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Kim B, Kim K, Yang S, Moon KC. Immunophenotypic and molecular changes during progression of papillary urothelial carcinoma. Investig Clin Urol 2024; 65:501-510. [PMID: 39249924 PMCID: PMC11390262 DOI: 10.4111/icu.20230318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/11/2024] [Accepted: 07/01/2024] [Indexed: 09/10/2024] Open
Abstract
PURPOSE Urothelial carcinoma has various molecular subtypes, each with different tumor characteristics. Although it is known that molecular changes occur during tumor progression, little is known about the specifics of these changes. In this study, we performed transcriptional analysis to understand the molecular changes during tumor progression. MATERIALS AND METHODS Formalin-fixed, paraffin-embedded tumor tissues were obtained from 12 patients with muscle-invasive bladder cancer (MIBC). The invasive and non-invasive papillary areas were identified in papillary urothelial carcinoma specimens. Immunohistochemistry (IHC) and mRNA sequencing were performed for each tumor area. RESULTS Patients with CK5/6-negative and CK20-positive non-invasive papillary areas were selected and classified into the IHC switch subgroup (CK5/6-positive and CK20-negative in the invasive area) and the IHC unchanged subgroup (CK5/6-negative and CK20-positive in the invasive area) according to the IHC results of the invasive area. We identified differences in the mRNA expression between the non-invasive papillary and invasive areas of the papillary MIBC tissue samples. In both the non-invasive papillary and invasive areas, the IHC switch subgroup showed basal subtype gene expression, while the IHC unchanged subgroup demonstrated luminal subtype gene expression. CONCLUSIONS The non-invasive papillary area showed a gene expression pattern similar to that of the invasive area. Therefore, even if the non-invasive papillary area exhibits a luminal phenotype on IHC, it can have a basal subtype gene expression depending on the invasive area.
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Affiliation(s)
- Bohyun Kim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Korea
| | - Sunah Yang
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
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2
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Hao S, Yang Z, Wang G, Cai G, Qin Y. Development of prognostic model incorporating a ferroptosis/cuproptosis-related signature and mutational landscape analysis in muscle-invasive bladder cancer. BMC Cancer 2024; 24:958. [PMID: 39107713 PMCID: PMC11302292 DOI: 10.1186/s12885-024-12741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Muscle-invasive bladder cancer (MIBC) is a prevalent and aggressive malignancy. Ferroptosis and cuproptosis are recently discovered forms of programmed cell death (PCD) that have attracted much attention. However, their interactions and impacts on MIBC overall survival (OS) and treatment outcomes remain unclear. METHODS Data from the TCGA-BLCA project (as the training set), cBioPortal database, and GEO datasets (GSE13507 and GSE32894, as the test sets) were utilized to identify hub ferroptosis/cuproptosis-related genes (FRGs and CRGs) and develop a prognostic signature. Differential expression analysis (DEA) was conducted, followed by univariate and multivariate Cox's regression analyses and multiple machine learning (ML) techniques to select genetic features. The performance of the ferroptosis/cuproptosis-related signature was evaluated using Kaplan-Meier (K-M) survival analysis and receiver-operating characteristics (ROC) curves. Mutational and tumour immune microenvironment landscapes were also explored. Real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) experiments confirmed the expression patterns of the hub genes, and functional assays assessed the effects of SCD knockdown on cell viability, proliferation, and migration. RESULTS DEA revealed dysregulated FRGs and CRGs in the TCGA MIBC cohort. SCD, DDR2, and MT1A were identified as hub genes. A prognostic signature based on the sum of the weighted expression of these genes demonstrated strong predictive efficacy in the training and test sets. Nomogram incorporating this signature accurately predicted 1-, 3-, and 5-year survival probabilities in the TCGA cohort and GSE13507 dataset. Copy number variation (CNV) and tumour immune microenvironment analysis revealed that high risk score level groups were associated with immunosuppression and lower tumour purity. The associations of risk scores with immunotherapy and chemical drugs were also explored, indicating their potential for guiding treatment for MIBC patients. The dysregulated expression patterns of three hub genes were validated by RT-qPCR experiments. CONCLUSIONS Targeting hub FRGs and CRGs could be a promising therapeutic approach for MIBC. Our prognostic model offers a new framework for MIBC subtyping and can inform personalized therapeutic strategies.
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Affiliation(s)
- Sida Hao
- Department of Urology, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou, 310003Zhejiang , China
| | - Zitong Yang
- Department of Urology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Gang Wang
- Department of Urology, Affiliated Hangzhou First People's Hospital, Xihu University School of Medicine, Hangzhou, Zhejiang, China
| | - Guofeng Cai
- Department of Urology, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou, 310003Zhejiang , China
| | - Yong Qin
- Department of Urology, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou, 310003Zhejiang , China.
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3
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Hashemi Gheinani A, Kim J, You S, Adam RM. Bioinformatics in urology - molecular characterization of pathophysiology and response to treatment. Nat Rev Urol 2024; 21:214-242. [PMID: 37604982 DOI: 10.1038/s41585-023-00805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/23/2023]
Abstract
The application of bioinformatics has revolutionized the practice of medicine in the past 20 years. From early studies that uncovered subtypes of cancer to broad efforts spearheaded by the Cancer Genome Atlas initiative, the use of bioinformatics strategies to analyse high-dimensional data has provided unprecedented insights into the molecular basis of disease. In addition to the identification of disease subtypes - which enables risk stratification - informatics analysis has facilitated the identification of novel risk factors and drivers of disease, biomarkers of progression and treatment response, as well as possibilities for drug repurposing or repositioning; moreover, bioinformatics has guided research towards precision and personalized medicine. Implementation of specific computational approaches such as artificial intelligence, machine learning and molecular subtyping has yet to become widespread in urology clinical practice for reasons of cost, disruption of clinical workflow and need for prospective validation of informatics approaches in independent patient cohorts. Solving these challenges might accelerate routine integration of bioinformatics into clinical settings.
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Affiliation(s)
- Ali Hashemi Gheinani
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Urology, Inselspital, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Jina Kim
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sungyong You
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rosalyn M Adam
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
- Department of Surgery, Harvard Medical School, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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4
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Suartz CV, Cordeiro MD, Botelho LAA, Gallucci FP, Cho DH, de Arruda Pessoa F, da Silva FR, Costa MSS, Cardili L, Audenet F, Mota JM, Toren P, Nahas WC, Ribeiro-Filho LA. Predicting individual outcomes after radical cystectomy in urothelial variants with Cancer of the Bladder Risk Assessment (COBRA) score. World J Urol 2024; 42:155. [PMID: 38483580 DOI: 10.1007/s00345-024-04798-5] [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: 07/10/2023] [Accepted: 01/14/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To validate the Cancer of the Bladder Risk Assessment (COBRA) score in patients with urothelial variants. METHODS Epidemiological, clinical, radiological, and anatomopathological data were collected from patients with urothelial carcinoma who underwent radical cystectomy at the Institute of Cancer of São Paulo between May 2008 and December 2022. Patients with the presence of at least 10% of any urothelial variants in the radical cystectomy specimens' anatomopathological exam were included in the study. The COBRA score and derivatives were applied and correlated with oncological outcomes. RESULTS A total of 680 patients [482 men (70.9%) and 198 women (29.1%)]; 66 years (IQR 59-73) underwent radical cystectomy for bladder tumor, and of these patients, a total of 167 patients presented any type of urothelial variant. The median follow-up time was 28.77 months (IQR 12-85). The three most prevalent UV were squamous differentiation (50.8%), glandular differentiation (31.3%), and micropapillary differentiation (11.3%). The subtypes with the worst prognosis were sarcomatoid with a median survival of 8 months (HR 1.161; 95% CI 0.555-2.432) and plasmacytoid with 14 months (HR 1.466; 95% CI 0.528-4.070). The COBRA score for patients with micropapillary variants demonstrated good predictive accuracy for OS (log-rank P = 0.009; 95% IC 6.78-29.21) and CSS (log-rank P = 0.002; 95% IC 13.06-26.93). CONCLUSIONS In our study, the COBRA score proved an effective risk stratification tool for urothelial histological variants, especially for the micropapillary urothelial variant. It may be helpful in the prognosis evaluation of UV patients after radical cystectomy.
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Affiliation(s)
- Caio Vinícius Suartz
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil.
| | - Maurício Dener Cordeiro
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Luiz Antonio Assan Botelho
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Fábio Pescarmona Gallucci
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - David Hamilton Cho
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Filipe de Arruda Pessoa
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Flávio Rossi da Silva
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Mateus Silva Santos Costa
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Leonardo Cardili
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - François Audenet
- Division of Urology, Université Paris Cité Faculté de Santé, Paris, France
| | - José Maurício Mota
- Genitourinary Medical Oncology Service, Institute of Cancer of São Paulo State, University of São Paulo, São Paulo, Brazil
| | - Paul Toren
- Division of Urology, Université Laval Faculté de Médecine, Quebec City, Canada
| | - William Carlos Nahas
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Leopoldo Alves Ribeiro-Filho
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
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5
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Fleming S, Gifkins D, Resnick HE, Shalaby W, Rosenberg P, Gaj C, Maio V, Crawford A, Lu-Yao G, Gao J, Siefker-Radtke A. Prognostic Value of Fibroblast Growth Factor Receptor Genetic Alterations in Metastatic Urothelial Carcinoma. Clin Genitourin Cancer 2024; 22:102054. [PMID: 38457853 DOI: 10.1016/j.clgc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Evidence is limited on whether fibroblast growth factor receptor gene alterations (FGFRalt) impact clinical outcomes in patients with locally advanced or metastatic urothelial cancer (mUC). This study evaluated progression-free survival (PFS) in patients with mUC based on FGFRalt status in the first-line setting (1L). PATIENTS AND METHODS Data on mUC patients were retrieved via convenience sampling of oncologists/urologists surveyed between August and September 2020 who treated at least 1 FGFRalt patient between July 2017 and June 2019. The questionnaire included information on patient demographics, FGFR status, treatment, and clinical and radiographic measures of progression. Primary endpoint was time from metastatic diagnosis to disease progression from initial treatment for FGFRalt and FGFRwt (wild-type) mUC. Cox proportional hazards models quantified adjusted risk of FGFR status relating to PFS. RESULTS A total of 414 patients were analyzed. Mean age was 64.5 years, 73.9% were male, and 52.7% had an FGFRalt. Among FGFRalt, 47.2% received chemotherapy, 27.5% immune checkpoint inhibition (ICI), 11.5% chemotherapy+ICI, and 13.8% other treatments in 1L. FGFR status did not influence PFS from time of mUC diagnosis or among 224 stratified patients receiving either chemotherapy or chemotherapy+ICI. However, among 97 patients with an FGFRalt receiving 1L ICI therapy only, adjusted risk of progression was twice that of FGFRwt (HR: 2.12; 95% CI: 1.13-4.00). CONCLUSION Although FGFRalt did not predict outcomes in the overall cohort, for patients treated with 1L ICI, FGFRalt had significantly higher rates of progression than FGFRwt patients. Further validation is needed to determine whether FGFRalt has a decreased benefit from ICI therapy.
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Affiliation(s)
| | | | | | | | | | | | - Vittorio Maio
- College of Population Health, Thomas Jefferson University, PA
| | - Albert Crawford
- College of Population Health, Thomas Jefferson University, PA
| | - Grace Lu-Yao
- College of Population Health, Thomas Jefferson University, PA; Sidney Kimmel Cancer Center at Jefferson, Philadelphia PA; Thomas Jefferson University Department of Medical Oncology, Philadelphia PA
| | - Jianjun Gao
- The University of Texas MD Anderson Cancer Center, Houston, TX
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6
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Li X, Li Y, Liu B, Chen L, Lyu F, Zhang P, He Q, Cheng L, Liu C, Song Y, Xing Y. P4HA2-mediated HIF-1α stabilization promotes erdafitinib-resistance in FGFR3-alteration bladder cancer. FASEB J 2023; 37:e22840. [PMID: 36943397 DOI: 10.1096/fj.202201247r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/03/2023] [Accepted: 02/14/2023] [Indexed: 03/23/2023]
Abstract
Erdafitinib is a novel fibroblast growth factor receptor (FGFR) inhibitor that has shown great therapeutic promise for solid tumor patients with FGFR3 alterations, especially in urothelial carcinoma. However, the mechanisms of resistance to FGFR inhibitors remain poorly understood. In this study, we found Erdafitinib could kill cells by inducing incomplete autophagy and increasing intracellular reactive oxygen species levels. We have established an Erdafitinib-resistant cell line, RT-112-RS. whole transcriptome RNA sequencing (RNA-Seq) and Cytospace analysis performed on Erdafitinib-resistant RT-112-RS cells and parental RT-112 cells introduced P4HA2 as a linchpin to Erdafitinib resistance. The gain and loss of function study provided evidence for P4HA2 conferring such resistance in RT-112 cells. Furthermore, P4HA2 could stabilize the HIF-1α protein which then activated downstream target genes to reduce reactive oxygen species levels in bladder cancer. In turn, HIF-1α could directly bind to P4HA2 promoter, indicating a positive loop between P4HA2 and HIF-1α in bladder cancer. These results suggest a substantial role of P4HA2 in mediating acquired resistance to Erdafitinib and provide a potential target for bladder cancer treatment.
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Affiliation(s)
- Xuexiang Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunxue Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bing Liu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Lyu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pu Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingliu He
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lulin Cheng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyu Liu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yarong Song
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yifei Xing
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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7
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Gerald T, Margulis V, Meng X, Bagrodia A, Cole S, Qin Q, Call SG, Mauer E, Lotan Y, Woldu SL. Actionable genomic landscapes from a real-world cohort of urothelial carcinoma patients. Urol Oncol 2023; 41:148.e17-148.e24. [PMID: 36653279 DOI: 10.1016/j.urolonc.2022.12.008] [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: 10/12/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recent targeted therapies for advanced and metastatic urothelial cancer have generated enthusiasm, but the actionable genomic landscape of early-stage disease remains largely unknown. Here, we utilized a large, real-world cohort to comprehensively investigate the incidence of genetic alterations with potential therapeutic implications at all stages of bladder cancer. MATERIALS AND METHODS We retrospectively analyzed next-generation sequencing (NGS) data from 1,562 bladder cancer patients (stages I-IV) with formalin-fixed, paraffin-embedded tumor biopsies sequenced using the Tempus xT solid tumor assay. Incidence of genetic alterations, tumor mutational burden (TMB), microsatellite instability (MSI), and PD-L1 status were assessed and stratified by bladder cancer stage. For patients with tumor-normal match sequencing (n=966), incidental germline alterations in 50 genes were assessed. RESULTS The cohort was composed of 165 stage I-II, 211 stage III, and 1,186 stage IV tumors. TMB-high, PD-L1 positive, and MSI-high status were noted in 14%, 33%, and 0.7% of tumors, respectively, and were similar across stages. Alterations in fibroblast growth factor receptor (FGFR)2/3, homologous recombination repair genes, additional DNA repair gene mutations (ERCC2, RB1, FANCC), and NTRK fusions were detected at similar frequencies across disease stages. We identified a low rate of incidental germline mutations in all tumors (5.2%) and in specific genes: MUTYH (1.9%), BRCA2 (0.5%), and ATM (0.8%). CONCLUSIONS Important subsets of patients demonstrate genetic alterations in potentially actionable molecular pathways at all stages. This analysis found minimal variability in these alterations across stages, providing rationale for early identification of genetic alterations and personalization of therapies at all stages for patients with bladder cancer.
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Affiliation(s)
- Thomas Gerald
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego, San Diego, CA
| | - Suzanne Cole
- Division of Hematology Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Qian Qin
- Division of Hematology Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
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Systemic therapy issues: Immunotherapy in nonmetastatic urothelial cancer. Urol Oncol 2023; 41:27-34. [PMID: 34756410 DOI: 10.1016/j.urolonc.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/01/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022]
Abstract
Non-muscle-invasive bladder cancer is one of the most common malignancies. Patients with intermediate-risk or high-risk disease can be treated with intravesical Bacillus Calmette-Guerin, a vaccine against tuberculosis. However, many of these patients will experience tumor recurrence, despite appropriate treatment. 1 The standard of care in these patients is radical cystectomy (RC) with urinary diversion. 2 Patients diagnosed with muscle-invasive bladder cancer (MIBC) have traditionally faced 2 main treatment options: RC and urinary diversion, as in Bacillus Calmette-Guerin-unresponsive Non-muscle-invasive bladder cancer, or alternatively, trimodal therapy comprising maximal transurethral resection of bladder tumor plus chemoradiation. 3 For patients with MIBC and clinical (c)T2-T4a, neoadjuvant chemotherapy (NAC) preceding RC is supported by Level 1 evidence with a modest 5-year overall survival benefit of 5% with cisplatin-based regimens. 4-9 A number of factors preclude MIBC patients from standard treatment options. For example, patients with serious comorbidities might be unable to tolerate general anesthesia, while others might be unwilling to adapt to the lifestyle changes after RC. 10-12 Likewise, patients with extensive carcinoma in situ or poor bladder function might not be optimal candidates for trimodal therapy or be prepared for the ongoing risk that salvage RC might be ultimately required. Reasons for the underuse of NAC range from the fear of delaying potentially curative surgery in nonresponders to patient ineligibility to cisplatin-based NAC. 13,14 Despite best efforts, in both surgical and bladder-sparing approaches, the 5-year overall survival in treated patients with MIBC is only 35% to 50%. 3,15 Strategies to improve overall prognosis as well as to reduce the indications of RC are desperately needed. Trial results have demonstrated the unprecedented ability of immune-checkpoint inhibitors to induce durable remissions in some patients with metastatic urothelial carcinoma. 16-20 Furthermore, immune-checkpoint inhibitors have shown to be better tolerated than traditional chemotherapy. 16 These successful results have spearheaded the research on these agents in earlier curative settings, with the shared goal of improving overall outcomes, and potentially avoid surgery in patients who show complete response (pT0). Strategies to enhance the immune response by combining immunotherapy with immune sensitizers such as chemotherapy, immunotherapy, targeted therapy or radiation are on the rise.
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9
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Benjamin DJ, Mar N, Rezazadeh Kalebasty A. Immunotherapy With Checkpoint Inhibitors in FGFR-Altered Urothelial Carcinoma. Clin Med Insights Oncol 2022; 16:11795549221126252. [PMID: 36186672 PMCID: PMC9520173 DOI: 10.1177/11795549221126252] [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: 06/16/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022] Open
Abstract
The treatment landscape of metastatic urothelial cancer (mUC) remained unchanged for over 30 years until the approval of immune checkpoint inhibitors (ICIs) in 2016. Since then, several ICIs have been approved for the treatment of mUC. In addition, recent molecular characterization of bladder cancer has revealed several subtypes, including those harboring fibroblast growth factor receptor (FGFR) mutations and fusion proteins. Erdafitinib, a pan-FGFR inhibitor, was approved for the treatment of metastatic/advanced UC in 2019. Some available evidence suggests ICI may have inferior response in advanced FGFR+ UC for unclear reasons, but may possibly be related to the tumor microenvironment. Several ongoing trials are evaluating erdafitinib in metastatic/advanced UC including the ongoing phase IB/II NORSE trial combining erdafitinib plus ICI, which may prove to offer a more robust and durable response in patients with FGFR+ metastatic/advanced UC.
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Affiliation(s)
- David J Benjamin
- Medical Oncology, Hoag Family Cancer Institute, Newport Beach, CA, USA
| | - Nataliya Mar
- Division of Hematology and Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, USA
| | - Arash Rezazadeh Kalebasty
- Division of Hematology and Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, USA
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10
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Valenza C, Antonarelli G, Giugliano F, Aurilio G, Verri E, Briganti A, Curigliano G, Necchi A. Emerging treatment landscape of non-muscle invasive bladder cancer. Expert Opin Biol Ther 2022; 22:717-734. [PMID: 35634893 DOI: 10.1080/14712598.2022.2082869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Non-muscle invasive bladder cancer (NMIBC) accounts for 70-75% of all bladder cancers and is a heterogeneous disease characterized by a wide spectrum of recurrences and progression. Adjuvant treatment for intermediate- and high-risk NMIBC is mainly represented by Bacillus Calmette Guerin (BCG). However, 20%-40% of patients develop disease recurrences or persistence following BCG treatment and are classified as "BCG unresponsive' (BCGu), thus representing a therapeutic challenge due to their worse prognosis and unavailability of effective intravesical treatments. AREAS COVERED We provide an overview of completed and ongoing clinical trials assessing the role of innovative immunological and target agents in patients with BCGu and BCG naive (BCGn) NMIBCs. New treatment options are emerging, demonstrating promising clinical activity, namely, pembrolizumab, atezolizumab, oportuzumab monatox, nadofaragene firadenovec, and N-803. EXPERT OPINION The increasing number of newer therapeutic agents for patients with NMIBC poses challenges regarding the choice of the most suited treatment option for each patient and the best treatment sequence, given their diverse mechanisms of action and varying degrees of activity. Tailored treatment approaches are advocated, based on a deeper comprehension of disease features, available therapies, patient's characteristics, and consequently, on the identification and validation of prognostic and predictive biomarkers.
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Affiliation(s)
- Carmine Valenza
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, Milan, Italy.,(DIPO), University of MilanDepartment of Oncology and Hemato-Oncology, Milan, Italy
| | - Gabriele Antonarelli
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, Milan, Italy.,(DIPO), University of MilanDepartment of Oncology and Hemato-Oncology, Milan, Italy
| | - Federica Giugliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, Milan, Italy.,(DIPO), University of MilanDepartment of Oncology and Hemato-Oncology, Milan, Italy
| | - Gaetano Aurilio
- Division of Urogenital and Head and Neck Tumours, European Institute of Oncology, Milan, Italy
| | - Elena Verri
- Division of Urogenital and Head and Neck Tumours, European Institute of Oncology, Milan, Italy
| | - Alberto Briganti
- San Raffaele Department of Medical Oncology, IRCCS San Raffaele Hospital and Scientific InstituteUniversity Vita-Salute, Milan, Italy
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, Milan, Italy.,(DIPO), University of MilanDepartment of Oncology and Hemato-Oncology, Milan, Italy
| | - Andrea Necchi
- San Raffaele Department of Medical Oncology, IRCCS San Raffaele Hospital and Scientific InstituteUniversity Vita-Salute, Milan, Italy
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11
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Zhou Z, Zhang Z, Chen H, Bao W, Kuang X, Zhou P, Gao Z, Li D, Xie X, Yang C, Chen X, Pan J, Tang R, Feng Z, Zhou L, Wang L, Yang J, Jiang L. SBSN drives bladder cancer metastasis via EGFR/SRC/STAT3 signalling. Br J Cancer 2022; 127:211-222. [PMID: 35484216 PMCID: PMC9296541 DOI: 10.1038/s41416-022-01794-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/25/2022] [Accepted: 03/11/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with metastatic bladder cancer have very poor prognosis and predictive biomarkers are urgently needed for early clinical detection and intervention. In this study, we evaluate the effect and mechanism of Suprabasin (SBSN) on bladder cancer metastasis. METHODS A tissue array was used to detect SBSN expression by immunohistochemistry. A tumour-bearing mouse model was used for metastasis evaluation in vivo. Transwell and wound-healing assays were used for in vitro evaluation of migration and invasion. Comprehensive molecular screening was achieved by western blotting, immunofluorescence, luciferase reporter assay, and ELISA. RESULTS SBSN was found markedly overexpressed in bladder cancer, and indicated poor prognosis of patients. SBSN promoted invasion and metastasis of bladder cancer cells both in vivo and in vitro. The secreted SBSN exhibited identical biological function and regulation in bladder cancer metastasis, and the interaction of secreted SBSN and EGFR could play an essential role in activating the signalling in which SBSN enhanced the phosphorylation of EGFR and SRC kinase, followed with phosphorylation and nuclear location of STAT3. CONCLUSIONS Our findings highlight that SBSN, and secreted SBSN, promote bladder cancer metastasis through activation of EGFR/SRC/STAT3 pathway and identify SBSN as a potential diagnostic and therapeutic target for bladder cancer.
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Affiliation(s)
- Zhongqiu Zhou
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China.,Meishan Women and Children's Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University, 620000, Meishan, China
| | - Zhuojun Zhang
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China
| | - Han Chen
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China
| | - Wenhao Bao
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China
| | - Xiangqin Kuang
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China
| | - Ping Zhou
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China
| | - Zhiqing Gao
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China
| | - Difeng Li
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China
| | - Xiaoyi Xie
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China
| | - Chunxiao Yang
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China
| | - Xuhong Chen
- Medical Research Center, Southern University of Science and Technology Hospital, 518055, Shenzhen, China
| | - Jinyuan Pan
- Department of Oncology, Huanggang Central Hospital of Yangtze University, 438000, Huanggang, China
| | - Ruiming Tang
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, 511518, Guangzhou, China
| | - Zhengfu Feng
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, 511518, Guangzhou, China
| | - Lihuan Zhou
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, 511518, Guangzhou, China
| | - Lan Wang
- Department of Pathogen Biology and Immunology, School of Basic Courses, Guangdong Pharmaceutical University, 510006, Guangzhou, China
| | - Jianan Yang
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China. .,Department of Urologic Oncosurgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China.
| | - Lili Jiang
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 510095, Guangzhou, China. .,Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, School of Basic Medical Science, Guangzhou Medical University, 511436, Guangzhou, China.
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12
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Zhao J, Zhou L, Pan Y, Chen L. A systematic review and meta-analysis of radical cystectomy in the treatment of muscular invasive bladder cancer (MIBC). Transl Androl Urol 2021; 10:3476-3485. [PMID: 34532272 PMCID: PMC8421829 DOI: 10.21037/tau-21-564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background A meta-analysis was conducted to evaluate the curative effect of radical cystectomy in the treatment of muscular invasive bladder cancer (MIBC). Methods Chinese and English databases were searched using free combinations of the terms “bladder cancer,” “radical cystectomy,” “muscle invasive bladder cancer,” and “bladder preservation.” Review Manager 5.3 software was used for the meta-analysis. Results A total of 12 articles were included in the meta-analysis, most of which had low-bias risk and were of medium and high quality. A funnel chart showed that the circles of some studies were basically symmetrical with the midline, suggesting that the research accuracy was high, the publications were not biased, and the final conclusions were credible. Twelve articles analyzed patients’ 5-year survival rate in randomized controlled trials (RCTs). In these RCTs, the experimental group (expt group) comprised 775 cases and the control group (ctrl group) comprised 766 cases. A heterogeneity test using the fixed-effects model (FEM) showed Chi2 =2.19, df =11, I2=0%, P=1.00>0.1, Z =2.57, odds ratio (OR) =1.30, 95% confidence interval (CI): 1.06–1.59, and P=0.01<0.05. 3 articles analyzed patients’ 10-year survival rates in RCTs. These trials comprised a total of 417 patients (209 in the expt group and 208 in the ctrl group). The overall heterogeneity test showed Chi2 =0.40, df =2, I2=0%, P=0.82>0.1, Z =1.42, OR =1.32, 95% CI: 0.90–1.94, and P=0.16>0.05. 6 articles analyzed 5-year distant metastasis rates (DMRs) in RCTs. The overall heterogeneity test showed Chi2 =1.68, df =5, I2=0%, P=0.89>0.1, Z =1.70, OR =1.28, 95% CI: 0.96–1.71, and P=0.09>0.05). Discussion Our meta-analysis confirmed that radical cystectomy is effective in the treatment of MIBC and is worthy of clinical promotion.
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Affiliation(s)
- Juan Zhao
- Urology Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Li Zhou
- Urology Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yan Pan
- Urology Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lan Chen
- Urology Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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13
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Lopez-Beltran A, López-Rios F, Montironi R, Wildsmith S, Eckstein M. Immune Checkpoint Inhibitors in Urothelial Carcinoma: Recommendations for Practical Approaches to PD-L1 and Other Potential Predictive Biomarker Testing. Cancers (Basel) 2021; 13:cancers13061424. [PMID: 33804698 PMCID: PMC8003923 DOI: 10.3390/cancers13061424] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary The predominant histologic type of bladder cancer is urothelial carcinoma (UC). Programmed cell death-ligand 1 (PD-L1) expression levels in UC tumors help clinicians determine which patients are more likely to respond to immuno-oncology (IO) therapies; as such, the harmonization of PD-L1 testing in evaluating patients is increasingly important. A series of international workshops, involving renowned pathologists and oncologists, were held to develop best practice approaches to PD-L1 testing in UC. It was agreed that robust control of analytical standards is required to obtain quality PD-L1 results and that interpretation and reporting of PD-L1 require clear inter-clinician communication. Recommendations for the best practices for PD-L1 testing in UC are provided. A PD-L1 test request form for pathology laboratories was also developed and included here, encouraging communication between clinicians and pathologists, and ensuring fast and high-quality test results. Novel biomarkers being evaluated for immuno-oncology agents in UC are also briefly discussed. Abstract Immuno-oncology (IO) agents (anti–programmed cell death 1 (PD-1) and anti–programmed cell death-ligand 1 (PD-L1)) are approved as first- and second-line treatments for metastatic UC. PD-L1 expression levels in UC tumors help clinicians determine which patients are more likely to respond to IO therapies. Assays for approved IO agents use different antibodies, immunohistochemical protocols, cutoffs (defining “high” vs. “low” PD-L1 expression), and scoring algorithms. The robust control of pre-analytical and analytical standards is needed to obtain high-quality PD-L1 results. To better understand the status and perspectives of biomarker-guided patient selection for anti–PD-1 and anti–PD-L1 agents in UC, three workshops were held from December 2018 to December 2019 in Italy, Malaysia, and Spain. The primary goal was to develop recommendations for best practice approaches to PD-L1 testing in UC. Recommendations pertaining to the interpretation and reporting of the results of PD-L1 assays from experienced pathologists and oncologists from around the globe are included. A test request form for pathology laboratories was developed as a critical first step for oncologists/urologists to encourage communication between clinicians and pathologists, ensuring fast and high-quality test results. In this era of personalized medicine, we briefly discuss novel biomarkers being evaluated for IO agents in UC.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Pathology and Surgery, Faculty of Medicine, Cordoba University, 14004 Cordoba, Spain
- Faculty of Medicine, Champalimaud Clinical Center, 1400-038 Lisbon, Portugal
- Correspondence: or
| | - Fernando López-Rios
- Pathology-Targeted Therapies Laboratory, HM Hospitales, 28050 Madrid, Spain;
| | - Rodolfo Montironi
- School of Medicine, Polytechnic University of the Marche Region (Ancona), 60126 Ancona, Italy;
| | | | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
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14
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Kim B, Jang I, Kim K, Jung M, Lee C, Park JH, Kim YA, Moon KC. Comprehensive Gene Expression Analyses of Immunohistochemically Defined Subgroups of Muscle-Invasive Urinary Bladder Urothelial Carcinoma. Int J Mol Sci 2021; 22:ijms22020628. [PMID: 33435173 PMCID: PMC7828072 DOI: 10.3390/ijms22020628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/08/2023] Open
Abstract
A number of urinary bladder urothelial carcinoma (UB UC) mRNA-based classification systems have been reported. It also has been observed that treatment response and prognosis are different for each molecular subtype. In this study, cytokeratin (CK)5/6 and CK20 immunohistochemistry (IHC) were performed, and IHC-based subgroup classification was applied. UB UC was classified into CK5/6 single-positive (SP), CK20 SP, double-positive (DP) and double-negative (DN) subgroups, and transcriptional analysis was performed. The results of gene ontology (GO) terms and functional analysis using differentially expressed genes indicate that, CK5/6 SP and DP subgroups were enriched in cell migration, immune activation, interleukin 6-Janus kinase-signal transducer and activator of transcription 3 (IL6-JAK-STAT3) signaling pathway and tumor necrosis factor-α signaling via the nuclear factor-κB (NF-κB) signaling pathway signature gene. In addition, compared with the other subgroups, the DN subgroup showed inhibited cell movement, cell migration, and cell activation. Furthermore, in survival analysis, the CK5/6 SP subgroup was significantly associated with poor progression-free survival (p = 0.008). The results of our study indicate that the CK5/6 positive subgroup exhibited high gene expression signature related to aggressive behavior and exhibited worse clinical outcome.
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Affiliation(s)
- Bohyun Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea; (B.K.); (M.J.); (C.L.)
| | - Insoon Jang
- Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Korea;
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul 03080, Korea;
| | - Minsun Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea; (B.K.); (M.J.); (C.L.)
| | - Cheol Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea; (B.K.); (M.J.); (C.L.)
| | - Jeong Hwan Park
- Department of Pathology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 03080, Korea; (J.H.P.); (Y.A.K.)
| | - Young A. Kim
- Department of Pathology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 03080, Korea; (J.H.P.); (Y.A.K.)
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea; (B.K.); (M.J.); (C.L.)
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-740-8380
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15
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Pederzoli F, Bandini M, Marandino L, Ali SM, Madison R, Chung J, Ross JS, Necchi A. Targetable gene fusions and aberrations in genitourinary oncology. Nat Rev Urol 2020; 17:613-625. [PMID: 33046892 DOI: 10.1038/s41585-020-00379-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 12/14/2022]
Abstract
Gene fusions result from either structural chromosomal rearrangement or aberrations caused by splicing or transcriptional readthrough. The precise and distinctive presence of fusion genes in neoplastic tissues and their involvement in multiple pathways central to cancer development, growth and survival make them promising targets for personalized therapy. In genitourinary malignancies, rearrangements involving the E26 transformation-specific family of transcription factors have emerged as very frequent alterations in prostate cancer, especially the TMPRSS2-ERG fusion. In renal malignancies, Xp11 and t(6;11) translocations are hallmarks of a distinct pathological group of tumours described as microphthalmia-associated transcription factor family translocation-associated renal cell carcinomas. Novel druggable fusion events have been recognized in genitourinary malignancies, leading to the activation of several clinical trials. For instance, ALK-rearranged renal cell carcinomas have shown responses to alectinib and crizotinib. Erdafitinib has been tested for the treatment of FGFR-rearranged bladder cancer. Other anti-fibroblast growth factor receptor 3 (FGFR3) compounds are showing promising results in the treatment of bladder cancer, including infigratinib and pemigatinib, and all are currently in clinical trials.
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Affiliation(s)
- Filippo Pederzoli
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Marco Bandini
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Marandino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Siraj M Ali
- Foundation Medicine Inc., Cambridge, MA, USA
| | | | - Jon Chung
- Foundation Medicine Inc., Cambridge, MA, USA
| | - Jeffrey S Ross
- Foundation Medicine Inc., Cambridge, MA, USA.,Upstate Medical University, Syracuse, NY, USA
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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16
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D'Angelo A, Bagby S, Galli IC, Bortoletti C, Roviello G. Overview of the clinical use of erdafitinib as a treatment option for the metastatic urothelial carcinoma: where do we stand. Expert Rev Clin Pharmacol 2020; 13:1139-1146. [PMID: 32935605 DOI: 10.1080/17512433.2020.1823830] [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: 01/29/2023]
Abstract
INTRODUCTION Erdafitinib is the first orally administered pan-fibroblast growth factor receptor (FGFR) kinase inhibitor approved by the Food and Drug Administration (FDA). AREAS COVERED Specifically binding to FGFR family (FGFR-1 to FGFR-4), erdafitinib leads to reduced cell signaling and cellular apoptosis. Coupled with the ability to bind to vascular endothelial growth factor 2 (VEGFR-2), KIT, Fms-related tyrosine kinase 4 (FLT4), platelet-derived growth factor receptor α and β (PDGFR-α and PDGFR-β), RET and colony-stimulating factor 1 receptor (CSF-1 R), erdafitinib has further reported antitumor features causing cell killing. EXPERT OPINION In this review, we provide a comprehensive overview of erdafitinib chemical structure, pharmacologic properties, and current knowledge of clinical efficacy in the treatment of locally advanced or metastatic urothelial carcinoma. This treatment, recently approved in the U.S., is available for adult patients harboring FGFR2/FGFR3 genetic alterations who progressed within 12 months of an adjuvant or neoadjuvant chemotherapy regimen including platinum or progressed during or after prior a chemotherapy regimen including platinum.
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Affiliation(s)
- Alberto D'Angelo
- Department of Biology and Biochemistry, University of Bath , Bath, UK
| | - Stefan Bagby
- Department of Biology and Biochemistry, University of Bath , Bath, UK
| | - Ilaria Camilla Galli
- Department of Health Sciences, University of Florence, Section of Pathological Anatomy, University Hospital of Florence , Florence, Italy
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17
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Kang HW, Kim WJ, Yun SJ. The therapeutic and prognostic implications of molecular biomarkers in urothelial carcinoma. Transl Cancer Res 2020; 9:6609-6623. [PMID: 35117271 PMCID: PMC8798786 DOI: 10.21037/tcr-20-1243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/20/2020] [Indexed: 12/27/2022]
Abstract
Urothelial cell carcinoma (UCC) of the bladder and upper urinary tract is a heterogeneous disease with distinct biologic features resulting in different clinical behaviors. Bladder cancer (BC) is classified into non-muscle invasive BC (NMIBC) and muscle invasive BC (MIBC). NMIBC is associated with high recurrence rates and risk of progression to invasive disease, whereas MIBC is complicated by systemic recurrence after radical cystectomy because of the limited efficacy of available therapies. UCC of the upper urinary tract (UUT-UCC) is a rare but aggressive urologic cancer characterized by multifocality, local recurrence, and metastasis. Conventional histopathologic evaluation of UCC, including tumor stage and grade, cannot accurately predict the behavior of BC and UUT-UCC. Recent clinical and preclinical studies aimed at understanding the molecular landscape of UCC have provided insight into molecular subtyping, inter- or intratumoral heterogeneity, and potential therapeutic targets. Combined analysis of molecular markers and standard pathological features may improve risk stratification and help monitor tumor progression and treatment response, ultimately improving patient outcomes. This review discusses prognostic and therapeutic biomarkers for BC and UUT-UCC, and describes recent advances in molecular stratification that may guide prognosis, patient stratification, and treatment selection.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, School of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Wun-Jae Kim
- Department of Urology, School of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Seok Joong Yun
- Department of Urology, School of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
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18
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Jiang DM, North SA, Canil C, Kolinsky M, Wood LA, Gray S, Eigl BJ, Basappa NS, Blais N, Winquist E, Mukherjee SD, Booth CM, Alimohamed NS, Czaykowski P, Kulkarni GS, Black PC, Chung PW, Kassouf W, van der Kwast T, Sridhar SS. Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada. Bladder Cancer 2020. [DOI: 10.3233/blc-200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott A. North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kolinsky
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A. Wood
- Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Samantha Gray
- Department of Oncology, Saint John Regional Hospital, Department of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Bernhard J. Eigl
- Department of Medicine, Division of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Naveen S. Basappa
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Normand Blais
- Department of Medicine, Division of Medical Oncology and Hematology, Centre Hospitalier de l’Université de Montréal; Université de Montréal, Montreal, QC, Canada
| | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Som D. Mukherjee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Nimira S. Alimohamed
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Girish S. Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter W. Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Srikala S. Sridhar
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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19
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Messing EM. New Salvage Treatments for Metastatic Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Vetterlein MW, Witjes JA, Loriot Y, Giannarini G, Albersen M, Ribal MJ, Rouprêt M. Cutting-edge Management of Muscle-invasive Bladder Cancer in 2020 and a Glimpse into the Future. Eur Urol Oncol 2020; 3:789-801. [PMID: 32553706 DOI: 10.1016/j.euo.2020.06.001] [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: 05/11/2020] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 01/15/2023]
Abstract
This case-based discussion describes the clinical course of a 63-yr-old patient who presented with gross hematuria and was diagnosed with a muscle-invasive bladder cancer at transurethral resection. Computed tomography revealed a locally advanced tumor, and the patient underwent neoadjuvant chemotherapy followed by open radical cystectomy with standard pelvic lymph node dissection. In a step-by-step fashion, we elaborate on diagnostic and therapeutic treatment options from two different vantage points: (1) guideline-adherent treatment with the state-of-the-art standard of care, and (2) a glimpse into the future discussing the evidence of potential additional or alternative approaches based on recent scientific advances. PATIENT SUMMARY: In this case-based discussion, we follow the clinical course of a patient with advanced bladder cancer and elaborate how the state-of-the-art treatment looks like in 2020, based on the best available evidence. This is compared with potential future treatment strategies, which may change and alternate our understanding of optimal bladder cancer care.
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Affiliation(s)
- Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yohann Loriot
- Department of Cancer Medicine, INSERM U981, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Center "Santa Maria della Misericordia", Udine, Italy
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maria J Ribal
- Department of Urology, University Hospital Clínic de Barcelona, Barcelona, Spain
| | - Morgan Rouprêt
- Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitié-Salpêtrière Hospital, Paris, France.
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21
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Chandrashekar DS, Chakravarthi BVSK, Robinson AD, Anderson JC, Agarwal S, Balasubramanya SAH, Eich ML, Bajpai AK, Davuluri S, Guru MS, Guru AS, Naik G, Della Manna DL, Acharya KK, Carskadon S, Manne U, Crossman DK, Ferguson JE, Grizzle WE, Palanisamy N, Willey CD, Crowley MR, Netto GJ, Yang ES, Varambally S, Sonpavde G. Therapeutically actionable PAK4 is amplified, overexpressed, and involved in bladder cancer progression. Oncogene 2020; 39:4077-4091. [PMID: 32231273 DOI: 10.1038/s41388-020-1275-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 12/30/2022]
Abstract
Muscle-invasive bladder carcinomas (MIBCs) are aggressive genitourinary malignancies. Metastatic urothelial carcinoma of the bladder is generally incurable by current chemotherapy and leads to early mortality. Recent studies have identified molecular subtypes of MIBCs with different sensitivities to frontline therapy, suggesting tumor heterogeneity. We have performed multi-omic profiling of the kinome in bladder cancer patients with the goal of identify therapeutic targets. Our analyses revealed amplification, overexpression, and elevated kinase activity of P21 (RAC1) activated kinase 4 (PAK4) in a subset of Bladder cancer (BLCA). Using bladder cancer cells, we confirmed the role of PAK4 in BLCA cell proliferation and invasion. Furthermore, we observed that a PAK4 inhibitor was effective in curtailing growth of BLCA cells. Transcriptomic analyses identified elevated expression of another kinase, protein tyrosine kinase 6 (PTK6), upon treatment with a PAK4 inhibitor and RNA interference of PAK4. Treatment with a combination of kinase inhibitors (vandetanib and dasatinib) showed enhanced sensitivity compared with either drug alone. Thus, PAK4 may be therapeutically actionable for a subset of MIBC patients with amplified and/or overexpressed PAK4 in their tumors. Our results also indicate that combined inhibition of PAK4 and PTK6 may overcome resistance to PAK4. These observations warrant clinical investigations with selected BLCA patients.
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Affiliation(s)
| | | | - Alyncia D Robinson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joshua C Anderson
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sumit Agarwal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Marie-Lisa Eich
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Maya S Guru
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Arjun S Guru
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gurudatta Naik
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deborah L Della Manna
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kshitish K Acharya
- Shodhaka Life Sciences Private Limited, Bengaluru, India.,Institute of Bioinformatics and Applied Biotechnology (IBAB), Biotech Park, Electronic City, Bengaluru, 560100, Karnataka, India
| | - Shannon Carskadon
- Vattikuti Urology Institute, Department of Urology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Upender Manne
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David K Crossman
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James E Ferguson
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William E Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nallasivam Palanisamy
- Vattikuti Urology Institute, Department of Urology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Christopher D Willey
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael R Crowley
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - George J Netto
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eddy S Yang
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sooryanarayana Varambally
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA. .,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. .,Informatics Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Guru Sonpavde
- Department of Medicine, Dana-Farber Cancer Institute, Boston, MA, USA.
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22
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Abstract
PURPOSE OF REVIEW Urothelial carcinoma is one of the 10 most common forms of cancer in the world with more than half a million cases diagnosed yearly. The past few years have witnessed a revolution in understanding the biology of urothelial carcinoma and the development of promising therapies. In this review, we summarize the emerging therapeutic approaches in the management of advanced urothelial carcinoma. RECENT FINDINGS Since 2016, the Food and Drug Administration (FDA) has approved five checkpoint inhibitors (CPIs), a fibroblast growth factor receptor (FGFR) inhibitor, and an antibody drug conjugate (ADC) for the treatment of advanced urothelial carcinoma. Additionally, the FDA has granted several breakthrough designations for other therapeutic strategies including other ADCs. SUMMARY CPIs, anti-FGFR agents and ADCs are significant advancements that offer new treatment options to patients with advanced urothelial carcinoma. However, there remains a need to understand mechanisms of resistance, identify biomarkers to choose potential responders, and learn the best strategy to sequence these agents in regards to lines of therapy.
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23
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Schmidt AL, Siefker-Radtke A, McConkey D, McGregor B. Renal Cell and Urothelial Carcinoma: Biomarkers for New Treatments. Am Soc Clin Oncol Educ Book 2020; 40:1-11. [PMID: 32379987 DOI: 10.1200/edbk_279905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Therapies for genitourinary malignancies have evolved considerably in the past five years. Combination treatment targeting biologically relevant immune and angiogenic pathways is improving patient survival in metastatic renal cell carcinoma (RCC), whereas immune checkpoint blockade (ICB), novel targeted therapy, and antibody drug conjugates have changed the landscape of urothelial cancer (UC) treatment. A daily challenge for clinicians is identifying patients who derive a preferential benefit from the available therapeutic options. The completion of large-scale genomics projects has yielded comprehensive descriptions of the molecular heterogeneity present in RCC and UC, although clinical applications of these data continue to evolve. Major molecular subtypes of RCC align well with histology subtype, and although some molecular characteristics appear to carry prognostic information, biomarkers predicting benefit from tyrosine kinase inhibitor (TKI) or immunotherapy are generally lacking. Unexpectedly, similar work has demonstrated that UC can be grouped into "molecular subtypes" that share properties with those found in breast cancer and other solid tumors. Furthermore, this molecular subtype classification is prognostic and potentially predictive of differential benefit from conventional and targeted therapies. This article provides an update on the current state of molecular biomarker development and potential clinical utility in RCC and UC.
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Affiliation(s)
| | | | - David McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
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24
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Lemke E, Sahasrabudhe D, Guancial E, Bylow K, Johnson S, Messing E, Kilari D. The Role of Metastasectomy in Urothelial Carcinoma: Where Are We in 2020? Clin Genitourin Cancer 2020; 18:e478-e483. [PMID: 32085986 DOI: 10.1016/j.clgc.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Systemic therapy is the mainstay of treatment for metastatic urothelial carcinoma (UC). Responses to first-line platinum-based therapy tend to be short-lived with potential toxicity. Despite the approval of checkpoint inhibitors, the long-term prognosis for patients with metastatic UC remains dismal. Herein we report the case of a patient with a solitary pulmonary metastatic lesion of urothelial origin as the only site of metastatic disease who remained free of disease for more than 2 years without systemic therapy after metastasectomy. We review the literature discussing the role of combined surgical and medical management of oligometastatic UC. As our case illustrates, a growing body of evidence suggests a potential role for a multimodal approach in patients with oligometastatic UC.
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Affiliation(s)
- Emily Lemke
- Department of Medicine, Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
| | - Deepak Sahasrabudhe
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | | | - Kathryn Bylow
- Department of Medicine, Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Scott Johnson
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Edward Messing
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | - Deepak Kilari
- Department of Medicine, Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
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25
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Zhu S, Yu W, Yang X, Wu C, Cheng F. Traditional Classification and Novel Subtyping Systems for Bladder Cancer. Front Oncol 2020; 10:102. [PMID: 32117752 PMCID: PMC7025453 DOI: 10.3389/fonc.2020.00102] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/20/2020] [Indexed: 12/31/2022] Open
Abstract
Bladder cancer is the most common tumor in the urinary system, with approximately 420,000 new cases and 160,000 deaths per year. The European Organization for Research and Treatment of Cancer (EOTRC) classifies non-muscular invasive bladder cancer (NMIBC) into low-risk, medium-risk and high-risk groups based on a comprehensive analysis of NMIBC pathological parameters and the risk of recurrence and progression to muscular invasive bladder cancer (MIBC). Traditional classification systems are based on pathologic grading, staging systems, and clinical prognosis. However, the pathological parameters of the tumor cannot fully reflect the “intrinsic characteristics” of bladder cancer, and tumors with a similar pathology exhibit different biological behaviors. Furthermore, although the traditional classification system cannot accurately predict the risk of recurrence or the progression of bladder cancer patients (BCs) individually, this method is widely used in clinical practice because of its convenient operation. With the development of sequencing and other technologies, the genetics-based molecular subtyping of bladder cancer has become increasingly studied. Compared with the traditional classification system, it provides more abundant tumor biological information and is expected to assist or even replace the traditional typing system in the future.
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Affiliation(s)
- Shaoming Zhu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Weimin Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiao Yang
- Department of Gynaecology and Obstetrics, Renmin Hospital of Peking University, Beijing, China
| | - Cheng Wu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
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26
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Abstract
Introduction: Since the approval of immune checkpoint inhibitors (ICIs), there has been continuing and significant progress in urothelial cancer (UC) treatment. However, only about one fifth of UC patients respond to ICI. Recently, erdafitinib was developed for treating locally advanced or metastatic UC (mUC) with FGFR3 or FGFR2 alterations, accounting for 15-20% of patients. Erdafitinib is the first targeted therapy ever approved for mUC.Areas covered: This review summarizes the preclinical and clinical data on erdafitinib for UC. PubMed search and relevant articles presented at international conferences were used for the literature search.Expert opinion: The FDA approval of erdafitinib provided a new treatment option for FGFR-altered UC progressing on platinum-based chemotherapy. It is not clear whether FGFR inhibitor is a preferred second-line treatment choice to ICI. Compared to ICI, erdafitinib has a better response rate in patients with visceral metastases. However, a shorter duration of response and toxicity profile of erdafitinib, particularly ocular toxicity, is an important consideration. Regular eye exams are recommended by the FDA. Tumor profiling during upfront therapy may help identify those who benefit at the time of progression. In summary, a high unmet need remains for new drugs in chemotherapy- and ICI-refractory UC.
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Affiliation(s)
- Kamaneh Montazeri
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joaquim Bellmunt
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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27
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Eich ML, Rodriguez Pena MDC, Chandrashekar DS, Chaux A, Agarwal S, Gordetsky JB, Ferguson JE, Sonpavde GP, Netto GJ, Varambally S. Expression and Role of Methylenetetrahydrofolate Dehydrogenase 1 Like (MTHFD1L) in Bladder Cancer. Transl Oncol 2019; 12:1416-1424. [PMID: 31401334 PMCID: PMC6700437 DOI: 10.1016/j.tranon.2019.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 01/18/2023] Open
Abstract
Cancer cells utilize vitamin folate to fulfill their excessive demand for nucleotides and amino acids. Dihydrofolate reductase (DHFR), an enzyme involved in folate metabolism converts dihydrofolate into tetrahydrofolate, which is required for the de novo synthesis of purines, and certain amino acids. DHFR inhibitors are used as a chemotherapeutic agent. Cancer sequencing analysis has identified additional enzymes in folate metabolism that are dysregulated in cancer. Methylenetetrahydrofolate dehydrogenase 1 like (MTHFD1L), one such enzyme is overexpressed in bladder cancer. MTHFD1L is a mitochondrial enzyme involved in the folate cycle by catalyzing the reaction of formyl-tetrahydrofolate to formate and tetrahydrofolate (THF). THF is crucial for de novo purine and thymidylate synthesis and is also involved in the regeneration of methionine. Cancer cells rely on purines derived from the de novo pathway for the nucleotides whereas normal cells favor the salvage pathway. In this study we examined MTHFD1L expression in bladder cancer. By using publicly available cancer transcriptome data analysis web-portal UALCAN, we found overexpression of MTHFD1L in bladder cancer and expression was associated with overall survival. RT-PCR and immunoblot analysis confirmed the overexpression of MTHFD1L in muscle invasive bladder cancer tissues compared to normal urothelium. Furthermore, our investigations suggested a critical role for MTHFD1L in bladder cancer cell proliferation, colony formation and invasion. Thus, in this study, we show the significance of the folate metabolic enzyme MTHFD1L in aggressive bladder cancers and suggest that being an enzyme, MTHFD1L serves as a valuable therapeutic target.
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Affiliation(s)
- Marie-Lisa Eich
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Alcides Chaux
- Department of Scientific Research, School of Postgraduate Studies, Norte University, Asunción, Paraguay
| | - Sumit Agarwal
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Pathology and Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James E Ferguson
- Department of Urology, The University of Alabama at Birmingham, Birmingham, AL, US; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Guru P Sonpavde
- Department of Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - George J Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sooryanarayana Varambally
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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28
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Loriot Y, Necchi A, Park SH, Garcia-Donas J, Huddart R, Burgess E, Fleming M, Rezazadeh A, Mellado B, Varlamov S, Joshi M, Duran I, Tagawa ST, Zakharia Y, Zhong B, Stuyckens K, Santiago-Walker A, De Porre P, O'Hagan A, Avadhani A, Siefker-Radtke AO. Erdafitinib in Locally Advanced or Metastatic Urothelial Carcinoma. N Engl J Med 2019; 381:338-348. [PMID: 31340094 DOI: 10.1056/nejmoa1817323] [Citation(s) in RCA: 852] [Impact Index Per Article: 170.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Alterations in the gene encoding fibroblast growth factor receptor (FGFR) are common in urothelial carcinoma and may be associated with lower sensitivity to immune interventions. Erdafitinib, a tyrosine kinase inhibitor of FGFR1-4, has shown antitumor activity in preclinical models and in a phase 1 study involving patients with FGFR alterations. METHODS In this open-label, phase 2 study, we enrolled patients who had locally advanced and unresectable or metastatic urothelial carcinoma with prespecified FGFR alterations. All the patients had a history of disease progression during or after at least one course of chemotherapy or within 12 months after neoadjuvant or adjuvant chemotherapy. Prior immunotherapy was allowed. We initially randomly assigned the patients to receive erdafitinib in either an intermittent or a continuous regimen in the dose-selection phase of the study. On the basis of an interim analysis, the starting dose was set at 8 mg per day in a continuous regimen (selected-regimen group), with provision for a pharmacodynamically guided dose escalation to 9 mg. The primary end point was the objective response rate. Key secondary end points included progression-free survival, duration of response, and overall survival. RESULTS A total of 99 patients in the selected-regimen group received a median of five cycles of erdafitinib. Of these patients, 43% had received at least two previous courses of treatment, 79% had visceral metastases, and 53% had a creatinine clearance of less than 60 ml per minute. The rate of confirmed response to erdafitinib therapy was 40% (3% with a complete response and 37% with a partial response). Among the 22 patients who had undergone previous immunotherapy, the confirmed response rate was 59%. The median duration of progression-free survival was 5.5 months, and the median duration of overall survival was 13.8 months. Treatment-related adverse events of grade 3 or higher, which were managed mainly by dose adjustments, were reported in 46% of the patients; 13% of the patients discontinued treatment because of adverse events. There were no treatment-related deaths. CONCLUSIONS The use of erdafitinib was associated with an objective tumor response in 40% of previously treated patients who had locally advanced and unresectable or metastatic urothelial carcinoma with FGFR alterations. Treatment-related grade 3 or higher adverse events were reported in nearly half the patients. (Funded by Janssen Research and Development; BLC2001 ClinicalTrials.gov number, NCT02365597.).
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Affiliation(s)
- Yohann Loriot
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Andrea Necchi
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Se Hoon Park
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Jesus Garcia-Donas
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Robert Huddart
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Earle Burgess
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Mark Fleming
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Arash Rezazadeh
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Begoña Mellado
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Sergey Varlamov
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Monika Joshi
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Ignacio Duran
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Scott T Tagawa
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Yousef Zakharia
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Bob Zhong
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Kim Stuyckens
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Ademi Santiago-Walker
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Peter De Porre
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Anne O'Hagan
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Anjali Avadhani
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Arlene O Siefker-Radtke
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
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Predicting outcomes in non-muscle invasive (Ta/T1) bladder cancer: the role of molecular grade based on luminal/basal phenotype. Virchows Arch 2019; 475:445-455. [PMID: 31240474 DOI: 10.1007/s00428-019-02593-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/14/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
Bladder cancer tumors can be divided into two molecular subtypes referred to as luminal or basal. Each subtype may react differently to current chemotherapy or immunotherapy. Likewise, the technology required for comprehensive molecular analysis is expensive and not yet applicable for routine clinical diagnostics. Therefore, it has been suggested that the immunohistochemical expressions of only two markers, luminal (CK20+, CK5/6-) and basal (CK5/6+, CK20-), is sufficient to identify the molecular subtypes of bladder cancer. This would represent a molecular grade that could be used in daily practice. Molecular classification is done using immunohistochemistry to assess luminal-basal phenotype based on tissular expression of CK20 and CK5/6 as surrogate for luminal or basal subtypes, respectively. A series of 147 non-muscle-invasive bladder carcinoma cases was selected, and the tumors were divided into four subgroups based on the presence of CK20 and/or CK5/6, that is, null (CK20-, CK5/6-), mixed (CK20+, CK5/6+), basal (CK20-, CK5/6+), and luminal (CK20+, CK5/6-) categories. Survival analysis was estimated using the Kaplan-Meier method and the log-rank test. Hazard ratios were calculated by Cox multivariate analysis. The molecular grade included cases with null (n = 89), mixed (n = 6), basal (n = 20), and luminal (n = 32) phenotypes with differences in recurrence-free, progression-free and cancer-specific survival associated with molecular-grade categories in patients with low- or high-grade Ta, or high-grade T1 tumors. The multivariate analysis identified the luminal phenotype as a predictor of more aggressive neoplasms. Our findings provide a rationale to investigate luminal and basal subtypes of bladder cancer using two gene expression signatures as surrogate markers and show that non-muscle-invasive bladder carcinoma can be stratified into biologically and clinically different subgroups by using an immunohistochemical classifier.
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The Role and Importance of Timely Radical Cystectomy for High-Risk Non-muscle-Invasive Bladder Cancer. Cancer Treat Res 2019; 175:193-214. [PMID: 30168123 DOI: 10.1007/978-3-319-93339-9_9] [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: 02/04/2023]
Abstract
Non-muscle-invasive bladder cancer accounts for the majority of incident bladder cancers but is a heterogeneous disease with variation in clinical presentation, course, and outcomes. Risk stratification techniques have attempted to identify those at highest risk of cancer recurrence and progression to help personalize and individualize treatment options. Radical cystectomy during the optimal window of curability could improve cancer outcomes; however, identifying the disease and patient characteristics as well as the correct timing to intervene remains difficult. We review the natural history of non-muscle-invasive bladder cancer, discuss different risk-stratification techniques and how they can help identify those most likely to benefit from radical treatment, and examine the evidence supporting the benefit of timely cystectomy.
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Jung M, Lee JH, Kim B, Park JH, Moon KC. Transcriptional Analysis of Immunohistochemically Defined Subgroups of Non-Muscle-Invasive Papillary High-Grade Upper Tract Urothelial Carcinoma. Int J Mol Sci 2019; 20:E570. [PMID: 30699951 PMCID: PMC6386996 DOI: 10.3390/ijms20030570] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
Immunohistochemical (IHC) staining for CK5/6 and CK20 was reported to be correlated with the prognosis of early urothelial carcinoma in a way contrary to that of advanced tumors for unknown reasons. We aimed to characterize the gene expression profiles of subgroups of non-muscle-invasive papillary high-grade upper tract urothelial carcinoma (UTUC) classified by CK5/6 and CK20 expression levels: group 1 (CK5/6-high/CK20-low), group 2 (CK5/6-high/CK20-high), and group 3 (CK5/6-low/CK20-high). Expression of group 3 was predictive of worse prognosis of non-muscle-invasive papillary high-grade UTUC. Transcriptional analysis revealed 308 differentially expressed genes across the subgroups. Functional analyses of the genes identified cell adhesion as a common process differentially enriched in group 3 compared to the other groups, which could explain its high-risk phenotype. Late cell cycle/proliferation signatures were also enriched in group 3 and in some of the other groups, which may be used as a prognostic biomarker complementary to CK5/6 and CK20. Group 2, characterized by low levels of genes associated with mitogen-activated protein kinase and tumor necrosis factor signaling pathways, was hypothesized to represent the least cancerous subtype considering its normal urothelium-like IHC pattern. This study would facilitate the application of easily accessible prognostic biomarkers in practice.
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Affiliation(s)
- Minsun Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Jeong Hoon Lee
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics and Systems Biomedical Informatics National Core Research Center, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Bohyun Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Jeong Hwan Park
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea.
- Department of Pathology, SMG-SNU Boramae Medical Center, Seoul 03080, Korea.
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea.
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Korea.
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Jung M, Kim B, Moon KC. Immunohistochemistry of cytokeratin (CK) 5/6, CD44 and CK20 as prognostic biomarkers of non-muscle-invasive papillary upper tract urothelial carcinoma. Histopathology 2018; 74:483-493. [PMID: 30286252 DOI: 10.1111/his.13763] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/29/2018] [Indexed: 12/18/2022]
Abstract
AIMS Immunohistochemical (IHC) staining for cytokeratin (CK) 5/6, CD44 and CK20 has been significantly associated with the prognosis of urinary bladder urothelial carcinoma, and probably reflects its molecular characteristics. We aimed to investigate the IHC-based subgroups and their prognostic effects on non-muscle-invasive papillary upper tract urothelial carcinoma (UTUC). METHODS AND RESULTS IHC staining for CK5/6, CK20 and CD44 was analysed in 211 patients with non-muscle-invasive papillary UTUC. Staining was classified as showing a negative, positive or normal pattern. We found that CK5/6-negative, CD44-negative and CK20-positive tumours were distinctly high-risk subgroups that were associated with high grade (CK5/6-negative, P < 0.001; CD44-negative, P < 0.001; CK20-positive, P = 0.017) and frequent intravesical recurrence (CK5/6-negative, P = 0.002). Using survival analysis with Kaplan-Meier and log-rank tests, we found that these IHC subgroups were correlated with poor progression-free (CK5/6-negative, P = 0.001; CD44-negative, P = 0.009; CK20-positive, P = 0.031) and cancer-specific (CK5/6-negative, P = 0.009) survival. Furthermore, CK5/6 negativity was an independent prognostic factor for shorter progression-free (P = 0.009) and cancer-specific (P = 0.045) survival. CK5/6 improved Harrell's C-indices for progression-free (0.68-0.77, P = 0.029) and cancer-specific (0.59-0.77, P < 0.001) survival. When markers were combined, luminal-like subtypes showed poor prognoses. CONCLUSIONS We demonstrated that IHC staining for CK5/6, CD44 and CK20 was significantly associated with the clinicopathological characteristics and prognoses of patients with non-muscle-invasive papillary UTUC. The IHC subgroups may be correlated with the molecular characteristics of non-muscle-invasive papillary UTUC.
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Affiliation(s)
- Minsun Jung
- Department of Pathology, Medical Research Centre, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bohyun Kim
- Department of Pathology, Medical Research Centre, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Chul Moon
- Department of Pathology, Medical Research Centre, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Medical Research Centre, Seoul National University College of Medicine, Seoul, Republic of Korea
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Chakravarthi BVSK, Rodriguez Pena MDC, Agarwal S, Chandrashekar DS, Hodigere Balasubramanya SA, Jabboure FJ, Matoso A, Bivalacqua TJ, Rezaei K, Chaux A, Grizzle WE, Sonpavde G, Gordetsky J, Netto GJ, Varambally S. A Role for De Novo Purine Metabolic Enzyme PAICS in Bladder Cancer Progression. Neoplasia 2018; 20:894-904. [PMID: 30121007 PMCID: PMC6098199 DOI: 10.1016/j.neo.2018.07.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/15/2022] Open
Abstract
Genomic and transcriptome sequencing of bladder cancer (BLCA) has identified multiple molecular alterations during cancer progression. Many of these identified genetic and epigenetic changes play a role in the progression of this disease. Studies have identified molecular subtypes in muscle-invasive bladder cancer (MIBC) with different sensitivities to frontline therapy suggesting the heterogeneity in these tumors and the importance of molecular characterization of MIBC to provide effective treatment. Specifically, it has become increasingly evident, as demonstrated by The Cancer Genome Atlas project, that metabolic enzymes are commonly dysregulated in BLCA. Elevated expression of multiple metabolic enzymes is due to the increased demand from rapidly proliferating BLCA cells requiring extensive nucleotide synthesis. Cancer cells utilize the de novo purine and pyrimidine biosynthetic pathway as a source of their nucleotide needs. In this study, we show that phosphoribosyl aminoimidazole succinocarboxamide synthetase (PAICS), an enzyme involved in de novo purine biosynthetic pathway, is significantly overexpressed in BLCA. Immunohistochemical staining of paraffin-embedded tissue sections showed that PAICS is overexpressed in MIBC. Furthermore, we found that tumor suppressor miR-128 negatively regulated PAICS expression by binding to its 3′-untranslated region. We also found that PAICS induces EMT by positively regulating SNAI1 and by a reduction in E-cadherin expression. Additionally, our in vitro functional studies and in vivo chicken chorioallantoic membrane assay show that PAICS plays a critical role in BLCA cell proliferation, invasion, and tumor growth. Collectively, our data suggest that targeting PAICS may provide a therapeutic option in BLCA.
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Affiliation(s)
- Balabhadrapatruni V S K Chakravarthi
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Sumit Agarwal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Andres Matoso
- Department of Pathology, Urology and Oncology, Johns Hopkins University, Baltimore, MD, USA; The Johns Hopkins University Greenberg Bladder Cancer Institute and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Johns Hopkins University Greenberg Bladder Cancer Institute and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Alcides Chaux
- Department of Scientific Research, Norte University, Asunción, Paraguay
| | - William E Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Guru Sonpavde
- Department of Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George J Netto
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sooryanarayana Varambally
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Informatics Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
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Pichler R, Horninger W, Heidegger I. ASCO 2018: highlights of urothelial cancer and prostate cancer. MEMO 2018; 11:284-290. [PMID: 30595755 PMCID: PMC6280775 DOI: 10.1007/s12254-018-0422-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/10/2018] [Indexed: 12/17/2022]
Abstract
Prostate cancer and urothelial carcinoma are the two most common urological cancers. The aim of this short review is to highlight abstracts from this year's ASCO Annual Meeting. The phase III SPCG-13 trial showed no difference in biochemical disease-free survival by the addition of docetaxel after primary radiation therapy of localized high-risk prostate cancer. In bone dominant metastatic castration resistant prostate cancer, the phase II radium-223 dose escalation study concluded that the currently used dose with 6 cycles of 55 kBq/kg remains the standard of care. The PARP inhibitor olaparib plus abiraterone provided a significant benefit in radiological progression-free survival compared with abiraterone alone, independent of homologous recombination repair (HRR) mutation status. In localized muscle-invasive urothelial carcinoma, two phase II trials (ABACUS and PURE-01) exploring the pathological complete remission rate of atezolizumab and pembrolizumab prior to cystectomy in cisplatin-unfit or cisplatin-fit patients are presented. Novel targeted therapies such as fibroblast growth factor receptor (FGFR) inhibitors or monoclonal antibodies against nectin-4 confirmed astonishing objective response rates in heavily pretreated metastatic urothelial carcinoma (mUC) patients, resulting in a median overall survival (OS) up to 13.8 months. Finally, updated 1‑year and 2‑year OS survival rates of pembrolizumab and atezolizumab in the first line setting of mUC are presented.
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Affiliation(s)
- Renate Pichler
- Department of Urology, Medical University Innsbruck, Anichstreet 35, 6020 Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstreet 35, 6020 Innsbruck, Austria
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Anichstreet 35, 6020 Innsbruck, Austria
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Nadal R, Apolo AB. Overview of Current and Future Adjuvant Therapy for Muscle-Invasive Urothelial Carcinoma. Curr Treat Options Oncol 2018; 19:36. [DOI: 10.1007/s11864-018-0551-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Ochoa AE, Choi W, Su X, Siefker-Radtke A, Czerniak B, Dinney C, McConkey DJ. Specific micro-RNA expression patterns distinguish the basal and luminal subtypes of muscle-invasive bladder cancer. Oncotarget 2018; 7:80164-80174. [PMID: 27845906 PMCID: PMC5348311 DOI: 10.18632/oncotarget.13284] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/12/2016] [Indexed: 11/25/2022] Open
Abstract
The roles of non-coding RNAs in controlling clinical and biological heterogeneity in bladder cancer remain unclear. We used TCGA's published dataset (n = 405 tumors) as a discovery cohort and created a new validation cohort to define the miRNA expression patterns in the basal and luminal molecular subtypes of muscle-invasive bladder cancer (MIBC). We identified 63 miRNAs by PAM, which optimally identified basal and luminal tumors. The targets of the top luminal miRNAs were activators of EMT (ZEB1, ZEB2) and basal subtype transcription (IL-6, EGFR, STAT3), whereas the targets of the top basal miRNAs were involved in adipogenesis pathways and luminal breast cancer (ERBB2, ERBB3). We also identified a 15-miRNA signature that identified stromally infiltrated basal and luminal MIBCs corresponding to the “cluster IV/immune undifferentiated/claudin-low” and “cluster II/luminal immune” subtypes identified previously, which likely contain samples with higher infiltration rates. Using the 63-miRNA signature, we accurately assigned MIBCs to the basal and luminal subtypes and confirmed that patients with basal tumors had shorter overall survival. The results strongly suggest that miRNAs contribute to the control of the gene expression patterns observed in basal and luminal MIBCs and that they can be used as biomarkers and candidate therapeutic targets.
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Affiliation(s)
- Andrea E Ochoa
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Woonyoung Choi
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xiaoping Su
- Department of Bioinformatics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arlene Siefker-Radtke
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bogdan Czerniak
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Colin Dinney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David J McConkey
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Program in Experimental Therapeutics, University of Texas Graduate School of Biomedical Sciences, Houston, Texas, USA.,Program in Cancer Biology, University of Texas Graduate School of Biomedical Sciences, Houston, Texas, USA.,Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
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Precision medicine for urothelial bladder cancer: update on tumour genomics and immunotherapy. Nat Rev Urol 2017; 15:92-111. [PMID: 29133939 DOI: 10.1038/nrurol.2017.179] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Effective management of advanced urothelial bladder cancer is challenging. New discoveries that improve our understanding of molecular bladder cancer subtypes have revealed numerous potentially targetable genomic alterations and demonstrated the efficacy of treatments that harness the immune system. These findings have begun to change paradigms of bladder cancer therapy. For example, DNA repair pathway mutations in genes such as ERCC2, FANCC, ATM, RB1, and others can predict responses to neoadjuvant platinum-based chemotherapies and to targeted therapies on the basis of mutation status. Furthermore, an increasing number of pan-cancer clinical trials (commonly referred to as basket or umbrella trials) are enrolling patients on the basis of molecular and genetic predictors of response. These studies promise to provide improved insight into the true utility of personalized medicine in the treatment of bladder cancer and many other cancer types. Finally, therapies that modulate immune responses have shown great benefit in many cancer types. Several immune checkpoint inhibitors that target programmed cell death protein 1 (PD1), its ligand PDL1, and cytotoxic T lymphocyte-associated protein 4 (CTLA4) have already been approved for use in bladder cancer, representing the most important change to the urological oncologist's tool-kit in over a decade. These advances also provide opportunities for personalization of bladder cancer therapy.
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Özdemir BC, Siefker-Radtke AO, Campbell MT, Subudhi SK. Current and Future Applications of Novel Immunotherapies in Urological Oncology: A Critical Review of the Literature. Eur Urol Focus 2017; 4:442-454. [PMID: 29056275 DOI: 10.1016/j.euf.2017.10.001] [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: 07/27/2017] [Revised: 09/03/2017] [Accepted: 10/10/2017] [Indexed: 01/05/2023]
Abstract
CONTEXT Immunotherapies promote anticancer responses with varying levels of success based on the tumor type. OBJECTIVE In this narrative review article, we searched the literature regarding immunotherapies in genitourinary malignancies to define the state of the field, explore future applications of immune checkpoint inhibitors, cytokines, vaccines, and cellular therapies in urological oncology and evaluate possible strategies to improve the selection of patients who might benefit from such approaches. EVIDENCE ACQUISITION We reviewed related literature, with a focus on recent studies about immunotherapies, predictors of response, and ongoing clinical trials. EVIDENCE SYNTHESIS Immunotherapies based on immune checkpoint blockade are approved as first- and second-line therapies for urothelial carcinoma (UC) and second-line therapies for renal cell carcinoma with limited success in prostate cancer. Programmed death-ligand 1 is the most commonly used predictive biomarker outside of UC; however, a substantial proportion of patients with tumors negative for programmed death-ligand 1 expression benefit from checkpoint inhibition, limiting its sensitivity. A high mutational load and molecular subtypes of UC are emerging as additional potential predictors. Genomic sequencing and gene expression analysis associate alterations of genes implicated in DNA repair pathways, such as BRCA1 and BRCA2, with immune checkpoint therapies. In prostate cancer, the vaccine, sipuleucel-T, is the only Food and Drug Administration-approved immunotherapy. CONCLUSIONS Immunotherapies are emerging as exciting new treatment options with a tolerable toxicity profile in urological cancers. Checkpoint inhibitors are effective only in a subset of patients, demanding personalized approaches that consider various clinical and molecular parameters to predict patient response. Clinical trials investigating the optimal timing, sequence, and combination of immunotherapies with standard of care and novel agents will guide therapy choices and improve patient outcome. PATIENT SUMMARY Clinical data supports the safety and efficacy of immune checkpoint inhibitors alone or in combination with other therapies in urological cancers.
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Affiliation(s)
- Berna C Özdemir
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | | | - Matthew T Campbell
- Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sumit K Subudhi
- Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Shah AY, Gao J, Siefker-Radtke AO. Five new therapies or just one new treatment? A critical look at immune checkpoint inhibition in urothelial cancer. Immunotherapy 2017; 9:781-784. [PMID: 28877627 DOI: 10.2217/imt-2017-0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Amishi Y Shah
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, 1515 Holcombe, Unit 1374, Houston, TX 77030, USA
| | - Jianjun Gao
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, 1515 Holcombe, Unit 1374, Houston, TX 77030, USA
| | - Arlene O Siefker-Radtke
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, 1515 Holcombe, Unit 1374, Houston, TX 77030, USA
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40
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Choi W, Ochoa A, McConkey DJ, Aine M, Höglund M, Kim WY, Real FX, Kiltie AE, Milsom I, Dyrskjøt L, Lerner SP. Genetic Alterations in the Molecular Subtypes of Bladder Cancer: Illustration in the Cancer Genome Atlas Dataset. Eur Urol 2017; 72:354-365. [PMID: 28365159 PMCID: PMC5764190 DOI: 10.1016/j.eururo.2017.03.010] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/06/2017] [Indexed: 12/14/2022]
Abstract
CONTEXT Recent whole genome mRNA expression profiling studies revealed that bladder cancers can be grouped into molecular subtypes, some of which share clinical properties and gene expression patterns with the intrinsic subtypes of breast cancer and the molecular subtypes found in other solid tumors. The molecular subtypes in other solid tumors are enriched with specific mutations and copy number aberrations that are thought to underlie their distinct progression patterns, and biological and clinical properties. OBJECTIVE The availability of comprehensive genomic data from The Cancer Genome Atlas (TCGA) and other large projects made it possible to correlate the presence of DNA alterations with tumor molecular subtype membership. Our overall goal was to determine whether specific DNA mutations and/or copy number variations are enriched in specific molecular subtypes. EVIDENCE We used the complete TCGA RNA-seq dataset and three different published classifiers developed by our groups to assign TCGA's bladder cancers to molecular subtypes, and examined the prevalence of the most common DNA alterations within them. We interpreted the results against the background of what was known from the published literature about the prevalence of these alterations in nonmuscle-invasive and muscle-invasive bladder cancers. EVIDENCE SYNTHESIS The results confirmed that alterations involving RB1 and NFE2L2 were enriched in basal cancers, whereas alterations involving FGFR3 and KDM6A were enriched in luminal tumors. CONCLUSIONS The results further reinforce the conclusion that the molecular subtypes of bladder cancer are distinct disease entities with specific genetic alterations. PATIENT SUMMARY Our observation showed that some of subtype-enriched mutations and copy number aberrations are clinically actionable, which has direct implications for the clinical management of patients with bladder cancer.
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Affiliation(s)
- Woonyoung Choi
- Department of Urology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA; Department of Cancer Biology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Andrea Ochoa
- Department of Urology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA; Department of Cancer Biology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA
| | - David J McConkey
- Department of Urology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA; Department of Cancer Biology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA.
| | - Mattias Aine
- Division of Oncology and Pathology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Mattias Höglund
- Division of Oncology and Pathology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - William Y Kim
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Francisco X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre-CNIO, Madrid, Spain; Departament de Ciències Experimentalsi de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Anne E Kiltie
- Department of Oncology, University of Oxford, Oxford, UK
| | - Ian Milsom
- Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Seth P Lerner
- TCGA Analysis Working Group, Baylor College of Medicine, Houston, Texas, USA
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Eich ML, Dyrskjøt L, Netto GJ. Toward personalized management in bladder cancer: the promise of novel molecular taxonomy. Virchows Arch 2017; 471:271-280. [PMID: 28429075 DOI: 10.1007/s00428-017-2119-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 12/13/2022]
Abstract
Empowered by the recent advances in next generation sequencing and bioinformatics technology, an unprecedented wave of integrated transcriptomic and genomic studies have impacted the field of bladder cancer. These studies not only have confirmed previously charted genetic pathways in bladder cancer development but also have led to the discovery of numerous additional crucial driver genetic alterations. As a result, a novel genomic-based taxonomy is emerging that promises to better define clinically relevant intrinsic subtypes of bladder cancer. The current review is an update on the above advances and their significant implications on the future of bladder cancer patient management.
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Affiliation(s)
- Marie-Lisa Eich
- Department of Pathology, University of Alabama in Birmingham (UAB), Birmingham, AL, USA
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - George J Netto
- Department of Pathology, University of Alabama in Birmingham (UAB), Birmingham, AL, USA.
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Naturally Occurring Canine Invasive Urinary Bladder Cancer: A Complementary Animal Model to Improve the Success Rate in Human Clinical Trials of New Cancer Drugs. Int J Genomics 2017; 2017:6589529. [PMID: 28487862 PMCID: PMC5401760 DOI: 10.1155/2017/6589529] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/13/2017] [Indexed: 12/01/2022] Open
Abstract
Genomic analyses are defining numerous new targets for cancer therapy. Therapies aimed at specific genetic and epigenetic targets in cancer cells as well as expanded development of immunotherapies are placing increased demands on animal models. Traditional experimental models do not possess the collective features (cancer heterogeneity, molecular complexity, invasion, metastasis, and immune cell response) critical to predict success or failure of emerging therapies in humans. There is growing evidence, however, that dogs with specific forms of naturally occurring cancer can serve as highly relevant animal models to complement traditional models. Invasive urinary bladder cancer (invasive urothelial carcinoma (InvUC)) in dogs, for example, closely mimics the cancer in humans in pathology, molecular features, biological behavior including sites and frequency of distant metastasis, and response to chemotherapy. Genomic analyses are defining further intriguing similarities between InvUC in dogs and that in humans. Multiple canine clinical trials have been completed, and others are in progress with the aim of translating important findings into humans to increase the success rate of human trials, as well as helping pet dogs. Examples of successful targeted therapy studies and the challenges to be met to fully utilize naturally occurring dog models of cancer will be reviewed.
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Funt SA, Rosenberg JE. Systemic, perioperative management of muscle-invasive bladder cancer and future horizons. Nat Rev Clin Oncol 2017; 14:221-234. [PMID: 27874062 PMCID: PMC6054138 DOI: 10.1038/nrclinonc.2016.188] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Many patients diagnosed with muscle-invasive bladder cancer (MIBC) will develop distant metastatic disease. Over the past three decades, perioperative cisplatin-based chemotherapy has been investigated for its ability to reduce the number of deaths from bladder cancer. Insufficient evidence is available to fully support the use of such chemotherapy in the adjuvant setting; however, neoadjuvant cisplatin-based combination chemotherapy has become a standard of care for eligible patients based on the improved disease-specific and overall survival demonstrated in two randomized phase III trials, compared with surgery alone. For patients with disease downstaging to non-MIBC at the time of radical cystectomy as a result of neoadjuvant chemotherapy, outcomes are outstanding, with 5-year overall survival of 80-90%. Nevertheless, the inability to define before treatment the patients who will and those who will not achieve such a response has impeded the achievement of better outcomes for patients with MIBC. High-throughput DNA and RNA profiling technologies might help to overcome this barrier and enable a more-personalized approach to the use of cytotoxic neoadjuvant chemotherapy. In the past 2 years, trial results have demonstrated the unprecedented ability of immune- checkpoint blockade to induce durable remissions in patients with metastatic disease that has progressed after chemotherapy; studies are now urgently needed to determine how best to incorporate this powerful therapeutic modality into the care of patients with MIBC. Herein, we review the evolution of chemotherapy and immunotherapy for muscle-invasive bladder cancer.
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Affiliation(s)
- Samuel A Funt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
| | - Jonathan E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
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44
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DNA Repair Pathway Alterations in Bladder Cancer. Cancers (Basel) 2017; 9:cancers9040028. [PMID: 28346378 PMCID: PMC5406703 DOI: 10.3390/cancers9040028] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/30/2022] Open
Abstract
Most bladder tumors have complex genomes characterized by a high mutation burden as well as frequent copy number alterations and chromosomal rearrangements. Alterations in DNA repair pathways—including the double-strand break (DSB) and nucleotide excision repair (NER) pathways—are present in bladder tumors and may contribute to genomic instability and drive the tumor phenotype. DNA damaging such as cisplatin, mitomycin C, and radiation are commonly used in the treatment of muscle-invasive or metastatic bladder cancer, and several recent studies have linked specific DNA repair pathway defects with sensitivity to DNA damaging-based therapy. In addition, tumor DNA repair defects have important implications for use of immunotherapy and other targeted agents in bladder cancer. Therefore, efforts to further understand the landscape of DNA repair alterations in bladder cancer will be critical in advancing treatment for bladder cancer. This review summarizes the current understanding of the role of DNA repair pathway alterations in bladder tumor biology and response to therapy.
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Abstract
Bladder cancer is a complex disease associated with high morbidity and mortality rates if not treated optimally. Awareness of haematuria as the major presenting symptom is paramount, and early diagnosis with individualised treatment and follow-up is the key to a successful outcome. For non-muscle-invasive bladder cancer, the mainstay of treatment is complete resection of the tumour followed by induction and maintenance immunotherapy with intravesical BCG vaccine or intravesical chemotherapy. For muscle-invasive bladder cancer, multimodal treatment involving radical cystectomy with neoadjuvant chemotherapy offers the best chance for cure. Selected patients with muscle-invasive tumours can be offered bladder-sparing trimodality treatment consisting of transurethral resection with chemoradiation. Advanced disease is best treated with systemic cisplatin-based chemotherapy; immunotherapy is emerging as a viable salvage treatment for patients in whom first-line chemotherapy cannot control the disease. Developments in the past 2 years have shed light on genetic subtypes of bladder cancer that might differ from one another in response to various treatments.
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Affiliation(s)
- Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Noah M Hahn
- Departments of Oncology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Per-Uno Malmström
- Department of Surgical Sciences, Urology, Uppsala University, Uppsala, Sweden
| | - Woonyoung Choi
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles C Guo
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Wassim Kassouf
- Department of Surgery (Urology), McGill University Health Center, Montreal, QC, Canada
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Buraschi S, Xu SQ, Stefanello M, Moskalev I, Morcavallo A, Genua M, Tanimoto R, Birbe R, Peiper SC, Gomella LG, Belfiore A, Black PC, Iozzo RV, Morrione A. Suppression of progranulin expression inhibits bladder cancer growth and sensitizes cancer cells to cisplatin. Oncotarget 2016; 7:39980-39995. [PMID: 27220888 PMCID: PMC5129986 DOI: 10.18632/oncotarget.9556] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/08/2016] [Indexed: 12/11/2022] Open
Abstract
We have recently demonstrated a critical role for progranulin in bladder cancer. Progranulin contributes, as an autocrine growth factor, to the transformed phenotype by modulating Akt-and MAPK-driven motility, invasion and anchorage-independent growth. Progranulin also induces F-actin remodeling by interacting with the F-actin binding protein drebrin. In addition, progranulin is overexpressed in invasive bladder cancer compared to normal tissue controls, suggesting that progranulin might play a key role in driving the transition to the invasive phenotype of urothelial cancer. However, it is not established whether targeting progranulin could have therapeutic effects on bladder cancer. In this study, we stably depleted urothelial cancer cells of endogenous progranulin by shRNA approaches and determined that progranulin depletion severely inhibited the ability of tumorigenic urothelial cancer cells to migrate, invade and grow in anchorage-independency. We further demonstrate that progranulin expression is critical for tumor growth in vivo, in both xenograft and orthotopic tumor models. Notably, progranulin levels correlated with response to cisplatin treatment and were upregulated in bladder tumors. Our data indicate that progranulin may constitute a novel target for therapeutic intervention in bladder tumors. In addition, progranulin may serve as a novel biomarker for bladder cancer.
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Affiliation(s)
- Simone Buraschi
- Department of Pathology, Anatomy and Cell Biology and The Cancer Cell Biology and Signaling Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Shi-Qiong Xu
- Department of Urology and Biology and The Prostate Cancer Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Manuela Stefanello
- Department of Urology and Biology and The Prostate Cancer Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Igor Moskalev
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Alaide Morcavallo
- Department of Urology and Biology and The Prostate Cancer Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Marco Genua
- Department of Urology and Biology and The Prostate Cancer Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Ryuta Tanimoto
- Department of Urology and Biology and The Prostate Cancer Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Ruth Birbe
- Department of Pathology, Anatomy and Cell Biology and The Cancer Cell Biology and Signaling Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Stephen C. Peiper
- Department of Pathology, Anatomy and Cell Biology and The Cancer Cell Biology and Signaling Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Leonard G. Gomella
- Department of Urology and Biology and The Prostate Cancer Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Antonino Belfiore
- Department of Health and Endocrinology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Peter C. Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Renato V. Iozzo
- Department of Pathology, Anatomy and Cell Biology and The Cancer Cell Biology and Signaling Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
| | - Andrea Morrione
- Department of Urology and Biology and The Prostate Cancer Program, Kimmel Cancer Center, Thomas Jefferson University, PA, Philadelphia, USA
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Lerner SP, Bajorin DF, Dinney CP, Efstathiou JA, Groshen S, Hahn NM, Hansel D, Kwiatkowski D, O’Donnell M, Rosenberg J, Svatek R, Abrams JS, Al-Ahmadie H, Apolo AB, Bellmunt J, Callahan M, Cha EK, Drake C, Jarow J, Kamat A, Kim W, Knowles M, Mann B, Marchionni L, McConkey D, McShane L, Ramirez N, Sharabi A, Sharpe AH, Solit D, Tangen CM, Amiri AT, Van Allen E, West PJ, Witjes JA, Quale DZ. Summary and Recommendations from the National Cancer Institute's Clinical Trials Planning Meeting on Novel Therapeutics for Non-Muscle Invasive Bladder Cancer. Bladder Cancer 2016; 2:165-202. [PMID: 27376138 PMCID: PMC4927845 DOI: 10.3233/blc-160053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The NCI Bladder Cancer Task Force convened a Clinical Trials Planning Meeting (CTPM) Workshop focused on Novel Therapeutics for Non-Muscle Invasive Bladder Cancer (NMIBC). Meeting attendees included a broad and multi-disciplinary group of clinical and research stakeholders and included leaders from NCI, FDA, National Clinical Trials Network (NCTN), advocacy and the pharmaceutical and biotech industry. The meeting goals and objectives were to: 1) create a collaborative environment in which the greater bladder research community can pursue future optimally designed novel clinical trials focused on the theme of molecular targeted and immune-based therapies in NMIBC; 2) frame the clinical and translational questions that are of highest priority; and 3) develop two clinical trial designs focusing on immunotherapy and molecular targeted therapy. Despite successful development and implementation of large Phase II and Phase III trials in bladder and upper urinary tract cancers, there are no active and accruing trials in the NMIBC space within the NCTN. Disappointingly, there has been only one new FDA approved drug (Valrubicin) in any bladder cancer disease state since 1998. Although genomic-based data for bladder cancer are increasingly available, translating these discoveries into practice changing treatment is still to come. Recently, major efforts in defining the genomic characteristics of NMIBC have been achieved. Aligned with these data is the growing number of targeted therapy agents approved and/or in development in other organ site cancers and the multiple similarities of bladder cancer with molecular subtypes in these other cancers. Additionally, although bladder cancer is one of the more immunogenic tumors, some tumors have the ability to attenuate or eliminate host immune responses. Two trial concepts emerged from the meeting including a window of opportunity trial (Phase 0) testing an FGFR3 inhibitor and a second multi-arm multi-stage trial testing combinations of BCG or radiotherapy and immunomodulatory agents in patients who recur after induction BCG (BCG failure).
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Affiliation(s)
| | - Dean F. Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Colin P. Dinney
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Susan Groshen
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Noah M. Hahn
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Donna Hansel
- University of California, La Jolla, San Diego, CA, USA
| | - David Kwiatkowski
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jonathan Rosenberg
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Robert Svatek
- UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Jeffrey S. Abrams
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Margaret Callahan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Eugene K. Cha
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles Drake
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jonathan Jarow
- Office of Hematology and Oncology Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Ashish Kamat
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Kim
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Margaret Knowles
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Bhupinder Mann
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Luigi Marchionni
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - David McConkey
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisa McShane
- Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Nilsa Ramirez
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Andrew Sharabi
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Arlene H. Sharpe
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - David Solit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Catherine M. Tangen
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Eliezer Van Allen
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | | | - J. A. Witjes
- Department of Urology, Radboud UMC, Nijmegen, The Netherlands
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Abstract
PURPOSE OF REVIEW Recently completed cancer genomics projects identified intrinsic subtypes in muscle-invasive bladder cancers. Here we will describe the studies that led to their discovery and review their biological and clinical properties. RECENT FINDINGS Whole genome mRNA expression profiling and unsupervised hierarchical cluster analyses identified intrinsic basal and luminal subtypes in muscle-invasive bladder cancers that are similar to the ones found in breast cancer. Tumors within each subtype have distinct responses to conventional cisplatin-based combination chemotherapy, and they contain gene expression signatures and DNA alterations that may render them vulnerable to clinically available targeted therapies. SUMMARY Like their breast cancer counterparts, basal bladder cancers are characterized by poor clinical outcomes in the absence of effective systemic therapy, but a large fraction of them do respond to neoadjuvant chemotherapy, suggesting that the tumors should be managed aggressively. On the contrary, tumors that belong to the 'p53-like' subtype tend to be chemoresistant, so patients with these tumors should probably be managed differently. It seems likely that prospective identification of tumor intrinsic subtype membership could complement the use of DNA-based biomarkers to identify the groups of patients who will benefit the most from chemotherapy and targeted agents.
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Jones RT, Felsenstein KM, Theodorescu D. Pharmacogenomics: Biomarker-Directed Therapy for Bladder Cancer. Urol Clin North Am 2015; 43:77-86. [PMID: 26614030 DOI: 10.1016/j.ucl.2015.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The clinical management of bladder cancer has seen little change over the last three decades and there is pressing need to identify more effective treatments for advanced disease. Low clinical use of neoadjuvant therapies stems from historical limitations in the ability to predict patients most likely to respond to combination chemotherapies. This article focuses on recent molecular and genetic studies, highlighting promising clinical trials and retrospective studies, and discusses emerging trials that use predictive biomarkers to match patients with therapies to which they are most likely to respond. The implementation of predictive genomic and molecular biomarkers will revolutionize urologic oncology and the clinical management of bladder cancer.
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Affiliation(s)
- Robert T Jones
- University of Colorado Cancer Center, Aurora, CO, USA; Medical Scientist Training Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth M Felsenstein
- University of Colorado Cancer Center, Aurora, CO, USA; Medical Scientist Training Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dan Theodorescu
- University of Colorado Cancer Center, Aurora, CO, USA; Medical Scientist Training Program, University of Colorado School of Medicine, Aurora, CO, USA.
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