molecular and clinical subtypes, potentially with different responses to treatment. Systemic chemotherapy is the standard approach for patients with inoperable locally advanced or metastatic UCs. Although initial response rates are high, the median survival with combination chemotherapy is about 15 months. In first-line chemotherapy several cisplatin-based regimens have been proposed. For patients with advanced UC who progress to first-line treatment, the only product licensed in Europe is vinflunine, a third-generation, semisynthetic, vinca alkaloid. Better response rates (15-60%), with higher toxicity rates and no overall survival (OS) benefit, are generally achieved in multidrug combinations, which often include taxanes and gemcitabine. The US FDA has recently approved five agents targeting the programmed death-1 and programmed death ligand-1 pathway as a second-line therapy in patients with locally advanced or metastatic UC with disease progression during or following platinum-containing chemotherapy. Potential therapeutic targets are present in 69% of tumours analyzed. Specific molecular alterations include those involved in the RTK/Ras/PI(3)K, cell-cycle regulation and chromatin-remodeling pathways, many of them have either targeted therapies approved or under investigation. Angiogenic agents, anti-epidermal growth factor receptor therapy, phosphoinositide 3-kinase (PI3K) and mammalian target of rapamycin (mTOR) pathway inhibitors and immunotherapeutic drugs are being successfully investigated.
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Affiliation(s)
- Maristella Bianconi
- Medical Oncology Unit, ‘Madonna del Soccorso’ Hospital, ASUR Marche AV5, San Benedetto del Tronto, Italy
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Luca Faloppi
- Medical Oncology Unit, Macerata General Hospital, ASUR Marche AV3, Macerata, Italy Department of Medical Oncology, ‘Duilio Casula’ Polyclinic, Cagliari State University, Cagliari, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, ‘Duilio Casula’ Polyclinic, Cagliari State University, Cagliari, Italy
| | - Matteo Santoni
- Medical Oncology Unit, Macerata General Hospital, ASUR Marche AV3, Macerata, Italy
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, Ancona, Marche, I−60126, Italy
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24
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Abdel-Malek R, Shohdy KS, Abbas N, Ismail M, Hamada E, Abdel-Kader Y. Safety of Vinflunine in Patients with Advanced Urothelial Carcinoma Refractory to Platinum-based Chemotherapy: A Prospective Pilot Study. Curr Drug Saf 2018; 14:31-36. [PMID: 30277164 DOI: 10.2174/1574886313666181001120752] [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: 03/04/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several single chemotherapeutic agents have been evaluated as the second-line treatment of advanced urothelial carcinoma. Despite encouraging efficacy outcomes, toxicity has often led to dose modifications or discontinuation. We aimed to assess the safety of vinflunine in a particular population of advanced transitional cell carcinoma of urothelium (TCCU), that were exposed to the previous toxicity of chemotherapy. METHODS This is an open-label, prospective, single-center pilot study to evaluate the response rate and safety profile of vinflunine in patients with advanced TCCU. It was planned to enroll 25 evaluable patients. Eligible patients are those with progressive disease after first-line platinum-based regimen for advanced or metastatic disease. RESULTS The study was prematurely closed due to two sudden deaths that were judged by the review board as treatment-related. Only ten patients were evaluated and received at least one cycle of vinflunine. All but one were male and seven underwent radical surgery. Eight had a distant metastasis (mainly lung and/or liver). Disease control rate was 40%, four patients had a partial response with median duration of response of 3.5 months. The median overall survival was 3.2 months (95% CI:1.67- 4.73). There were three serious adverse events namely two sudden deaths and one grade 4 thrombocytopenia. Nine grade 3/4 adverse events occurred. The most common all-grade adverse events were fatigue (50%), constipation (40%) and vomiting (40%). Moreover, grade 3 fatigue occurred in 30% of patients. Only one patient, who achieved PR for 5 months, was fit to receive further cytotoxic chemotherapy. CONCLUSION The activity of vinflunine in advanced urothelial carcinoma came at the expense of its safety. The use of vinflunine has to be limited to the selected group of patients. However, this is a single institute experience in a limited number of patients.
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Affiliation(s)
- Raafat Abdel-Malek
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Kyrillus S Shohdy
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Noha Abbas
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Ismail
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Emad Hamada
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Abdel-Kader
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
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25
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Merseburger AS, Apolo AB, Chowdhury S, Hahn NM, Galsky MD, Milowsky MI, Petrylak D, Powles T, Quinn DI, Rosenberg JE, Siefker-Radtke A, Sonpavde G, Sternberg CN. SIU-ICUD recommendations on bladder cancer: systemic therapy for metastatic bladder cancer. World J Urol 2018; 37:95-105. [PMID: 30238401 DOI: 10.1007/s00345-018-2486-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/10/2018] [Indexed: 01/24/2023] Open
Abstract
The SIU (Société Internationale d'Urologie)-ICUD (International Consultation on Urologic Diseases) working group on systemic therapy for metastatic bladder cancer has summarized the most recent findings on the aforementioned topic and came to conclusions and recommendations according to the evidence published. In Europe and the United States, treatment for metastatic UC has changed a great deal recently, mainly involving a move from chemotherapy to immune checkpoint blockers. This is particularly true in platinum-refractory disease, where supportive randomized data exist. Five checkpoint blockers have been approved in this setting by the FDA: avelumab, atezolizumab, durvalumab, nivolumab, and pembrolizumab. Nivolumab, pembrolizumab, and atezolizumab have been approved in Europe.
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Affiliation(s)
- Axel S Merseburger
- Department of Urology, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Andrea B Apolo
- Center for Cancer Research, National Cancer Institute, NIH Maryland, Bethesda, USA
| | | | - Noah M Hahn
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Matthew D Galsky
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Matthew I Milowsky
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | - David I Quinn
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | | | - Arlene Siefker-Radtke
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guru Sonpavde
- Department of Medical Oncology, Bladder Cancer Center, Dana Farber Cancer Institute, Boston, MA, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy.
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26
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Beyond first-line systemic treatment for metastatic urothelial carcinoma of the bladder. Clin Transl Oncol 2018; 21:280-288. [DOI: 10.1007/s12094-018-1935-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
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27
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Matsumoto R, Abe T, Ishizaki J, Kikuchi H, Harabayashi T, Minami K, Sazawa A, Mochizuki T, Akino T, Murakumo M, Osawa T, Maruyama S, Murai S, Shinohara N. Outcome and prognostic factors in metastatic urothelial carcinoma patients receiving second-line chemotherapy: an analysis of real-world clinical practice data in Japan. Jpn J Clin Oncol 2018; 48:771-776. [PMID: 29939285 PMCID: PMC6057543 DOI: 10.1093/jjco/hyy094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/13/2018] [Indexed: 01/07/2023] Open
Abstract
Objectives The objective of the present study was to investigate the survival outcome and prognostic factors of metastatic urothelial carcinoma patients treated with second-line systemic chemotherapy in real-world clinical practice. Methods Overall, 114 patients with metastatic urothelial carcinoma undergoing second-line systemic chemotherapy were included in this retrospective analysis. The dominant second-line chemotherapy was a paclitaxel-based combination regimen (60%, 68/114). We assessed the progression-free survival and overall survival times using the Kaplan–Meier method. The Cox proportional hazards model was applied to identify the factors affecting overall survival. Results The median progression-free survival and overall survival times were 4 and 9 months, respectively. In the multivariate analysis, an Eastern Cooperative Oncology Group performance status score greater than 0 at presentation, C-reactive protein level ≧1 mg/dl and poor response to prior chemotherapy were adverse prognostic indicators. Patients with 0, 1, 2 and 3 of those risk factors had a median overall survival of 17, 12, 7 and 3 months, respectively. Conclusions The Eastern Cooperative Oncology Group performance status at presentation, C-reactive protein level and response to prior chemotherapy were prognostic factors for metastatic urothelial carcinoma patients undergoing second-line chemotherapy. In the future, this information might help guide the choice of salvage treatment, such as second-line chemotherapy or immune checkpoint inhibitors, after the failure of first-line chemotherapy.
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Affiliation(s)
- Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Junji Ishizaki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine
| | | | - Keita Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Ataru Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | | | | | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine
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28
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Takeyama Y, Kato M, Nishihara C, Yamasaki T, Iguchi T, Tamada S, Kuratsukuri K, Nakatani T. Comparison of efficacy and toxicity of second-line combination chemotherapy regimens in patients with advanced urothelial carcinoma. Int J Clin Oncol 2018; 23:944-950. [PMID: 29785621 DOI: 10.1007/s10147-018-1288-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/01/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and toxicities of second-line chemotherapy regimens with docetaxel and gemcitabine (GD), or paclitaxel and gemcitabine (GP) for advanced or metastatic urothelial carcinoma (UC) that did not respond to first-line platinum-based chemotherapy. METHODS From 2002 to 2017, 78 patients with metastatic UCs that progressed after platinum-based chemotherapy were treated with either GD (n = 41) or GP (n = 37). We compared these two different regimens by analyzing their efficacy and toxicities in a retrospective manner. RESULTS Of the 78 patients enrolled in this study, it was possible to determine treatment efficacy in 70; the proportion of patients with objective response and disease control were 8.6 (9/70) and 54.3% (38/70), respectively. The median progression-free survival and overall survival in the total population (GP and GD) were 3.5 (95% CI 0.6-53.3) and 9.6 months (95% CI 1.2-53.3), respectively. There was no significant difference between the two regimens (GD or GP) regarding survival outcomes. Treatment-related adverse events were mostly manageable, but one patient died as a result of febrile neutropenia. The presence of liver metastasis and anemia (Hb < 10.0 g/dl) was prognostic factors for worse survival. CONCLUSIONS Combination chemotherapy with either GP or GD was a favorable and well-tolerated second-line treatment regimen for patients with advanced or metastatic UC following the failure of a platinum-based regimen. Further study using a large prospective cohort is needed to identify patients who will benefit from second-line combination therapy.
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Affiliation(s)
- Yuji Takeyama
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Minoru Kato
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan.
| | - Chikako Nishihara
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Takeshi Yamasaki
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Taro Iguchi
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Satoshi Tamada
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Katsuyuki Kuratsukuri
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Tatsuya Nakatani
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
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29
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Abstract
Since the development of systemic combination chemotherapy, postchemotherapy extirpation has been performed in selected patients mainly with locally advanced and/or initially unresectable bladder cancer, and, in very selected patients, surgical consolidation for visceral metastases has also been performed. The purpose of this article was to review and summarize the current evidence for the role of surgical consolidation in metastatic urothelial carcinoma.
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30
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Niegisch G, Gerullis H, Lin SW, Pavlova J, Gondos A, Rudolph A, Haas G, Hennies N, Kramer MW. A Real-World Data Study to Evaluate Treatment Patterns, Clinical Characteristics and Survival Outcomes for First- and Second-Line Treatment in Locally Advanced and Metastatic Urothelial Cancer Patients in Germany. J Cancer 2018; 9:1337-1348. [PMID: 29721042 PMCID: PMC5929077 DOI: 10.7150/jca.23162] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/30/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Worldwide, urothelial carcinoma (UC) is a common cause of morbidity and mortality. In particular, the incidence of bladder cancer varies widely across Europe; Germany has the ninth highest international age-standardized incidence. For advanced UC or metastatic UC (mUC), platinum-based combination chemotherapy is the standard first-line (1L) treatment; however, there is wide heterogeneity of second-line (2L) treatments, ranging from vinflunine in parts of Europe to taxanes and other agents elsewhere in Europe, in the United States and globally. Limited data exist on treatment patterns and outcomes in patients with advanced UC or mUC in the routine clinical setting in Germany. The objective of this study was to describe clinical characteristics, treatment patterns and subsequent outcomes in this setting. Methods: This retrospective observational cohort analysis evaluated 1L and 2L treatment patterns and overall survival (OS) in patients aged ≥18 years with advanced UC or mUC (T4b, N2-3 and/or M1) at office-based urology and academic as well as nonacademic urology clinics throughout Germany between 1 November 2009 and 2 June 2016. Data were obtained through the GermanOncology database and additional treatment centers using similar electronic case report forms. Results: Among the 435 patients included in the analysis, 435 received 1L treatment and 125 received 2L treatment. Median age at start of 1L treatment was 69 years, 75% of patients were male, 75% were current or ex-smokers, 15% had hemoglobin <10 g/dL and 44% had creatinine clearance<60 mL/min/1.73; proportions were similar with 2L treatment. Cardiovascular disease was the most frequently reported comorbidity (65%), followed by diabetes (19%). Most patients (77%) received 1L platinum-based combination treatment (most commonly gemcitabine + cisplatin, 83%). Of those treated with 2L treatment, 66% received a single agent (most commonly vinflunine, 71%). Median OS (95% CI) with 1L treatment was 16.1 months (13.7-19.2) overall and 17.7 months (14.4-24.2) with 1L cisplatin + gemcitabine. In the 1L setting, 12-month OS was 61%, 24-month OS was 39% and 36-month OS was 26%. Median (95% CI) OS with 2L treatment was 9.2 months (5.5-11.6) overall and 5.9 months (4.1-12.6) with 2L vinflunine. In the 2L setting, OS rates for the same time periods were 40%, 22% and 8%, respectively. Median (95% CI) progression-free survival was 7 months (6.4-8.1) and 4 months (3.0-4.8), respectively, in the 1L and 2L settings. Objective response rates were 34% in the 1L setting and 14% in the 2L setting. No difference in OS by sex or smoking status was noted. Patients with or without renal impairment had a 12-month OS of 54% or 69%, respectively. OS at 12 months was 63% among patients with an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 to 1 vs 53% among patients with an ECOG PS of ≥2. Cox regression analysis found no difference in OS between vinflunine and other 2L treatments (P = 0.69). Conclusions: This study provides a contemporary multicenter assessment of real-world treatment patterns and outcomes among palliatively treated patients with UC in Germany. The findings were generally consistent with the poor treatment outcomes observed globally, underscoring the need for effective 1L and 2L treatment for advanced UC or mUC.
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Affiliation(s)
- Günter Niegisch
- Department of Urology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Holger Gerullis
- School of Medicine and Health Sciences, University Hospital for Urology, Carl von Ossietzky University Oldenburg, Germany
| | | | | | - Adam Gondos
- Real World Insights, QuintilesIMS, Frankfurt, Germany
| | - Anja Rudolph
- Real World Insights, QuintilesIMS, Frankfurt, Germany
| | - Gabriele Haas
- Real World Insights, QuintilesIMS, Frankfurt, Germany
| | - Nora Hennies
- Real World Insights, QuintilesIMS, Frankfurt, Germany
| | - Mario W. Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
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31
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Yuasa T, Urakami S, Yonese J. Recent advances in medical therapy for metastatic urothelial cancer. Int J Clin Oncol 2018; 23:599-607. [PMID: 29556919 PMCID: PMC6097083 DOI: 10.1007/s10147-018-1260-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/27/2018] [Indexed: 01/05/2023]
Abstract
Cytotoxic chemotherapy has been the mainstay of medical therapy for metastatic urothelial cancer. Currently, the gemcitabine/cisplatin regimen is widely used worldwide as the standard first-line medical treatment. Very recently, in 2017, pembrolizumab, a highly selective, humanized monoclonal IgG4κ isotype antibody against programmed death 1, was approved as a second-line treatment to be used after platina-based chemotherapy for metastatic urothelial cancer in Japan. Based on its promising anti-tumor efficacy and manageable safety profile as demonstrated in the phase III KEYNOTE-045 trial, pembrolizumab therapy is expected to be rapidly introduced for treating metastatic urothelial cancer in clinical practice. The paradigm of medical treatment for patients with metastatic UC is dramatically changing through the introduction of this and other immune-checkpoint inhibitors. In this article, we provide a brief overview of these immune-checkpoint inhibitors and a comprehensive summary of the use of cytotoxic chemotherapy for metastatic urothelial cancer, including ongoing clinical trials.
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Affiliation(s)
- Takeshi Yuasa
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
| | - Shinji Urakami
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.,Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Junji Yonese
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan
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32
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Lorch A, Niegisch G. Metastatic Bladder Cancer Disease and Its Treatment. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_26-1] [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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33
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Giridhar KV, Kohli M. Management of Muscle-Invasive Urothelial Cancer and the Emerging Role of Immunotherapy in Advanced Urothelial Cancer. Mayo Clin Proc 2017; 92:1564-1582. [PMID: 28982487 DOI: 10.1016/j.mayocp.2017.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 12/21/2022]
Abstract
The incidence of bladder cancer has increased in the past decade, and mortality from bladder cancer remains a substantial public health burden. After 3 decades of minimal progress in the treatment of advanced-stage disease, recent advances in the genomic characterization of urothelial cancer and breakthroughs in bladder cancer therapeutics have rejuvenated the field. This review highlights the landmark clinical trials of chemotherapy in both the neoadjuvant and advanced or metastatic urothelial carcinoma settings. We describe treatment paradigms for multimodal treatment of locally advanced bladder cancer, including discussion on bladder preservation strategies. Lastly, we discuss novel immunomodulatory, targeted, and combination therapies in development for the treatment of advanced urothelial carcinoma.
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Affiliation(s)
- Karthik V Giridhar
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
| | - Manish Kohli
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN.
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34
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Gilad Y, Tuchinsky H, Ben-David G, Minnes R, Gancz A, Senderowitz H, Luboshits G, Firer MA, Gellerman G. Discovery of potent molecular chimera (CM358) to treat human metastatic melanoma. Eur J Med Chem 2017; 138:602-615. [PMID: 28710962 DOI: 10.1016/j.ejmech.2017.06.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/18/2022]
Abstract
The resistance of cancer cells to chemotherapeutic agents, whether through intrinsic mechanisms or developed resistance, motivates the search for new chemotherapeutic strategies. In the present report, we demonstrate a facile synthetic strategy towards the discovery of new anti-cancer substances. This strategy is based on simple covalent coupling between known anti-cancer drugs, which results in novel 'chimeric' small molecules. One of these novel compounds, CM358, is the product of an amide bond formation between the known Topoisomerase II (Topo II) inhibitor amonafide (AM) and the known DNA mustard alkylator chlorambucil (CLB). It demonstrates significant enhanced cytotoxicity over an equimolar mixture of AM and CLB in various cancer cell lines and in a xenograft model of human metastatic melanoma. Topo II inhibition as well as in silico docking studies suggest that CM358 is a stronger Topo II binder than AM. This may be attributed, at least partially, to the placement of the CLB moiety in a favorable orientation with respect to DNA cross-linking with nearby guanines. In a human metastatic melanoma (WM 266-4) xenograft model, this compound was profoundly superior to a mixture of AM and CLB in reduction of tumor growth, maintenance of body weight and extension of overall survival.
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MESH Headings
- Animals
- Antineoplastic Agents/chemical synthesis
- Antineoplastic Agents/chemistry
- Antineoplastic Agents/pharmacology
- Cell Proliferation/drug effects
- DNA Topoisomerases, Type II/metabolism
- Dose-Response Relationship, Drug
- Drug Discovery
- Drug Screening Assays, Antitumor
- Heterocyclic Compounds, 3-Ring/chemical synthesis
- Heterocyclic Compounds, 3-Ring/chemistry
- Heterocyclic Compounds, 3-Ring/pharmacology
- Humans
- Melanoma/drug therapy
- Melanoma/pathology
- Mice
- Mice, Nude
- Models, Molecular
- Molecular Structure
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/pathology
- Pyrimidinones/chemical synthesis
- Pyrimidinones/chemistry
- Pyrimidinones/pharmacology
- Structure-Activity Relationship
- Topoisomerase II Inhibitors/chemical synthesis
- Topoisomerase II Inhibitors/chemistry
- Topoisomerase II Inhibitors/pharmacology
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Affiliation(s)
- Y Gilad
- Department of Chemical Sciences, Ariel University, Ariel, 40700, Israel
| | - H Tuchinsky
- Department of Molecular Biology, Ariel University, Ariel, 40700, Israel
| | - G Ben-David
- Department of Chemistry, Bar Ilan University, Ramat Gan, 5290002, Israel
| | - R Minnes
- Department of Physics, Ariel University, Ariel, 40700, Israel
| | - A Gancz
- Department of Molecular Biology, Ariel University, Ariel, 40700, Israel
| | - H Senderowitz
- Department of Chemistry, Bar Ilan University, Ramat Gan, 5290002, Israel
| | - G Luboshits
- Department of Chemical Engineering, Ariel University, Ariel, 40700, Israel
| | - M A Firer
- Department of Chemical Engineering, Ariel University, Ariel, 40700, Israel
| | - G Gellerman
- Department of Chemical Sciences, Ariel University, Ariel, 40700, Israel.
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35
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A three-drug co-delivery system based on reduction-sensitive polymeric prodrug to effectively reverse multi-drug resistance. Chem Res Chin Univ 2017. [DOI: 10.1007/s40242-017-6450-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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36
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Abstract
Systemic chemotherapy is essential for the management of muscle-invasive bladder cancer (MIBC) and metastatic bladder cancer (BCa). Neoadjuvant chemotherapy is key to the management of MIBC with many cisplatin-based regimens. Adjuvant chemotherapy may be considered for selected patients who did not receive neoadjuvant therapy. Systemic chemotherapy with radiotherapy is a critical component of a trimodal bladder-preserving approach and is superior to radiotherapy alone. Cisplatin-based chemotherapy has been the mainstay for metastatic BCa. Immunotherapy in the form of checkpoint inhibitors is a promising new drug for the treatment of BCa. Molecular characterization of each individual BCa is likely to lead to a target-directed therapeutic revolution.
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Affiliation(s)
- Ian G. Pinto
- Department of Hematology and Medical Oncology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
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González Del Alba A, Arranz JÁ, Puente J, Méndez-Vidal MJ, Gallardo E, Grande E, Pérez-Valderrama B, González-Billalabeitia E, Lázaro-Quintela M, Pinto Á, Lainez N, Piulats JM, Esteban E, Maroto Rey JP, García JA, Suárez C. Recent advances in genitourinary tumors: A review focused on biology and systemic treatment. Crit Rev Oncol Hematol 2017; 113:171-190. [PMID: 28427506 DOI: 10.1016/j.critrevonc.2017.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/23/2016] [Accepted: 03/09/2017] [Indexed: 01/04/2023] Open
Abstract
Updated information published up to 2016 regarding major advances in renal cancer, bladder cancer, and prostate cancer is here presented. Based on an ever better understanding of the genetic and molecular alterations that govern the initial pathogenic mechanisms of tumor oncogenesis, an improvement in the characterization and treatment of urologic tumors has been achieved in the past year. According to the Cancer Genome Atlas (ATLAS) project, alterations in the MET pathway are characteristics of type 1 papillary renal cell carcinomas, and activation of NRF2-ARE pathway is associated with the biologically distinct type 2. While sunitinib and pazopanib continue to be the standard first-line treatment in metastatic renal cell carcinoma of clear cell histology, nivolumab and cabozantinib are now the agents of choice in the second-line setting. In relation to urothelial bladder carcinoma, new potential molecular targets such as FGFR3, PI3K/AKT, RTK/RAS, CDKN2A, ARIDIA, ERBB2 have been identified. Response to adjuvant cisplatin-based chemotherapy appears to be related to basal, luminal, and p53-like intrinsic subtypes. A phase II study with eribulin and a maintenance phase II trial with vinflunine have shown promising results. Similarly, the use of the check point inhibitors in advanced disease is likely to revolutionize the management of patients who have progressed after cisplatin-based chemotherapy. In prostate cancer, seven mutually exclusive molecular subtypes have been identified by the TCGA project. Chemotherapy has been consolidated as a key treatment for castration-sensitive metastatic prostate cancer, and abiraterone, enzalutamide, cabazitaxel, and radium-223 remain standard therapeutic options for men with metastatic castration-resistant prostate cancer. All this progress will undoubtedly contribute to the development of new treatments and therapeutic strategies that will improve the survival and quality of life of our patients.
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Affiliation(s)
| | - José Ángel Arranz
- Medical Oncology Department, Unit of Urological and Gynecological Tumors, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Puente
- Medical Oncology Department, Hospital Universitario San Carlos, Madrid, Spain
| | - María José Méndez-Vidal
- Oncology Department, Maimonides Institute of Medical Research (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Enrique Gallardo
- Oncology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Enrique Grande
- Medical Oncology Department, GI, Endocrine and Translational Research Unit, Early Drug Development Unit-IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Álvaro Pinto
- Medical Oncology Department, Hospital Universitario La Paz, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Madrid, Spain
| | - Nuria Lainez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Josep M Piulats
- Medical Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emilio Esteban
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Jorge A García
- Hematology/Oncology and Urology Departments, Cleveland Clinic, Cleveland, OH, United States
| | - Cristina Suárez
- Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Salah S, Lee JL, Rozzi A, Kitamura H, Matsumoto K, Vis DJ, Srinivas S, Morales-Barrera R, Carles J, Al-Rimawi D, Lee S, Kim KH, Izumi K, Lewin J. Second-line Chemotherapy in Older Patients With Metastatic Urothelial Carcinoma: Pooled Analysis of 10 Second-line Studies. Clin Genitourin Cancer 2017; 15:e563-e571. [PMID: 28065418 DOI: 10.1016/j.clgc.2016.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/05/2016] [Accepted: 12/10/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Older patients with metastatic urothelial carcinoma (UC) are under-represented in clinical trials, and data regarding outcomes for second-line therapy is limited. MATERIALS AND METHODS Individual data for patients with metastatic UC, aged ≥ 70 years, were pooled from 10 second-line studies. The influence of potential prognostic factors on overall survival (OS) was assessed via univariate and multivariate Cox regression analysis. RESULTS In total, 102 patients were included; the median age was 74.0 years (range, 70-88 years). Second-line chemotherapy was single-agent in 42 (41%) patients and combination regimens in 60 (59%) patients. Median progression-free and OS were 4.3 and 9.7 months, respectively. In multivariate analysis, age > 75 years, Eastern Cooperative Oncology Group performance status ≥ 1, serum hemoglobin < 10 g/dL, and non-lymph node only metastasis predicted inferior OS. Median OS for patients with 0, 1, 2, and ≥ 3 adverse factors was unreached, 15.5, 9.8, and 4.8 months, respectively (P < .001). There was no difference in OS between patients treated with single-agent or combination chemotherapy. Combination regimens were associated with higher occurrences of any ≥ grade 2 toxicity (80% vs. 38%; P < .001), ≥ grade 2 hematologic (78% vs. 12%; P < .001), and ≥ grade 2 gastrointestinal toxicity (36% vs. 7%; P < .001). CONCLUSION In this pooled analysis of older patients with metastatic UC, combination chemotherapy for second-line treatment was associated with greater toxicity without improvement in OS. Eastern Cooperative Oncology Group performance status ≥1, serum hemoglobin < 10 g/dL, and age > 75 years predicted worse survival, whereas isolated lymph node metastasis predicted a favorable outcome.
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Affiliation(s)
- Samer Salah
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.
| | - Jae-Lyun Lee
- Department of Oncology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Antonio Rozzi
- Medical Oncology Unit, Istituto Neurotraumatologico Italiano (INI), Grottaferrata, Rome, Italy
| | - Hiroshi Kitamura
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Daniel J Vis
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sandy Srinivas
- Medical Oncology Department, Stanford University Medical Center, Stanford, CA
| | - Rafael Morales-Barrera
- Genitourinary, CNS, and Sarcoma Tumor Unit, Vall d' Hebron University Hospital, Vall d' Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Carles
- Genitourinary, CNS, and Sarcoma Tumor Unit, Vall d' Hebron University Hospital, Vall d' Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dalia Al-Rimawi
- Office of Scientific Affairs and Research, King Hussein Cancer Centre, Amman, Jordan
| | - Soonil Lee
- Division of Hematology-Oncology, Department of Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Ki Hong Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Chungcheongnam-do, Korea
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
| | - Jeremy Lewin
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada
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Abe T, Ishizaki J, Kikuchi H, Minami K, Matsumoto R, Harabayashi T, Sazawa A, Mochizuki T, Chiba S, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Maruyama S, Murai S, Shinohara N. Outcome of metastatic urothelial carcinoma treated by systemic chemotherapy: Prognostic factors based on real-world clinical practice in Japan. Urol Oncol 2016; 35:38.e1-38.e8. [PMID: 27693091 DOI: 10.1016/j.urolonc.2016.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/19/2016] [Accepted: 08/27/2016] [Indexed: 11/17/2022]
Abstract
AIM To clarify prognostic factors of metatstatic urothelial carcinoma treated by systemic chemotherapy in real-world clinical practice in the Japanese population. MATERIALS AND METHODS A total of 228 patients with metastatic urothelial carcinoma undergoing systemic chemotherapy between 2000 and 2013 were included in the present multi-institutional study. The gemcitabine plus cisplatin regimen was administered as first-line chemotherapy to 131 patients, whereas methotrexate, vinblastine, doxorubicin, and cisplatin or its modified regimen was given to 71 patients. Of the 228 patients, 119 received at least 2 different regimens and 22 underwent resection of metastases (metastasectomy). Multivariate survival analysis was performed using the Cox proportional hazards model. The characteristics included were age, sex, Eastern Cooperative Oncology Group performance status (PS), primary site, pathology of primary site, hemoglobin levels, lactate dehydrogenase levels, C-reactive protein levels, corrected calcium levels, estimated glomerular filtration rate levels, history of prior chemotherapy, metastatic sites, resection of primary site, number of metastatic organs, and metastasectomy. RESULTS The median overall survival (OS) time was 17 months. On multivariate analysis, female sex, good Eastern Cooperative Oncology Group PS at presentation, hemoglobin level≥10g/dl, and single organ metastasis were significant independent predictors of prolonged OS. For the survival effect of metastasectomy, the median OS time of the 22 patients with metastasectomy was 53 months, which was significantly longer when compared with patients not undergoing metastasectomy (15mo). After adjustment for the 4 aforementioned prognostic factors, metastasectomy still remained significant (hazard ratio: 0.364, P = 0.0008). CONCLUSIONS Female sex, more favorable PS at presentation, hemoglobin level>10g/dl, and single organ metastasis were favorable prognostic factors. In addition, metastasectomy was associated with long-term disease control.
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Affiliation(s)
- Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Junji Ishizaki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keita Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Ataru Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | - Satoshi Chiba
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | | | - Naoto Miyajima
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kunihiko Tsuchiya
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Abufaraj M, Gust K, Moschini M, Foerster B, Soria F, Mathieu R, Shariat SF. Management of muscle invasive, locally advanced and metastatic urothelial carcinoma of the bladder: a literature review with emphasis on the role of surgery. Transl Androl Urol 2016; 5:735-744. [PMID: 27785430 PMCID: PMC5071186 DOI: 10.21037/tau.2016.08.23] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Locally advanced (T3b, T4 and N1-N3) and metastatic urothelial bladder cancer (BCa) is a lethal disease with poor survival outcomes. Combination chemotherapy remains the treatment of choice in patients with metastatic disease and an important part of treatment in addition to radical cystectomy (RC) in patients with locally advanced tumour. Approximately half of patients who underwent RC for muscle invasive BCa relapse after surgery with either local recurrence or distant metastasis. This review focuses on the management of muscle invasive, locally advanced and metastatic BCa with emphasis on the role of surgery; to summarize the current knowledge in order to enhance clinical decision-making and counselling process.
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Affiliation(s)
- Mohammad Abufaraj
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Kilian Gust
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; ; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Marco Moschini
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; ; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Beat Foerster
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; ; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Francesco Soria
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; ; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Romain Mathieu
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Shahrokh F Shariat
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; ; Karl Landsteiner Institute of Urology and Andrology, 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
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Xue C, An X, Cao Y, Chen T, Yang W, Deng Y, Han H, Teng X, Zhou F, Shi Y. Effectiveness of capecitabine with or without docetaxel therapy for the treatment of patients with advanced urothelial carcinoma: a single-institution experience. Oncotarget 2016; 7:63722-63729. [PMID: 27577082 PMCID: PMC5325398 DOI: 10.18632/oncotarget.11641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/29/2016] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness and toxicity of capecitabine (C) chemotherapy regimen with or without (w/o) docetaxel (D) in patients with advanced urothelial carcinoma (UC). RESULTS Clinical benefit rate were similar in two arms (C arm vs DC arm: 38.9% vs 45.5%, p = 0.411). There were two cases achieved partial response in DC arm. In C arm, the median PFS was 3.0 months (95% CI 2.5-3.5 months) and median OS was 11.3 months (95% CI 8.6-14.1 months). In DC arm, the median PFS was 2.2 months (95% CI 1.7-2.7 months) and median OS was 18 months (95% CI 6.8-29.9 months). Adverse events were mostly acceptable, including myelosuppession, hand-foot syndrome and mucositis. Anemia and leukopenia was found more in the DC arm than in the C arm. MATERIALS AND METHODS This is a one-center, observational, retrospective study. From April 2009 to March 2015, a total of 29 patients with metastatic UC were included in the study. Survivals, response rates and toxicities were collected retrospectively. CONCLUSIONS The result showed the activity and toxicity of C w/o D. As DC treatment did not reveal better outcome, C or D single-agent might be an option in platinum-failed patients with advanced urothelial carcinoma. Further clinical trials are warranted.
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Affiliation(s)
- Cong Xue
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xin An
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ye Cao
- Department of GCP, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Tanhuan Chen
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wei Yang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yingfei Deng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Hui Han
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xiaoyu Teng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Fangjian Zhou
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yanxia Shi
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
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Sonpavde G, Pond GR, Di Lorenzo G, Buonerba C, Rozzi A, Lanzetta G, Necchi A, Giannatempo P, Raggi D, Matsumoto K, Choueiri TK, Mullane S, Niegisch G, Albers P, Lee JL, Kitamura H, Kume H, Bellmunt J. Impact of Prior Platinum-Based Therapy on Patients Receiving Salvage Systemic Treatment for Advanced Urothelial Carcinoma. Clin Genitourin Cancer 2016; 14:494-498. [PMID: 27262369 DOI: 10.1016/j.clgc.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/06/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Trials of salvage therapy for advanced urothelial carcinoma have required prior platinum-based therapy. This practice requires scrutiny because non-platinum-based first-line therapy may be offered to cisplatin-ineligible patients. PATIENTS AND METHODS Data of patients receiving salvage systemic chemotherapy were collected. Data on prior first-line platinum exposure were required in addition to treatment-free interval, hemoglobin, Eastern Cooperative Oncology Group performance status, albumin, and liver metastasis status. Cox proportional hazard regression was used to evaluate their association with overall survival (OS) after accounting for salvage single-agent or combination chemotherapy. RESULTS Data were obtained from 455 patients previously exposed to platinum-based therapy and 37 not exposed to platinum. In the group exposed to prior platinum therapy, salvage therapy consisted of a single-agent taxane (n = 184) or a taxane-containing combination chemotherapy (n = 271). In the group not exposed to prior platinum therapy, salvage therapy consisted of taxane or vinflunine (n = 20), 5-fluorouracil (n = 1), taxane-containing combination chemotherapy (n = 12), carboplatin-based combinations (n = 2), and cisplatin-based combinations (n = 2). The median OS for the prior platinum therapy group was 7.8 months (95% confidence interval, 7.0, 8.1), and for the group that had not received prior platinum therapy was 9.0 months (95% confidence interval, 6.0, 11.0; P = .50). In the multivariable analysis, prior platinum therapy versus no prior platinum exposure did not confer an independent impact on OS (hazard ratio, 1.10; 95% confidence interval, 0.75, 1.64; P = .62). CONCLUSION Prior platinum- versus non-platinum-based chemotherapy did not have a prognostic impact on OS after accounting for major prognostic factors in patients receiving salvage systemic chemotherapy for advanced urothelial carcinoma. Lack of prior platinum therapy should not disqualify patients from inclusion onto trials of salvage therapy.
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Affiliation(s)
- G Sonpavde
- UAB Comprehensive Cancer Center, Birmingham, AL.
| | - G R Pond
- McMaster University, Hamilton, Ontario, Canada
| | | | - C Buonerba
- Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy
| | - A Rozzi
- Istituto Neurotraumatologico Italiano, Grottaferrata, Italy
| | - G Lanzetta
- Istituto Neurotraumatologico Italiano, Grottaferrata, Italy
| | - A Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - P Giannatempo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - K Matsumoto
- Kitasato University School of Medicine, Sagamihara, Japan
| | - T K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - S Mullane
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - G Niegisch
- Heinrich Heine University, Medical Faculty, Dusseldorf, Germany
| | - P Albers
- Heinrich Heine University, Medical Faculty, Dusseldorf, Germany
| | - J L Lee
- Asan Medical Center, Seoul, South Korea
| | - H Kitamura
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - H Kume
- University of Tokyo Hospital, Tokyo, Japan
| | - J Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Zargar-Shoshtari K, Kongnyuy M, Sharma P, Fishman MN, Gilbert SM, Poch MA, Pow-Sang JM, Spiess PE, Zhang J, Sexton WJ. Clinical role of additional adjuvant chemotherapy in patients with locally advanced urothelial carcinoma following neoadjuvant chemotherapy and cystectomy. World J Urol 2016; 34:1567-1573. [PMID: 27072536 DOI: 10.1007/s00345-016-1825-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/04/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) can downstage invasive bladder cancers prior to radical cystectomy (RC) and improve overall survival. However, the optimal management in patients with persistent non-organ confined disease (pT3-T4 and/or pN+) following RC has not been completely defined. The aim of this study was to describe outcomes associated with the use of adjuvant chemotherapy (AC) in patients with residual non-organ confined cancer at RC following NAC. MATERIALS AND METHODS Using data from a high-volume referral institution, pT3-T4 and/or pN+ patients who received NAC and then also RC were identified. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were assessed with Kaplan-Meier analysis. RESULTS From 2001 to 2013, 161 patients received NAC and then RC. Eighty-eight pT3-T4 and/or pN+ patients were identified. Twenty-nine (33 %) received AC. Adjuvant chemotherapy in the majority of patients was carboplatin-based (16), followed by cisplatin (8) and other, mainly taxane-containing regimens (5). The median RFS was 17.5 months in the AC and 13.7 months in the non-AC group (p = 0.78). AC remained an insignificant predictor for RFS after adjusting for pT, pN and margin status (HR 0.89, 95 % CI 0.48-1.68]). CSS was 23 and 22 months (p = 0.65) and remained insignificant after adjusting for pathologic confounders. CONCLUSIONS In our current study population, adjuvant conventional cytotoxic chemotherapy was not associated with significant improvements in RFS or CSS. The choice of AC regimens, and incorporation of newer treatments, may be the key for improving outcomes in this high-risk patient group.
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Affiliation(s)
- Kamran Zargar-Shoshtari
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Michael Kongnyuy
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Pranav Sharma
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Mayer N Fishman
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Julio M Pow-Sang
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Jingsong Zhang
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
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Wu XJ, Zhi Y, He P, Zhou XZ, Zheng J, Chen ZW, Zhou ZS. Comparison of single agent versus combined chemotherapy in previously treated patients with advanced urothelial carcinoma: a meta-analysis. Onco Targets Ther 2016; 9:1535-43. [PMID: 27042121 PMCID: PMC4801158 DOI: 10.2147/ott.s97062] [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: 11/25/2022] Open
Abstract
Background Platinum-based chemotherapy is the standard treatment for advanced urothelial cancer (UC) and is generally used in the first-line setting. However, the optimal salvage treatment for previously treated UC patients is unclear. We conducted a systematic review of published clinical trials of single agent versus combined chemotherapy as salvage treatment in previously treated UC patients. Methods Trials published between 1994 and 2015 were identified by an electronic search of public databases (MEDLINE, EMBASE, Cochrane library). All relevant studies were independently identified by two authors for inclusion. Demographic data, treatment regimens, objective response rate (ORR), disease control rate (DCR), median progression-free and overall survival (PFS, OS), and grade 3/4 toxicities were extracted and analyzed using Comprehensive Meta Analysis software (Version 2.0). Results Fifty cohorts with 1,685 patients were included for analysis: 814 patients were treated with single agent chemotherapy and 871 with combined chemotherapy. Pooled OS was significantly higher at 1 year for combined chemotherapy than for single agent (relative risk [RR] 1.52; 95% CI: 1.01–2.37; P=0.03) but not for 2-year OS (RR 1.31; 95% CI: 0.92–1.85; P=0.064). Additionally, combined chemotherapy significantly improved ORR (RR 2.25; 95% CI: 1.60–3.18; P<0.001) and DCR (RR 1.12; 95% CI: 1.01–1.25, P=0.033) compared to single agent for advanced UC patients. As for grade 3 and 4 toxicities, more frequencies of leukopenia and thrombocytopenia were observed in the combined chemotherapy than in single agent group, while equivalent frequencies of anemia, nausea, vomiting, and diarrhea were found between the two groups. Conclusion In comparison with single agent alone, combined chemotherapy as salvage treatment for advanced UC patients significantly improved ORR, DCR, and 1-year OS, but not 2-year OS. Our findings support the need to compare combined chemotherapy with single agent alone in the salvage setting in large prospective trials due to its potential survival benefit in advanced UC patients.
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Affiliation(s)
- Xiao-Jun Wu
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Yi Zhi
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Peng He
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Xiao-Zhou Zhou
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Ji Zheng
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Zhi-Wen Chen
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Zhan-Song Zhou
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
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Lin X, Liao Y, Chen X, Long D, Yu T, Shen F. Regulation of Oncoprotein 18/Stathmin Signaling by ERK Concerns the Resistance to Taxol in Nonsmall Cell Lung Cancer Cells. Cancer Biother Radiopharm 2016; 31:37-43. [PMID: 26881937 DOI: 10.1089/cbr.2015.1921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Taxol is a cytotoxic antiepithelioma chemotherapy drug widely used clinically, which results in appearing a broad range of taxol-resistant tumors. Oncoprotein 18 (Op18)/stathmin is a genetically highly conserved small-molecule cytosolic phosphoprotein and highly expressed in tumors. Extracellular signal-regulated kinase (ERK) is a main member of mitogen-activated protein kinases (MAPKs). The study demonstrated that combination of blockage of ERK signal by ERK inhibitor PD98059 and Taxol greatly promoted taxol-induced cellular apoptosis and growth inhibition, decreased the expression of Op18/stathmin and total levels of phosphor-Op18/stathmin, while weakened the cyclin-dependent kinase 2 (cdc2) activity and antiapoptotic protein Bcl-2 expression and inhibited IL-10 autocrine in taxol-resistant NCI-H1299 cells; Taxol-resistant NCI-H1299 cells expressed high levels of ERK and phosphor-ERK in contrast to taxol-sensitive CNE1 cells, and ERK mainly phosphorylated Op18/stathmin at Ser 25 site. These findings suggest that ERK-mediated Op18/stathmin is involved in taxol resistance of tumors; blockage of ERK signal improves the sensitivity of tumor cells to taxol, which provides new clues for treating taxol-resistant carcinomas.
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Affiliation(s)
- Xuechi Lin
- 1 Department of Medical Laboratory, Changsha Medical University , Changsha, China .,2 Department of Clinical Laboratory, Hunan Normal University , Changsha, Hunan
| | - Ying Liao
- 1 Department of Medical Laboratory, Changsha Medical University , Changsha, China .,3 Department of Anatomy, Histology and Embryology, Institute of Neuroscience, Changsha Medical University , Changsha, China
| | - Xian Chen
- 1 Department of Medical Laboratory, Changsha Medical University , Changsha, China
| | - Dan Long
- 1 Department of Medical Laboratory, Changsha Medical University , Changsha, China
| | - Ting Yu
- 1 Department of Medical Laboratory, Changsha Medical University , Changsha, China
| | - Fang Shen
- 1 Department of Medical Laboratory, Changsha Medical University , Changsha, China .,2 Department of Clinical Laboratory, Hunan Normal University , Changsha, Hunan
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Necchi A, Lo Vullo S, Mariani L, Raggi D, Giannatempo P, Calareso G, Togliardi E, Crippa F, Di Genova N, Perrone F, Colecchia M, Paolini B, Pelosi G, Nicolai N, Procopio G, Salvioni R, De Braud FG. An open-label, single-arm, phase 2 study of the Aurora kinase A inhibitor alisertib in patients with advanced urothelial cancer. Invest New Drugs 2016; 34:236-42. [PMID: 26873642 DOI: 10.1007/s10637-016-0328-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/01/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Progress in developing effective salvage therapies for UC is warranted. Alisertib is an orally available, selective inhibitor of the aurora kinase A. METHODS A single-group, phase 2 trial was conducted with alisertib 50 mg orally BID for 7 days, with 14d rest until disease progression (PD) (NCT02109328). The primary endpoint (EP) was RECIST 1.1 objective response-rate (ORR, H0 ≤ 5%, H1 ≥ 20%, α = 10% and β = 20%). Eligibility included failure of at least one platinum-based regimen. RESULTS From 10/2014 to 04/2015, 22 patients were enrolled (20 evaluable for response), 8 (36.4%) in second-line and 14 (63.6 %) beyond the second-line. Eight (36.4%) had an ECOG-performance status 1-2. Two partial responses (PR, ORR: 9.1%), 7 stable disease (SD) and 11 PD were obtained. Median follow-up was 8.3 months (IQR: 7-10.3), 6-month progression-free survival (PFS) was 13.6% (95%CI: 4.8-39.0). Two SD are still receiving treatment after 11.5 and 6.3 months. Median overall survival (OS) was not reached (6-month OS: 59.1%, 95%CI: 41.7-83.7). Hb < 10 g/dl was significantly associated with shorter PFS and OS multivariably (p = 0.031 and p = 0.033). Tissue of the case with 11.5 month SD harbored a missense mutation of mTOR (E1813D), the nonsense mutation Q527STOP of TSC1, HER3 and TAF1L missense mutations. Grade 3-4 adverse events (AE) were: 40.9% mucositis, 36.4% fatigue, 18.2% neutropenia (13.6% febrile neutropenia). There were 2 treatment-related deaths. CONCLUSIONS The study did not meet the primary EP, yet sustained disease control was obtained in about 14% of patients. The incidence of AE and the issue of patient selection are two major concerns.
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Affiliation(s)
- Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milano, Italy.
| | - Salvatore Lo Vullo
- Clinical Epidemiology and Trials Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Luigi Mariani
- Clinical Epidemiology and Trials Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Raggi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milano, Italy
| | - Patrizia Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milano, Italy
| | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elena Togliardi
- Pharmacy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Flavio Crippa
- Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nicola Di Genova
- Clinical Trials Center, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Federica Perrone
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Maurizio Colecchia
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Biagio Paolini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giuseppe Pelosi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Università degli Studi di Milano, Milano, Italy
| | - Nicola Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milano, Italy
| | - Roberto Salvioni
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo G De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milano, Italy
- Università degli Studi di Milano, Milano, Italy
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Di Lorenzo G, Pagliuca M, Perillo T, Zarrella A, Verde A, De Placido S, Buonerba C. Complete Response and Fatigue Improvement With the Combined Use of Cyclophosphamide and Quercetin in a Patient With Metastatic Bladder Cancer: A Case Report. Medicine (Baltimore) 2016; 95:e2598. [PMID: 26844468 PMCID: PMC4748885 DOI: 10.1097/md.0000000000002598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bladder cancer is a major cause of cancer-related mortality, with an estimated 74,000 new cases and 16,000 deaths in the United States in 2015. In patients with metastatic disease, vinflunine and taxanes are the most widely used chemotherapy agents in the second-line setting after failure of platinum-based treatment. Cyclophosphamide has been used in combination with paclitaxel in urothelial carcinoma of the bladder, but there are no data about the effectiveness of cyclophosphamide administered as a single agent.We here describe the first case of an advanced bladder cancer patient suffering from grade 2 fatigue.He benefited from administration of third-line single-agent metronomic oral cyclophosphamide plus oral doses of quercetin. A complete, prolonged radiologic response according to the RECIST criteria 1.1 was achieved with minimal toxicity and an improvement in fatigue.Further studies are required to assess the potential benefits associated with the combined use of cyclophosphamide plus quercetin in advanced bladder cancer patients.
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Affiliation(s)
- Giuseppe Di Lorenzo
- From the Medical Oncology Unit, Department of Clinical Medicine, Federico II University, Naples, Italy
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Soave A, Rink M. Words of Wisdom. Re: Vinflunine in Routine Clinical Practice for the Treatment of Advanced or Metastatic Urothelial Cell Carcinoma--Data from a Prospective, Multicenter Experience. Eur Urol 2016; 69:373-4. [PMID: 26758521 DOI: 10.1016/j.eururo.2015.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Armin Soave
- University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany
| | - Michael Rink
- University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany.
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Sonpavde G, Pond GR, Bellmunt J. Reply from Authors re: Tracy L. Rose, Matthew I. Milowsky. A Small Step Toward Improving Salvage Treatment for Metastatic Bladder Cancer--At What Cost? Eur Urol 2016;69:642-44: Combination Chemotherapy as a Viable Salvage Therapy Strategy for Advanced Urothelial Carcinoma. Eur Urol 2015; 69:644-645. [PMID: 26415779 DOI: 10.1016/j.eururo.2015.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Guru Sonpavde
- University of Alabama at Birmingham, Comprehensive Cancer Center, Birmingham, AL, USA.
| | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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50
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Rose TL, Milowsky MI. A Small Step Toward Improving Systemic Treatment for Metastatic Bladder Cancer--At What Cost? Eur Urol 2015; 69:642-644. [PMID: 26346677 DOI: 10.1016/j.eururo.2015.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Tracy L Rose
- Department of Medicine, Division of Hematology and Medical Oncology, University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, NC, USA
| | - Matthew I Milowsky
- Department of Medicine, Division of Hematology and Medical Oncology, University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, NC, USA.
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