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Kronstedt S, Saffati G, Hinojosa-Gonzalez DE, Doppalapudi SK, Boyle J, Chua K, Jang TL, Cacciamani GE, Ghodoussipour S. Early Adjuvant Chemotherapy Improves Survival in Muscle Invasive Bladder Cancer: A Systematic Review and Meta-analysis. Urology 2024:S0090-4295(24)00770-2. [PMID: 39233282 DOI: 10.1016/j.urology.2024.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/14/2024] [Accepted: 08/29/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To evaluate whether earlier administration of adjuvant chemotherapy (AC) can significantly augment survival rates in muscle-invasive bladder cancer. METHODS We systematically searched PubMed, Cochrane Central, Scopus, and Web of Science library databases for original articles that looked at timing to AC after radical cystectomy. Heterogeneity was assessed using Higgins I2%, with values over 50% considered heterogeneous and analyzed with a random effects model; otherwise, a fixed effects model was used. Studies were stratified based on the cutoff time used for administering AC. Two primary cutoffs were employed: 45 days and 90 days. Immediate AC was defined as chemotherapy administered before the predefined cutoff, while delayed AC was defined as chemotherapy administered after this cutoff. Comparisons were made between immediate versus delayed. RESULTS A total of 5 studies were included. Overall survival (OS) was reported in all of the studies. The meta-analysis showed that immediate AC significantly improved OS, with a hazard ratio (HR) of 1.20 [1.06, 1.36], P=.004. When stratifying by the timing of therapy, starting chemotherapy within 45 days resulted in a greater improvement in survival (HR 1.27 [1.02, 1.59], P=.03) compared to starting within 90 days (HR 1.17 [1.00, 1.36], P=.04). CONCLUSION The findings of this systematic review and meta-analysis emphasize that the timing of AC post-radical cystectomy significantly influences survival outcomes in patients with MIBC. The benefits of early AC initiation underscore its potential in mitigating disease progression and improving long-term survival rates.
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Affiliation(s)
- Shane Kronstedt
- Scott Department of Urology, Baylor College of Medicine, Houston, TX.
| | - Gal Saffati
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | | | - Sai Krishnaraya Doppalapudi
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Cancer Institute of New Jersey, New Brunswick, NJ
| | - Joseph Boyle
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Kevin Chua
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas L Jang
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Cancer Institute of New Jersey, New Brunswick, NJ
| | - Giovanni E Cacciamani
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Saum Ghodoussipour
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Cancer Institute of New Jersey, New Brunswick, NJ
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Campbell MT, Shah AY, Msaouel P, Tannir NM, Siefker-Radtke AO, Kamat AM, Navai N, Dinney CPN, Rao P, Guo CC, Sheth RA, Venkatesan AM, Tidwell RS, Yadav SS, Gu A, Chen H, Macaluso M, Duan F, Basu S, Jindal S, Sharma P. A Pilot Study of the CD38 Antagonist Daratumumab in Patients with Metastatic Renal Cell Carcinoma or Muscle-Invasive Bladder Cancer. CANCER RESEARCH COMMUNICATIONS 2024; 4:2444-2453. [PMID: 39207194 PMCID: PMC11406637 DOI: 10.1158/2767-9764.crc-24-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/28/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE We performed a pilot study of daratumumab (an mAb directed against CD38) in muscle-invasive bladder cancer (MIBC) and treatment-refractory metastatic renal cell carcinoma (mRCC). EXPERIMENTAL DESIGN Patients with MIBC underwent baseline transurethral resection of the bladder tumor followed by four weekly doses of daratumumab prior to cystectomy. Patients with mRCC underwent baseline and sequential biopsies after eight weekly doses. The primary endpoint was safety. The secondary endpoints were pathologic complete response rate for the MIBC cohort and objective response rate and progression-free survival for the mRCC cohort. Exploratory analyses included immune monitoring and overall survival. A Bayesian sequential monitoring design for toxicity was used for excessive toxicity. RESULTS In both the MIBC (n = 8) and mRCC (n = 8) cohorts, no toxicity events were encountered. In the MIBC cohort, one patient experienced pathologic complete response rate. In the mRCC cohort, no objective responses were reported, and the median progression-free survival was 1.5 months (95% confidence interval, 1.1-1.8 months). Immune monitoring found significant reductions in NK cells in circulation in both cohorts after treatment. In the tissue analysis, IHC found evidence of diminished CD38 presence in mRCC with treatment, whereas the baseline levels in MIBC were low. CONCLUSION Treatment with daratumumab was safe. No signal of efficacy was detected in mRCC, and conclusions on the activity in MIBC were limited. Evidence of daratumumab targeting CD38 was detected in circulating immune cells and within the tumor microenvironment of mRCC and MIBC. SIGNIFICANCE In this prospective clinical trial of daratumumab, treatment in patients with MIBC and mRCC was safe. Limited efficacy was observed. Treatment with daratumumab resulted in CD38-expressing immune cell subsets to be targeted both in circulation and within the tumor microenvironment.
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Affiliation(s)
- Matthew T Campbell
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amishi Y Shah
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Arlene O Siefker-Radtke
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Colin P N Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Priya Rao
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles C Guo
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rahul A Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aradhana M Venkatesan
- Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rebecca S Tidwell
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shalini S Yadav
- Immunotherapy Platform, University of MD Anderson Cancer Center, Houston, Texas
| | - Aidi Gu
- Immunotherapy Platform, University of MD Anderson Cancer Center, Houston, Texas
| | - Hong Chen
- Immunotherapy Platform, University of MD Anderson Cancer Center, Houston, Texas
- James P. Allison Institute, University of MD Anderson Cancer Center, Houston, Texas
| | - Marc Macaluso
- Immunotherapy Platform, University of MD Anderson Cancer Center, Houston, Texas
- James P. Allison Institute, University of MD Anderson Cancer Center, Houston, Texas
| | - Fei Duan
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sreyashi Basu
- Immunotherapy Platform, University of MD Anderson Cancer Center, Houston, Texas
- James P. Allison Institute, University of MD Anderson Cancer Center, Houston, Texas
| | - Sonali Jindal
- Immunotherapy Platform, University of MD Anderson Cancer Center, Houston, Texas
- James P. Allison Institute, University of MD Anderson Cancer Center, Houston, Texas
| | - Padmanee Sharma
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Immunotherapy Platform, University of MD Anderson Cancer Center, Houston, Texas
- James P. Allison Institute, University of MD Anderson Cancer Center, Houston, Texas
- Department of Immunology, University of MD Anderson Cancer Center, Houston, Texas
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Escott M, Yi Y, Foret A, Li T, Hsieh M, Delacroix SE, Wu X, Westerman ME. Impact of rural location on receipt of standard of care treatment and survival for locally advanced bladder cancer in Louisiana. Cancer Med 2024; 13:e7301. [PMID: 38923853 PMCID: PMC11199337 DOI: 10.1002/cam4.7301] [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: 11/30/2023] [Revised: 02/22/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE We aim to determine the effect of region of residence (urban vs. rural) on the odds of receiving standard of care treatment for locally advanced BCa in Louisiana and its impact on survival outcomes. METHODS Using the Louisiana Tumor Registry, we identified American Joint Committee on Cancer (AJCC) stage II or III, BCa diagnoses in Louisiana residents between 2010 and 2020. Treatment received was classified as standard or non-standard of care according to American Urological Association (AUA) guidelines and location of residence was determined using Rural Urban Commuting Area-Tract-level 2010 (RUCA). Multivariable logistic regression analyses and multivariate cox proportional hazard analyses were performed. RESULTS Of 983 eligible patients, 85.6% (841/983) lived in urban areas. Overall, only 37.5% received standard-of-care (SOC) for the definitive management of locally advanced bladder cancer. Individuals living in rural areas (OR 0.53, 95% CI: 0.31-0.91, p = 0.02) were less likely to receive standard of care treatment. Both rural residence and receipt of non-standard of care therapy were associated with an increased risk of bladder cancer-specific (adj HR 1.53, 95% CI: 1.09-2.14, p = 0.01 and adj HR: 1.85, 95% CI: 1.43-2.39, <0.0001) and overall mortality (adj HR: 1.28, 95% CI: 1.01-1.61, p = 0.04 and adj HR: 1.73 95% CI: 1.44-2.07, p < 0.0001). CONCLUSIONS Most patients with locally advanced bladder cancer in Louisiana do not receive SOC therapy. Individuals living in rural locations are more likely to receive non-standard of care therapy than individuals in urban areas. Nonstandard of care treatment and rural residence are both associated with worse survival outcomes for Louisiana residents with locally advanced bladder cancer.
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Affiliation(s)
- Megan Escott
- School of MedicineLSU Health Science CenterNew OrleansLouisianaUSA
- Department of UrologyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Yong Yi
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | - Ashley Foret
- School of MedicineLSU Health Science CenterNew OrleansLouisianaUSA
| | - TingTing Li
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | - Mei‐Chin Hsieh
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | | | - Xiao‐Cheng Wu
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | - Mary E. Westerman
- Department of UrologyLSU Health Science CenterNew OrleansLouisianaUSA
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Wang Z, He W, Ying Y, Wang M, Chen Q, Zhang Z, Zeng S, Xu C. Patients With Muscle-Invasive Bladder Cancer With Lymphovascular Invasion in Transurethral Resection Specimen Benefits Most From Platinum-Based Neoadjuvant Chemotherapy. Clin Genitourin Cancer 2024; 22:201-209.e7. [PMID: 37989709 DOI: 10.1016/j.clgc.2023.10.014] [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: 07/14/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE The survival benefit of neoadjuvant chemotherapy (NAC) before definitive radical cystectomy (RC) varied among patients, suggesting proper selection of patients for NAC to maximize the survival benefit. This study aimed to investigate the role of lymphovascular invasion (LVI) in transurethral resection (TUR) specimens in selecting patients with MIBC for NAC. METHODS Two retrospective cohorts of patients with cT2-4aN0 MIBC who underwent RC from 2004 to 2015 provided by Lund University were included. Inverse probability weighting was applied to make the NAC-treated (NAC) and untreated (non-NAC) cohorts comparable. Survival benefits were estimated with Kaplan-Meier curves and Cox proportional hazards models. The primary endpoint was cancer-specific survival (CSS). LVI in TUR specimens and molecular taxonomies (BASE47, UNC, and LundTax) were examined, and bulk RNA-seq datasets were explored for LVI-relevant signatures. RESULTS A total of 341 patients with cT2-4aN0 MIBC were included. The NAC cohort included 125 patients, whereas the non-NAC cohort included 216 patients. The 3-year CSS benefit of NAC was 7.1%. For patients with positive LVI in TUR specimens, the 3-year CSS benefit of NAC was 26.2% (48.1% vs. 74.3%), with a risk reduction of 56% (HR = 0.44, P = .03). A sensitivity analysis confirmed a significant interaction between LVI and NAC. This study failed to identify the molecular subtypes that maximized the survival benefit of NAC. Exploration of LVI-relevant signatures remains inconclusive. CONCLUSIONS LVI in TUR specimens could help identify patients with MIBC who would derive maximal survival benefit from NAC. Further prospective validation is necessary.
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Affiliation(s)
- Ziwei Wang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Wei He
- Department of Clinical Medicine, Naval Medical University, Shanghai, China
| | - Yidie Ying
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Maoyu Wang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Qing Chen
- Department of Urology, Changhai Hospital, Shanghai, China
| | | | - Shuxiong Zeng
- Department of Urology, Changhai Hospital, Shanghai, China.
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Shanghai, China.
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Tripathi N, Fortuna GG, Gebrael G, Dal E, Mathew Thomas V, Gupta S, Swami U. Predictors of response to neoadjuvant therapy in urothelial cancer. Crit Rev Oncol Hematol 2024; 194:104236. [PMID: 38128631 DOI: 10.1016/j.critrevonc.2023.104236] [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: 05/22/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Neoadjuvant cisplatin-based chemotherapy (NACC) followed by radical cystectomy is the standard treatment for localized muscle-invasive bladder cancer (MIBC). Patients who achieve a complete pathological response following NACC have better overall survival than those with residual disease. However, a subset of patients does not derive benefit from NACC while experiencing chemotherapy-related side effects that may delay cystectomy, which can be detrimental. There is a need for predictive and prognostic biomarkers to better stratify patients who will derive benefits from NACC. This review summarizes the currently available literature on various predictors of response to neoadjuvant chemotherapy. Covered predictors include clinical factors, treatment regimens (including chemotherapy and immunotherapy), histological predictors, and molecular predictors such as DNA repair genes, p53, FGFR3, ERBB2, Bcl-2, EMMPRIN, survivin, choline-phosphate cytidylyltransferase-α, epigenetic markers, immunological markers, other molecular predictors and gene expression profiling. Further, we elaborate on the potential role of neoadjuvant immunotherapy and the correlative biomarkers of response.
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Affiliation(s)
- Nishita Tripathi
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Gliceida Galarza Fortuna
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Georges Gebrael
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Emre Dal
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Vinay Mathew Thomas
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Sumati Gupta
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Umang Swami
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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Reike MJ, Reicherz A, Tully KH, Bahlburg H, Maas M, Bach P, Klümper N, Eckstein M, Hartmann A, Breyer J, Erben P, Bolenz C, Noldus J, Berg S, Roghmann F. An Empirical Survey on the Adaption of Neoadjuvant Chemotherapy in Bladder Cancer. Urol Int 2024; 108:183-189. [PMID: 38246156 DOI: 10.1159/000536321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The aim of the study was to determine the adaption of neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC) in Germany, Austria, and Switzerland and especially underlying reasons for potential low adherence to guidelines. METHODS We conducted a non-validated survey among 336 urologic departments in Germany, Austria, and Switzerland. RedCap questionnaires were electronically distributed and included 23 items concerning the general NAC administration standards and guideline compliance in patient counseling regarding the actual treatment. RESULTS The return rate of the questionnaire was 19.1% (63/336). Although 45 departments (71.4%) claim to perform NAC as the standard of care, only 49% of eligible patients actually receive NAC. An advanced disease stage (≥cT3) and a high tumor volume were mentioned to support the application of NAC, whereas 35% of responders worry about deterioration of patients' preoperative status due to NAC. Furthermore, 26.7% of respondents are concerned about the low extent of survival benefit. CONCLUSION Application of NAC in eligible MIBC patients in Germany, Austria, and Switzerland remains low. Although the majority of urologic departments discuss NAC and acknowledge the need for intensified treatment in advanced disease stages, not all eligible patients will actually receive NAC before radical cystectomy.
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Affiliation(s)
- Moritz J Reike
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Alina Reicherz
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Karl H Tully
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Henning Bahlburg
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Moritz Maas
- Department of Urology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Peter Bach
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Niklas Klümper
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes Breyer
- Department of Urology, University of Regensburg, Caritas St. Josef Hospital, Regensburg, Germany
| | - Philipp Erben
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Sebastian Berg
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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Saito T, Matsumoto K, Tanaka N, Fukumoto K, Yasumizu Y, Takeda T, Morita S, Kosaka T, Mizuno R, Asanuma H, Hara S, Oya M. Prognostic impact of tumor ureteral invasion on recurrence after radical cystectomy. Int Urol Nephrol 2024; 56:129-135. [PMID: 37731158 DOI: 10.1007/s11255-023-03808-6] [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: 08/04/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Several preoperative factors have been suggested to be risk factors of disease recurrence after radical cystectomy. There is no study focusing on the impact on prognosis of bladder tumor ureteral invasion in preoperative imaging. METHODS The study population consisted of 136 patients, all of whom underwent radical cystectomy during the period between 2007-2019. We excluded patients with concurrent or a history of upper tract urothelial carcinoma and who underwent radical cystectomy for other cancers or nononcologic reasons. The starting point of this study was the timing of neoadjuvant chemotherapy or radical cystectomy and the endpoint was the timing of disease recurrence. To identify the factors influencing recurrence, univariate and multivariate analyses were performed using the Cox proportional hazard model. Recurrence-free survival curves were constructed using the Kaplan-Meier method. RESULTS Ureteral invasion was observed in 20 (14.7%) patients. Disease recurrence was observed in 11 (55.0%) of 20 ureteral invasion positive patients and 35 (30.2%) of 116 ureteral invasion negative patients, respectively. In the ureteral invasion positive group, clinical T and N stage were higher and hydronephrosis were more common than in the ureteral invasion negative group. According to the multivariate analysis, ureteral invasion (hazard ratio: 2.307, p = 0.016) and clinical N stage ≥ 1 (hazard ratio: 2.140, p = 0.028) were independent risk factors for postoperative recurrence. In the ureteral invasion positive group, more local recurrences were observed. CONCLUSION This study suggested that ureteral invasion in preoperative imaging is a significant risk factor for postoperative recurrence.
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Affiliation(s)
- Takafumi Saito
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Keishiro Fukumoto
- Department of Urology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-Ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Yota Yasumizu
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shinya Morita
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Satoshi Hara
- Department of Urology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-Ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
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8
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Lim KYY, Chu K, Rajarubendra N, Huang J, Pook D, Manohar P, Harper M, Donnellan S, Ranasinghe W. Patterns of chemotherapy use in muscle-invasive bladder cancer in a tertiary centre. Bladder (San Franc) 2023; 10:e21200013. [PMID: 38163008 PMCID: PMC10754695 DOI: 10.14440/bladder.2023.872] [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: 10/13/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives Although neoadjuvant chemotherapy (NAC) has been demonstrated to have significant benefits to survival in patients with muscle-invasive bladder cancer (MIBC), the current utilization of NAC in Australia is unknown. The aim of this study was to evaluate the patterns of neoadjuvant and adjuvant chemotherapy (AC) use in patients undergoing cystectomy for MIBC at a large tertiary institution in Australia. Methods A retrospective study was conducted using data of patients who underwent a radical cystectomy (RC) at a high-volume centre for MIBC between 2011 and 2021. Results Of 69 patients who had a cystectomy for ≥ pT2 bladder cancer, 73.9% were eligible for NAC. However, of those eligible, only five patients received NAC (9.8%). Of the total patients who were eligible for AC, only 44.4% received postoperative chemotherapy. Common reasons for the lack of uptake were due to patients being unfit or declining treatment. There was no difference in progression-free survival or overall survival in those who received NAC and AC. Conclusions The majority of patients undergoing RC for MIBC received AC compared to NAC, reflecting the real-world challenge of NAC uptake. This highlights the need for ongoing improvements in selection and usage of NAC and less reliance of AC utilization post RC.
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Affiliation(s)
- Kylie Yen-Yi Lim
- Department of Urology, Monash Health, Casey, VIC, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Kevin Chu
- Department of Urology, Monash Health, Casey, VIC, Australia
| | | | - James Huang
- Department of Urology, Monash Health, Casey, VIC, Australia
| | - David Pook
- Department of Oncology, Monash Health, Clayton, VIC, Australia
| | - Paul Manohar
- Department of Urology, Monash Health, Casey, VIC, Australia
| | - Matthew Harper
- Department of Urology, Monash Health, Casey, VIC, Australia
| | | | - Weranja Ranasinghe
- Department of Urology, Monash Health, Casey, VIC, Australia
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
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9
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Kool R, Marcq G, Breau RH, Black PC, Shayegan B, Kim M, Busca I, Abdi H, Dawidek MT, Uy M, Fervaha G, Cury FL, Alimohamed NS, Izawa JI, Jeldres C, Rendon R, Siemens DR, Kulkarni GS, Kassouf W. Radiation-based Therapy for Muscle-invasive Bladder Cancer: Contemporary Outcomes Across Tertiary Centers. Eur Urol Oncol 2023; 6:597-603. [PMID: 37005214 DOI: 10.1016/j.euo.2023.03.004] [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: 08/22/2022] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Radiation therapy (RT) is an alternative to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). OBJECTIVE To analyze predictors of complete response (CR) and survival after RT for MIBC. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter retrospective study of 864 patients with nonmetastatic MIBC who underwent curative-intent RT from 2002 to 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Regression models were used to explore prognostic factors associated with CR, cancer-specific survival (CSS), and overall survival (OS). RESULTS AND LIMITATIONS The median patient age was 77 yr and median follow-up was 34 mo. Disease stage was cT2 in 675 patients (78%) and cN0 in 766 (89%). Neoadjuvant chemotherapy (NAC) was given to 147 patients (17%) and concurrent chemotherapy to 542 (63%). A CR was experienced by 592 patients (78%). cT3-4 stage (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.29-0.63; p < 0.001) and hydronephrosis (OR 0.50, 95% CI 034-0.74; p = 0.001) were significantly associated with lower CR. The 5-yr survival rates were 63% for CSS and 49% for OS. Higher cT stage (HR 1.93, 95% CI 1.46-2.56; p < 0.001), carcinoma in situ (HR 2.10, 95% CI 1.25-3.53; p = 0.005), hydronephrosis (HR 2.36, 95% CI 1.79-3.10; p < 0.001), NAC use (HR 0.66, 95% CI 0.46-0.95; p = 0.025), and whole-pelvis RT (HR 0.66, 95% CI 0.51-0.86; p = 0.002) were independently associated with CSS; advanced age (HR 1.03, 95% CI 1.01-1.05; p = 0.001), worse performance status (HR 1.73, 95% CI 1.34-2.22; p < 0.001), hydronephrosis (HR 1.50, 95% CI 1.17-1.91; p = 0.001), NAC use (HR 0.69, 95% CI 0.49-0.97; p = 0.033), whole-pelvis RT (HR 0.64, 95% CI 0.51-0.80; p < 0.001), and being surgically unfit (HR 1.42, 95% CI 1.12-1.80; p = 0.004) were associated with OS. The study is limited by the heterogeneity of different treatment protocols. CONCLUSIONS RT for MIBC yields a CR in most patients who elect for curative-intent bladder preservation. The benefit of NAC and whole-pelvis RT require prospective trial validation. PATIENT SUMMARY We investigated outcomes for patients with muscle-invasive bladder cancer treated with curative-intent radiation therapy as an alternative to surgical removal of the bladder. The benefit of chemotherapy before radiotherapy and whole-pelvis radiation (bladder plus the pelvis lymph nodes) needs further study.
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Affiliation(s)
- Ronald Kool
- Division of Urology, McGill University Health Center, Montreal, Canada; Department of Abdominal Surgery, Erasto Gaertner Cancer Center, Curitiba, Brazil
| | - Gautier Marcq
- Division of Urology, McGill University Health Center, Montreal, Canada; Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France; Cancer Heterogeneity Plasticity and Resistance to Therapies, CNRS, Inserm, University of Lille, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Rodney H Breau
- Ottawa Hospital Research Institute, Division of Urology, University of Ottawa, Ottawa, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Bobby Shayegan
- Division of Urology, McMaster University, Hamilton, Canada
| | - Michael Kim
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Ionut Busca
- Ottawa Hospital Research Institute, Division of Urology, University of Ottawa, Ottawa, Canada
| | - Hamidreza Abdi
- Ottawa Hospital Research Institute, Division of Urology, University of Ottawa, Ottawa, Canada
| | - Mark T Dawidek
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Michael Uy
- Division of Urology, McMaster University, Hamilton, Canada
| | - Gagan Fervaha
- Department of Urology, Queen's University, Kingston, Canada
| | - Fabio L Cury
- Division of Urology, McGill University Health Center, Montreal, Canada; Department of Radiation Oncology, McGill University Health Center, Montreal, Canada
| | | | | | - Claudio Jeldres
- Division of Urology, University of Sherbrooke, Sherbrooke, Canada
| | - Ricardo Rendon
- Division of Urology, Dalhousie University, Halifax, Canada
| | | | - Girish S Kulkarni
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Wassim Kassouf
- Division of Urology, McGill University Health Center, Montreal, Canada.
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10
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Li R, Naidu S, Fan W, Rose K, Huelster H, Grass GD, Vosoughi A, Dhillon J, Kim Y, Gupta S, Jain RK, Zhang J, Zemp L, Yu A, Poch MA, Spiess PE, Pow-Sang J, Gilbert SM, Sexton WJ. Effectiveness of perioperative chemotherapy and radical cystectomy in treating bladder cancer. Urol Oncol 2023; 41:457.e17-457.e24. [PMID: 37880002 DOI: 10.1016/j.urolonc.2023.09.017] [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: 03/05/2023] [Revised: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Despite abundant evidence supporting the use of perioperative chemotherapy from clinical trials, no study to date has comprehensively evaluated its use in the treatment of muscle-invasive bladder cancer (MIBC) in the real-world setting. Little is known regarding the impact of pretreatment disease stage and real-world factors such as patient comorbidities preventing timely completion of therapy on its effectiveness. This study aims to assess the usage of perioperative chemotherapy and examines its impact on pathologic downstaging rates and recurrence free survival in patients undergoing radical cystectomy. METHODS A retrospective review was conducted in 805 patients with muscle invasive bladder cancer undergoing radical cystectomy with no perioperative chemotherapy, 761 with presurgical chemotherapy followed by radical cystectomy, and 134 radical cystectomy followed by adjuvant chemotherapy. Relevant clinicopathologic features were reviewed. Recurrence-free survival and Overall Survival probability estimates were calculated using the Kaplan-Meier method and compared using the Log-rank or Gehan-Breslow tests. The prognostic effects of presurgical chemotherapy and adjuvant chemotherapy regimens were evaluated by estimating hazard ratio and 95% confidence interval from an adjusted Cox proportional hazards model. Statistical tests were 2-sided, and significance was defined as P-value < 0.05. RESULTS In this contemporary, real-world cohort, 5-yr RFS was found to be 65.6% in pT0, 59.1%in pT2, and 10.8% in pN+ patients. Presurgical chemotherapy increased pathologic downstaging rates from 27.5% to 41.1% in patients with ≥cT2 BCa. Stratified by clinical T-stage, only cT2 patients derived recurrence-free survival (Median 45.3 months vs. 29.0 months, P < 0.01) and overall survival (Median 62.3 months vs. 41.9 months, P < 0.001) benefits. In patients with adverse pathologic features (≥pT3 or pN+), adjuvant chemotherapy improved recurrence-free survival (Median 22.8 months vs. 10.0 months, P < 0.0001) and overall survival (Median OS 32.4 months vs. 16.3 months, P < 0.0001). CONCLUSIONS We report real-world outcomes from a large cohort of muscle-invasive bladder cancer patients undergoing surgical treatment with/out perioperative chemotherapy. Pathologic response rates to pre-surgical chemotherapy were modest and led to clinical benefit only in cT2 patients. Adjuvant chemotherapy provided survival benefit for pathologically advanced MIBC patients irrespective of pT/N staging.
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Affiliation(s)
- Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL.
| | - Shreyas Naidu
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Wenyi Fan
- Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Kyle Rose
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Heather Huelster
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - George Daniel Grass
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Aram Vosoughi
- Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jasreman Dhillon
- Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Youngchul Kim
- Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Rohit K Jain
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jingsong Zhang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Logan Zemp
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Alice Yu
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Michael A Poch
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Julio Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
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11
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Maas M, Black PC. Radical Transurethral Resection of Bladder Tumor in Seemingly Organ-confined Muscle-invasive Bladder Cancer: Con. Eur Urol Focus 2022; 9:223-224. [PMID: 36220762 DOI: 10.1016/j.euf.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022]
Abstract
Bladder-preserving therapy using radical transurethral resection of bladder tumor is currently not a reasonable curative treatment option given the inaccuracy of diagnostic modalities. However, owing to the disadvantages of radical cystectomy, research on bladder-preserving treatment options remains important.
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Affiliation(s)
- Moritz Maas
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Department of Urology, University of Tübingen, Tübingen, Germany
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
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12
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Nomogram based on baseline clinicopathological characteristics for predicting bladder cancer-specific survival to neoadjuvant chemotherapy in muscle-invasive bladder cancer. World J Urol 2022; 40:2627-2634. [DOI: 10.1007/s00345-022-04147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022] Open
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13
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Are We Ready to Implement Molecular Subtyping of Bladder Cancer in Clinical Practice? Part 2: Subtypes and Divergent Differentiation. Int J Mol Sci 2022; 23:ijms23147844. [PMID: 35887192 PMCID: PMC9317362 DOI: 10.3390/ijms23147844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Following several attempts to achieve a molecular stratification of bladder cancer (BC) over the last decade, a "consensus" classification has been recently developed to provide a common base for the molecular classification of bladder cancer (BC), encompassing a six-cluster scheme with distinct prognostic and predictive characteristics. In order to implement molecular subtyping (MS) as a risk stratification tool in routine practice, immunohistochemistry (IHC) has been explored as a readily accessible, relatively inexpensive, standardized surrogate method, achieving promising results in different clinical settings. The second part of this review deals with the pathological and clinical features of the molecular clusters, both in conventional and divergent urothelial carcinoma, with a focus on the role of IHC-based subtyping.
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14
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Benidir T, Lone Z, Zhang A, Nowacki AS, Munoz-Lopez C, Hegde P, Fung K, Fajnzylber J, Abouassaly R, Berglund R, Klein EA, Eltemamy M, Kaouk J, Weight CJ, Almassi N, Pascal-Haber G, Lee BH. Comparing Pathologic and Survival Outcomes Between Primary and Secondary Muscle Invasive Bladder Cancer when treated by Radical Cystectomy With or Without Neoadjuvant Chemotherapy. Urology 2022; 168:137-142. [PMID: 35772481 DOI: 10.1016/j.urology.2022.06.012] [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: 04/10/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To compare pathologic and survival outcomes between primary muscle invasive (pMIBC) and secondary muscle invasive (sMIBC) bladder cancer patients who were treated with or without cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). METHODS We reviewed cT2-T4/N0 MIBC patients at our institution between 2010-2019. pMIBC was defined as presenting with > cT2 disease on initial or restaging TURBT with no prior history of bladder cancer. sMIBC was defined as prior history of NMIBC that was treated with at least one induction course of BCG that progressed to MIBC. Outcomes analyzed included pathologic downstaging rates defined as <pT2/N0, pathologic complete response rates (pT0/N0), and survival outcomes (RFS, CSS, OS). Survival outcomes were analyzed using the Kaplan-Meier Method or Gray's test with log rank. Cox Proportional Hazards and semiparametric hazards models proposed by Fine and Gray were constructed to identify predictors of oncologic outcomes. RESULTS 333 patients were included in the analysis (sMIBC: 48 vs pMIBC: 285). There were no differences in pathologic downstaging (sMIBC: 54% vs. pMIBC: 51%, p=0.67) or pathologic complete response (sMIBC: 33% vs. pMIBC: 28, p=0.46). Survival analysis showed no differences when patients were treated with NAC+RC in oncologic outcomes. On regression analysis, only >pT2 and N+ disease were predictors of poorer CSS and OS. Separate analysis of sMIBC patients whom underwent RC only (N=61), demonstrated inferior oncologic outcomes to other cohorts (p<0.01). CONCLUSION There were no differences in pathologic response or survival between pMIBC and sMIBC patients when managed with NAC and RC.
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Affiliation(s)
- Tarik Benidir
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Zaeem Lone
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Ao Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Amy S Nowacki
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, Ohio
| | | | - Pranay Hegde
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Kevin Fung
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | | | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan Berglund
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Mohammed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Nima Almassi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Byron H Lee
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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15
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Wei Y, Amend B, Todenhöfer T, Lipke N, Aicher WK, Fend F, Stenzl A, Harland N. Urinary Tract Tumor Organoids Reveal Eminent Differences in Drug Sensitivities When Compared to 2-Dimensional Culture Systems. Int J Mol Sci 2022; 23:ijms23116305. [PMID: 35682984 PMCID: PMC9181330 DOI: 10.3390/ijms23116305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 12/31/2022] Open
Abstract
Generation of organoids from urinary tract tumor samples was pioneered a few years ago. We generated organoids from two upper tract urothelial carcinomas and from one bladder cancer sample, and confirmed the expression of cytokeratins as urothelial antigens, vimentin as a mesenchymal marker, and fibroblast growth factor receptor 3 by immunohistochemistry. We investigated the dose response curves of two novel components, venetoclax versus S63845, in comparison to the clinical standard cisplatin in organoids in comparison to the corresponding two-dimensional cultures. Normal urothelial cells and tumor lines RT4 and HT1197 served as controls. We report that upper tract urothelial carcinoma cells and bladder cancer cells in two-dimensional cultures yielded clearly different sensitivities towards venetoclax, S63845, and cisplatin. Two-dimensional cultures were more sensitive at low drug concentrations, while organoids yielded higher drug efficacies at higher doses. In some two-dimensional cell viability experiments, colorimetric assays yielded different IC50 toxicity levels when compared to chemiluminescence assays. Organoids exhibited distinct sensitivities towards cisplatin and to a somewhat lesser extent towards venetoclax or S63845, respectively, and significantly different sensitivities towards the three drugs investigated when compared to the corresponding two-dimensional cultures. We conclude that organoids maintained inter-individual sensitivities towards venetoclax, S63845, and cisplatin. The preclinical models and test systems employed may bias the results of cytotoxicity studies.
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Affiliation(s)
- Yi Wei
- Center for Medicine Research, Eberhard Karls University, 72072 Tuebingen, Germany; (Y.W.); (N.L.); (W.K.A.)
| | - Bastian Amend
- Department of Urology, University Hospital, 72076 Tuebingen, Germany; (B.A.); (T.T.); (A.S.)
| | - Tilman Todenhöfer
- Department of Urology, University Hospital, 72076 Tuebingen, Germany; (B.A.); (T.T.); (A.S.)
| | - Nizar Lipke
- Center for Medicine Research, Eberhard Karls University, 72072 Tuebingen, Germany; (Y.W.); (N.L.); (W.K.A.)
| | - Wilhelm K. Aicher
- Center for Medicine Research, Eberhard Karls University, 72072 Tuebingen, Germany; (Y.W.); (N.L.); (W.K.A.)
| | - Falko Fend
- Institute for Pathology, Eberhard Karls University, 72076 Tuebingen, Germany;
| | - Arnulf Stenzl
- Department of Urology, University Hospital, 72076 Tuebingen, Germany; (B.A.); (T.T.); (A.S.)
| | - Niklas Harland
- Department of Urology, University Hospital, 72076 Tuebingen, Germany; (B.A.); (T.T.); (A.S.)
- Correspondence: ; Tel.: +49-7071-298-6613
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16
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Kool R, Yanev I, Hijal T, Vanhuyse M, Cury FL, Souhami L, Kassouf W, Dragomir A. Trimodal therapy vs. radical cystectomy for muscle-invasive bladder cancer: A Canadian cost-effectiveness analysis. Can Urol Assoc J 2022; 16:189-198. [PMID: 35099381 PMCID: PMC9245963 DOI: 10.5489/cuaj.7430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Trimodal therapy (TMT) is a suitable alternative to neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for patients with muscle-invasive bladder cancer (MIBC). In this study, we conducted a cost-effectiveness evaluation of RC±NAC vs. TMT for MIBC in the universal and publicly funded Canadian healthcare system. METHODS We developed a Markov model with Monte-Carlo microsimulations. Rates and probabilities of transitioning within different health states (e.g., cure, locoregional recurrence, distant metastasis, death) were input in the model after a scoped literature review. Two main scenarios were considered: 1) academic center; and 2) populational-level. Results were reported in life-years gained (LYG), quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER). A sensitivity analysis was performed. RESULTS A total of 20 000 patients were simulated. For the academic center model, TMT was associated with increased effectiveness (both in LYG and QALY) at a higher cost compared to RC±NAC at five and 10 years. This resulted in an ICER of $19 746/QALY per patient undergoing the TMT strategy at 10 years of followup. For the populational-level model, RC±NAC was associated with higher effectiveness at 10 years, with an ICER of $3319/QALY per patient. This study was limited by heterogeneity within the studies used to build the model. CONCLUSIONS In this study, TMT performed in academic centers was cost-effective compared to RC±NAC, with higher effectiveness at a higher cost. On the other hand, RC±NAC was considered cost-effective compared to TMT at the populational-level. Further studies are needed to confirm these results.
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Affiliation(s)
- Ronald Kool
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Ivan Yanev
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Marie Vanhuyse
- Division of Medical Oncology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Fabio L. Cury
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Luis Souhami
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Wassim Kassouf
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Alice Dragomir
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
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17
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Hensley PJ, Panebianco V, Pietzak E, Kutikov A, Vikram R, Galsky MD, Shariat S, Roupret M, Kamat AM. Contemporary Staging for Muscle-Invasive Bladder Cancer: Accuracy and Limitations. Eur Urol Oncol 2022; 5:403-411. [DOI: 10.1016/j.euo.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 11/15/2022]
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18
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Bhanvadia RR, Lotan Y. Progress in the development of tissue-based biomarkers for urothelial cancer. Expert Rev Anticancer Ther 2022; 22:605-619. [PMID: 35459430 DOI: 10.1080/14737140.2022.2070154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION As the understanding of molecular mechanisms of bladder cancer advances, molecularly-guided precision medicine becomes increasingly relevant. Biomarkers play a critical role in this setting, predicting treatment response and identifying candidates for targeted therapies. AREAS COVERED Current literature on biomarkers in their role in disease prognosis, and response to neoadjuvant and adjuvant therapies. In non-muscle invasive bladder cancer, particular focus is on markers of disease progression, and response to intravesical therapy. In muscle invasive and advanced bladder cancer, particular emphasis is on markers associated with neoadjuvant chemotherapy, as well as systemic immunotherapy. We discuss current shortcomings and pitfalls in contemporary markers, and future avenues of prospective research. EXPERT OPINION The focus on biomarkers has moved from immunohistochemical analysis and tumor-related phenotypic changes to examining genetic alterations. Single marker analysis has been shown to be insufficient in predicting both disease course and response to therapy, and studies have shifted towards examining marker combinations and genetic classifiers. Ultimately, significant progress in implementing biomarkers into clinical guidelines remains elusive, largely due to lack of prospective studies in well-defined patient cohorts and with clinically-meaningful endpoints. Until then, despite their promising value, tissue markers should be limited to experimental settings and clinical trials.
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Affiliation(s)
- Raj R Bhanvadia
- Department of Urology, University of Texas Southwestern, Dallas, Texas 75390
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, Texas 75390
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Choi SY, Ha MS, Chi BH, Kim JW, Chang IH, Kim TH, Myung SC, Kim M, Lee KE, Kim Y, Woo HK, Kyoung DS, Kim H. Neoadjuvant versus adjuvant chemotherapy in bladder cancer: a nationwide cohort study. J Cancer Res Clin Oncol 2022; 148:3135-3144. [DOI: 10.1007/s00432-022-03926-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/13/2022] [Indexed: 12/01/2022]
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20
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Neoadjuvant and Adjuvant Therapy for Muscle-Invasive Bladder Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Kukreja JB, Li R, Narayan VM, Lim A, Seif M, Wang X, Kamat A, Dinney C, Navai N. Oncologic Equipoise Between Robotic and Open Radical Cystectomy. J Endourol 2021; 35:1168-1176. [PMID: 33619985 DOI: 10.1089/end.2020.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Our objective was to establish the incidence of positive surgical margins, recurrence patterns, and recurrence-free (RFS) and overall survival (OS) in a large cohort of patients undergoing robotic (robot-assisted radical cystectomy [RARC]) and open radical cystectomy (ORC). Materials and Methods: We performed a large retrospective cohort study at a high-volume academic tertiary referral center. Patients were those who underwent RC for bladder cancer from 2005 to 2017. Patients were allocated to ORC or RARC by patient and surgeon choice. Propensity matching and a multivariable analysis were performed to determine factors predictive of RFS and OS after RC. All analyses were done with SAS 9.4. Results: The study included 1885 patients, 13.5% of whom underwent RARC. There was no difference in positive soft tissue surgical margins (2.4% in ORC and 1.2% in RARC). There were no differences in recurrence patterns, nor in the severity of pathology distribution between the two cohorts. Peritoneal carcinomatosis was seen in 1.1% of ORC and 0.8% in RARC. Shorter RFS was associated with younger age (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.03-1.05, p < 0.001), neoadjuvant chemotherapy (HR 1.41, 95% CI 1.14-1.75, p = 0.002), higher pathologic stage (stage ≥T2 HR 2.45, 95% CI 1.91-3.16, p < 0.001), lymph node positivity at cystectomy (HR 1.92, 95% CI 1.50-2.47, p < 0.001), and positive surgical margins (HR 1.49, 95% CI 1.09-2.05, p = 0.01). RFS and OS did not differ by surgical approach (HR 1.04, 95% CI 0.83-1.30), p = 0.75 and (HR 0.89, 95% CI 0.67-1.19), p = 0.43, respectively. Conclusion: The data from this study support continued use of RARC as a safe oncologic procedure, with similar outcomes to ORC.
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Affiliation(s)
- Janet Baack Kukreja
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Division of Urology, University of Colorado, Denver, Colorado, USA
| | - Roger Li
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Division of Urology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Vikram M Narayan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Lim
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed Seif
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xuemei Wang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashish Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Colin Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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22
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Understanding the Barriers to Neoadjuvant Chemotherapy in Patients with Muscle Invasive Bladder Cancer: A Quality Improvement Initiative. UROLOGY PRACTICE 2021; 8:217-225. [PMID: 33655019 DOI: 10.1097/upj.0000000000000200] [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] [Indexed: 11/25/2022]
Abstract
Purpose Utilization of neoadjuvant chemotherapy (NAC) for the management of muscle-invasive bladder cancer remains low. We sought to understand our practice of NAC use in order to design a quality improvement initiative geared towards optimizing medical oncology referral. Materials and Methods We identified 339 patients with ≥cT2 bladder cancer treated with radical cystectomy between 2012-2017 at our institution. We assessed the rate of referral to medical oncology, rate of NAC administration, as well as medical, patient and provider variables associated with NAC use. Bayesian logistic regression modeling identified variables associated with NAC use and chart review provided granular patient-level data. Results 85% (n=289) of patients were referred to medical oncology and 62.5% (n=212) received NAC. Renal insufficiency, hearing loss, and treating urologist were conclusively associated with lower odds of NAC use. 46 patients were not referred to medical oncology and 50% of these had medical contraindications to cisplatin cited as the reason for no referral. 38 patients met with medical oncology but did not receive NAC. 30 (79%) had comorbidities that impacted this decision with 15 (39%) ineligible based on impaired renal function. Conclusions Despite the relatively high rates of medical oncology referral and NAC use in this cohort, there are still opportunities to improve the efficiency of this practice. Quality improvement initiatives could optimize the referral of patients with ≥T2 bladder cancer for consideration of cisplatin-based NAC and establish an important quality metric in the management of these patients.
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23
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Ikeda J, Ohe C, Yoshida T, Kuroda N, Saito R, Kinoshita H, Tsuta K, Matsuda T. Comprehensive pathological assessment of histological subtypes, molecular subtypes based on immunohistochemistry, and tumor-associated immune cell status in muscle-invasive bladder cancer. Pathol Int 2021; 71:173-182. [PMID: 33503295 DOI: 10.1111/pin.13060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022]
Abstract
Molecular assessments of muscle-invasive bladder cancer (MIBC) have yielded several molecular categorizations associated with basal and luminal subtypes or tumor-associated immune cell status (TAICs). However, the histological relationships among histological subtypes, molecular subtypes, and TAICs and their clinical implications remain unclear. Thus, we aimed to evaluate the histological associations among these factors and their clinicopathological outcomes. We retrospectively analyzed 106 patients with MIBC who underwent radical cystectomy. The histological subtypes and TAICs were evaluated with hematoxylin and eosin staining, while the basal and luminal molecular subtypes were determined by immunohistochemical expression of cytokeratin (CK) 5/6, CK14, CK20, GATA3 and uroplakin II. Urothelial carcinoma with squamous differentiation and the sarcomatoid variant were highly associated with the basal subtype (P < 0.001 and P = 0.04, respectively). Additionally, high TAICs were significantly correlated with the basal subtype (P < 0.001). Although there was no significant difference in the cancer-specific survival (CSS) rate between molecular subtypes (P = 0.295), TAICs significantly discriminated CSS rates (P < 0.001). Furthermore, the combination of molecular subtypes and TAICs significantly stratified cancer-specific mortality rates. In conclusion, a comprehensive pathological evaluation of histological subtypes, molecular subtypes, and TAICs is feasible and can influence the oncological outcome.
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Affiliation(s)
- Junichi Ikeda
- Department of Pathology and Laboratory Medicine, Kansai Medical University Hospital, Osaka, Japan.,Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan
| | - Chisato Ohe
- Department of Pathology and Laboratory Medicine, Kansai Medical University Hospital, Osaka, Japan
| | - Takashi Yoshida
- Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan
| | - Naoto Kuroda
- Department of Pathology, Kobe Kyodo Hospital, Hyogo, Japan
| | - Ryoichi Saito
- Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan
| | - Koji Tsuta
- Department of Pathology and Laboratory Medicine, Kansai Medical University Hospital, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan
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24
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Regmi SK, Konety BR. Variant Histology: Management Pearls. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Risk Stratification of Patients: Risk Tables and Assessment – NMIBC and MIBC. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Neoadjuvant PD-L1 plus CTLA-4 blockade in patients with cisplatin-ineligible operable high-risk urothelial carcinoma. Nat Med 2020; 26:1845-1851. [PMID: 33046869 PMCID: PMC9768836 DOI: 10.1038/s41591-020-1086-y] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/28/2020] [Indexed: 01/25/2023]
Abstract
Immune checkpoint therapy is being tested in the neoadjuvant setting for patients with localized urothelial carcinoma1,2, with one study reporting data in cisplatin-ineligible patients who received anti-PD-L1 monotherapy2. The study reported that patients with bulky tumors, a known high-risk feature defined as greater than clinical T2 disease, had fewer responses, with pathological complete response rate of 17%2. Here we report on the first pilot combination neoadjuvant trial ( NCT02812420 ) with anti-PD-L1 (durvalumab) plus anti-CTLA-4 (tremelimumab) in cisplatin-ineligible patients, with all tumors identified as having high-risk features (n = 28). High-risk features were defined by bulky tumors, variant histology, lymphovascular invasion, hydronephrosis and/or high-grade upper tract disease3-5. The primary endpoint was safety and we observed 6 of 28 patients (21%) with grade ≥3 immune-related adverse events, consisting of asymptomatic laboratory abnormalities (n = 4), hepatitis and colitis (n = 2). We also observed pathological complete response of 37.5% and downstaging to pT1 or less in 58% of patients who completed surgery (n = 24). In summary, we provide initial safety, efficacy and biomarker data with neoadjuvant combination anti-PD-L1 plus anti-CTLA-4, which warrants further development for patients with localized urothelial carcinoma, especially cisplatin-ineligible patients with high-risk features who do not currently have an established standard-of-care neoadjuvant treatment.
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27
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Tholomier C, Souhami L, Kassouf W. Bladder-sparing protocols in the treatment of muscle-invasive bladder cancer. Transl Androl Urol 2020; 9:2920-2937. [PMID: 33457265 PMCID: PMC7807363 DOI: 10.21037/tau.2020.02.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/29/2019] [Indexed: 01/06/2023] Open
Abstract
Bladder-sparing protocols (BSP) have been gaining widespread popularity as an attractive alternative to radical cystectomy (RC) for muscle-invasive bladder cancer. Unimodal therapies are inferior to multimodal regimens. The most promising regimen is trimodal therapy (TMT), which is a combination of maximal transurethral resection of bladder tumor (TURBT), radiotherapy, and chemotherapy. In appropriately selected patients (low volume unifocal T2 disease, complete TURBT, no hydronephrosis and no carcinoma-in-situ), comparable oncological outcomes to RC have been reported in large retrospective studies, with a potential improvement in overall quality of life (QOL). TMT also offers the possibility for definitive therapy for patients who are not surgically fit to undergo RC. Routine biopsy of previous tumor resection is recommended to assess response. Prompt salvage RC is required in non-responders and for recurrent muscle-invasive disease, while non-muscle-invasive recurrence can be managed conservatively with TURBT +/- intravesical BCG. Long-term follow-up consisting of routine cystoscopy, urine cytology, and cross-section imaging is required. Further studies are warranted to better define the role of neoadjuvant or adjuvant chemotherapy in the setting of TMT. Finally, future research on predictive markers of response to TMT and on the integration of immunotherapy in bladder sparing protocols is ongoing and is highly promising.
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Affiliation(s)
- Côme Tholomier
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Luis Souhami
- Department of Radiation Oncology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
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28
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Soria F, Black PC, Fairey AS, Cookson MS, Yu EY, Kassouf W, Dall'Era MA, Sridhar SS, McGrath JS, Wright JL, Thorpe AC, Morgan TM, Daneshmand S, Holzbeierlein JM, Bivalacqua TJ, North S, Barocas DA, Lotan Y, Grivas P, Stephenson AJ, Shah JB, van Rhijn BW, Spiess PE, Shariat SF, Gontero P. Neoadjuvant chemotherapy plus radical cystectomy versus radical cystectomy alone in clinical T2 bladder cancer without hydronephrosis. BJU Int 2020; 128:79-87. [PMID: 33152179 DOI: 10.1111/bju.15289] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess the efficacy of neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in a retrospective multicentre cohort of patients with cT2N0M0 bladder cancer (BCa) without preoperative hydronephrosis. PATIENTS AND METHODS This was a propensity-based analysis of 619 patients. Of these, 316 were treated with NAC followed by RC and 303 with upfront RC. After multiple imputations, inverse probability of treatment weighting (IPTW) was used to account for potential selection bias. Multivariable logistic regression analysis was performed to evaluate the impact of NAC on pathological complete response and downstaging at RC, while IPTW-adjusted Kaplan-Meier curves and Cox regression models were built to evaluate the impact of NAC on overall survival (OS). RESULTS After IPTW-adjusted analysis, standardised differences between groups were <15%. A complete response (pT0N0) at final pathology was achieved in 94 (30%) patients receiving NAC and nine (3%) undergoing upfront RC. Downstaging to non-muscle-invasive disease (<pT2N0M0) was observed in 174 (55%) patients after NAC and in 72 (24%) without NAC. On multivariable analysis, NAC was found to be an independent predictor of both pathological complete response and downstaging. No significant difference with respect to OS was observed between groups with a median follow-up of 18 months. CONCLUSIONS In patients with cT2N0 BCa and no preoperative hydronephrosis, NAC increased the rate of pathological complete response and downstaging.
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Affiliation(s)
- Francesco Soria
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Michael S Cookson
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - Evan Y Yu
- Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Wassim Kassouf
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - Marc A Dall'Era
- Department of Urology, Davis Medical Center, University of California at Davis, Sacramento, CA, USA
| | | | - John S McGrath
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK
| | | | - Andrew C Thorpe
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Todd M Morgan
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Siamak Daneshmand
- USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Jeff M Holzbeierlein
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Trinity J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Scott North
- Cross Cancer Institute, Edmonton, AB, Canada.,Department of Oncology, University of Alberta, Alberta, AB, Canada
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew J Stephenson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jay B Shah
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Bas W van Rhijn
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Shahrokh F Shariat
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY, USA.,Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
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29
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Liu S, Wang H, Li J, Zhang J, Wu J, Li Y, Piao Y, Pan L, Xiang R, Yue S. FZR1 as a novel biomarker for breast cancer neoadjuvant chemotherapy prediction. Cell Death Dis 2020; 11:804. [PMID: 32978372 PMCID: PMC7519164 DOI: 10.1038/s41419-020-03004-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/29/2022]
Abstract
The concept of breast-conserving surgery is a remarkable achievement of breast cancer therapy. Neoadjuvant chemotherapy is being used increasingly to shrink the tumor prior to surgery. Neoadjuvant chemotherapy is reducing the tumor size to make the surgery with less damaging to surrounding tissue and downstage locally inoperable disease to operable. However, non-effective neoadjuvant chemotherapy could increase the risks of delaying surgery, develop unresectable disease and metastatic tumor spread. The biomarkers for predicting the neoadjuvant chemotherapy effect are scarce in breast cancer treatment. In this study, we identified that FZR1 can be a novel biomarker for breast cancer neoadjuvant chemotherapy according to clinical patient cohort evaluation and molecular mechanism investigation. Transcriptomic data analysis indicated that the expression of FZR1 is correlated with the effect of neoadjuvant chemotherapy. Mechanistically, we demonstrate that FZR1 is pivotal to the chemotherapy drugs induced apoptosis and cell cycle arrest. FZR1 is involved in the stability of p53 by impairing the phosphorylation at ser15 site. We demonstrate that the expression of FZR1 detected by quantification of IHC can be an effective predictor of neoadjuvant chemotherapy in animal experiment and clinical patient cohort. To obtain more benefit for breast cancer patient, we propose that the FZR1 IHC score using at the clinical to predict the effect of neoadjuvant chemotherapy.
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Affiliation(s)
- Shuo Liu
- School of Medicine, Nankai University, Tianjin, China
| | - Haobin Wang
- Department of Breast & Thyroid Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, Sichuan, China
| | - Jun Li
- School of Medicine, Nankai University, Tianjin, China
| | - Jianhui Zhang
- Sichuan hospital & Institute, Sichuan cancer center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jian Wu
- Department of Breast & Thyroid Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, Sichuan, China
| | - Yi Li
- Department of Radiology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, Sichuan, China
| | - Yongjun Piao
- School of Medicine, Nankai University, Tianjin, China
| | - Leiting Pan
- The Key Laboratory of Weak-Light Nonlinear Photonics of Education Ministry, School of Physics and TEDA Institute of Applied Physics, Nankai University, Tianjin, China
| | - Rong Xiang
- School of Medicine, Nankai University, Tianjin, China. .,2011 Project Collaborative Innovation Center for Biotherapy of Ministry of Education, Tianjin, China.
| | - Shijing Yue
- School of Medicine, Nankai University, Tianjin, China.
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30
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Pederzoli F, Bandini M, Marandino L, Raggi D, Giannatempo P, Salonia A, Gallina A, Briganti A, Montorsi F, Necchi A. Neoadjuvant Chemotherapy or Immunotherapy for Clinical T2N0 Muscle-invasive Bladder Cancer: Time to Change the Paradigm? Eur Urol Oncol 2020; 4:1006-1010. [PMID: 32847746 DOI: 10.1016/j.euo.2020.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
A 41-yr-old, otherwise healthy, premenopausal woman presented at our uro-oncology clinic with a diagnosis of muscle-invasive bladder cancer following a transurethral resection of the bladder performed at another center. After a thorough discussion with the patient, she was enrolled in the phase II PURE-01 trial (NCT02736266), testing three cycles of neoadjuvant pembrolizumab (200mg) every 3 wk before radical cystectomy. Before treatment, imaging studies were obtained as per the protocol using computed tomography (CT), [18F]fluorodeoxyglucose positron emission tomography/CT, and multiparametric magnetic resonance imaging of the bladder, defining a clinically localized T2N0M0 stage. As per the protocol, potential biomarkers were assessed, including PD-L1 expression (84% combined positive score), tumor mutational burden (16.67 mut/Mb), and genomic profiling (FoundationONE assay; somatic mutation in TP53, EZH2, APC, TERT, CDKN1A, CDKN1B, and ARID1A genes, and truncation in BRCA2 gene). After immunotherapy, the patient underwent a robot-assisted radical cystectomy with extended pelvic lymph node dissection. The final pathology report revealed absence of residual disease (ie, pathological complete response, ypT0ypN0). During follow-up, the only relevant and permanent immune-mediated adverse event was hypothyroidism secondary to an autoimmune thyroiditis. It appeared 2 mo after radical cystectomy and it was managed successfully with hormonal replacement therapy. Two years after treatment, the patient is asymptomatic and free from disease recurrence. PATIENT SUMMARY: Increasing evidence suggests that frontline neoadjuvant immunotherapy may be beneficial for patients diagnosed with non-locally advanced, muscle-invasive bladder cancer (cT2N0), with fewer drawbacks than traditional chemotherapy. Although further studies are needed in support, this vision opens the opportunity for future clinical trials testing the potential incremental benefits of immunotherapy and the utility of novel biomarker- and imaging-based strategies to assess response to therapy.
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Affiliation(s)
- Filippo Pederzoli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Marco Bandini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Laura Marandino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Gallina
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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31
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Lee KCE, Mui WH, Chan W, Wong CSF, Chu SKP. Outcomes of neoadjuvant chemotherapy using gemcitabine and cisplatin in muscle invasive bladder cancer: A retrospective analysis of the patient and treatment factors in a single institute. Cancer Rep (Hoboken) 2020; 2:e1170. [PMID: 32721111 DOI: 10.1002/cnr2.1170] [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: 12/18/2018] [Revised: 02/02/2019] [Accepted: 02/13/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Meta-analysis had shown a significant 5% absolute survival benefit in favour of neoadjuvant chemotherapy (NAC) with cisplatin-based chemotherapy before radical cystectomy (RC) and pelvic lymphadenectomy (PLND) for patients with muscle invasive bladder cancer (MIBC). Those who had pathological complete response (pCR) to NAC could have long-term progression-free survival (PFS) and overall survival (OS). AIM To identify the treatment and patient factors which could predict a pCR to NAC and the associated PFS and OS in a single institute. METHODS AND RESULTS We retrospectively reviewed the records of patients who had received NAC with gemcitabine and cisplatin (GC) in our centre from January 2004 to December 2017. The patients' age, tumour stage, baseline estimated glomerular filtration rate (eGFR), chemotherapy chart, and pathological information were recorded. There were 25 men and five women who had received NAC followed by RC. pCR was noted in the surgical specimen of 11 (37%) patients. The mean dose of gemcitabine was significantly higher in the pCR group than the non-pCR group (9850 vs 7852 mg, P = 0.039) as was the dose-intensity of cisplatin (87.4% vs 71.3%, P = 0.044). After a median follow-up of 38 months (range 4.3-154), seven patients had disease progression. The estimated 3-year PFS is 74.9% (95% confidence interval [CI], 66.7%-83.3%). None of the patients who achieved pCR relapsed, while six out of seven patients who had pN1 disease developed distant metastasis (DM). Only two patients died of DM while two other patients died of unrelated causes. The estimated 3-year OS is 88.9% (95% CI 82.8%-95%). CONCLUSIONS We have demonstrated that the dose intensity of GC is a major determinant of pCR, which predicts longer RFS and OS. Further research in gene expression profiling of MIBC to help selecting patient for NAC is needed.
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Affiliation(s)
- Ka Chai Eric Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Wing Ho Mui
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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32
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Motterle G, Andrews JR, Morlacco A, Karnes RJ. Predicting Response to Neoadjuvant Chemotherapy in Bladder Cancer. Eur Urol Focus 2020; 6:642-649. [DOI: 10.1016/j.euf.2019.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/14/2019] [Accepted: 10/24/2019] [Indexed: 01/07/2023]
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33
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Harmon SA, Sanford TH, Brown GT, Yang C, Mehralivand S, Jacob JM, Valera VA, Shih JH, Agarwal PK, Choyke PL, Turkbey B. Multiresolution Application of Artificial Intelligence in Digital Pathology for Prediction of Positive Lymph Nodes From Primary Tumors in Bladder Cancer. JCO Clin Cancer Inform 2020; 4:367-382. [PMID: 32330067 PMCID: PMC7259877 DOI: 10.1200/cci.19.00155] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To develop an artificial intelligence (AI)-based model for identifying patients with lymph node (LN) metastasis based on digital evaluation of primary tumors and train the model using cystectomy specimens available from The Cancer Genome Atlas (TCGA) Project; patients from our institution were included for validation of the leave-out test cohort. METHODS In all, 307 patients were identified for inclusion in the study (TCGA, n = 294; in-house, n = 13). Deep learning models were trained from image patches at 2.5×, 5×, 10×, and 20× magnifications, and spatially resolved prediction maps were combined with microenvironment (lymphocyte infiltration) features to derive a final patient-level AI score (probability of LN metastasis). Training and validation included 219 patients (training, n = 146; validation, n = 73); 89 patients (TCGA, n = 75; in-house, n = 13) were reserved as an independent testing set. Multivariable logistic regression models for predicting LN status based on clinicopathologic features alone and a combined model with AI score were fit to training and validation sets. RESULTS Several patients were determined to have positive LN metastasis in TCGA (n = 105; 35.7%) and in-house (n = 3; 23.1%) cohorts. A clinicopathologic model that considered using factors such as age, T stage, and lymphovascular invasion demonstrated an area under the curve (AUC) of 0.755 (95% CI, 0.680 to 0.831) in the training and validation cohorts compared with the cross validation of the AI score (likelihood of positive LNs), which achieved an AUC of 0.866 (95% CI, 0.812 to 0.920; P = .021). Performance in the test cohort was similar, with a clinicopathologic model AUC of 0.678 (95% CI, 0.554 to 0.802) and an AI score of 0.784 (95% CI, 0.702 to 0.896; P = .21). In addition, the AI score remained significant after adjusting for clinicopathologic variables (P = 1.08 × 10-9), and the combined model significantly outperformed clinicopathologic features alone in the test cohort with an AUC of 0.807 (95% CI, 0.702 to 0.912; P = .047). CONCLUSION Patients who are at higher risk of having positive LNs during cystectomy can be identified on primary tumor samples using novel AI-based methodologies applied to digital hematoxylin and eosin-stained slides.
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Affiliation(s)
- Stephanie A. Harmon
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Thomas H. Sanford
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD
- Department of Urology, Upstate Medical University, Syracuse, NY
| | - G. Thomas Brown
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD
- National Library of Medicine, National Institutes of Health, Bethesda, MD
| | - Chris Yang
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | | | - Joseph M. Jacob
- Department of Urology, Upstate Medical University, Syracuse, NY
| | | | - Joanna H. Shih
- Division of Cancer Treatment and Diagnosis, Biometric Research Program, National Cancer Institute, Bethesda, MD
| | | | - Peter L. Choyke
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
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Jiang DM, Chung P, Kulkarni GS, Sridhar SS. Trimodality Therapy for Muscle-Invasive Bladder Cancer: Recent Advances and Unanswered Questions. Curr Oncol Rep 2020; 22:14. [PMID: 32008105 DOI: 10.1007/s11912-020-0880-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Bladder-sparing trimodality therapy (TMT) has become an accepted alternative to cystectomy for selected muscle invasive bladder cancer (MIBC) patients unfit for cystectomy or opting for bladder preservation. This review will summarize recent advances in TMT for MIBC. RECENT FINDINGS A growing body of literature has emerged which supports the use of TMT. However, its delivery is yet to be standardized. The role of chemotherapy and predictive biomarkers remain to be elucidated. Novel bladder-sparing approaches, drug combinations including immunotherapy and targeted therapies are under investigation in clinical trials, with the goal of ultimately enhancing survival and quality of life outcomes. Recent advances in TMT have made bladder preservation possible for MIBC patients seeking an alternative local therapy to cystectomy. With careful patient selection, TMT offers comparable survival outcomes to cystectomy, and improved quality of life as patients are able to successfully retain their bladder.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Canada, 700 University Avenue, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, University of Toronto, Canada, 700 University Ave, Toronto, ON, Canada
| | - Girish S Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Canada, 6-824, 700 University Avenue, Toronto, ON, Canada
| | - Srikala S Sridhar
- Department of Medicine, Division of Medical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Canada, 700 University Avenue, Toronto, ON, Canada.
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Black AJ, Zargar H, Zargar-Shoshtari K, Fairey AS, Mertens LS, Dinney CP, Mir MC, Krabbe LM, Cookson MS, Jacobsen NE, Griffin J, Montgomery JS, Vasdev N, Yu EY, Xylinas E, Campain NJ, Kassouf W, Dall'Era MA, Seah JA, Ercole CE, Horenblas S, McGrath JS, Aning J, Shariat SF, Wright JL, Thorpe AC, Morgan TM, Holzbeierlein JM, Bivalacqua TJ, North S, Barocas DA, Lotan Y, Grivas P, Stephenson AJ, Shah JB, van Rhijn BW, Spiess PE, Daneshmand S, Sridhar SS, Black PC. The prognostic value of the neutrophil-to-lymphocyte ratio in patients with muscle-invasive bladder cancer treated with neoadjuvant chemotherapy and radical cystectomy. Urol Oncol 2019; 38:3.e17-3.e27. [PMID: 31676278 DOI: 10.1016/j.urolonc.2019.09.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/02/2019] [Accepted: 09/25/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The neutrophil-to-lymphocyte ratio (NLR) is an attractive marker because it is derived from routine bloodwork. NLR has shown promise as a prognostic factor in muscle invasive bladder cancer (MIBC) but its value in patients receiving neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is not yet established. Since NLR is related to an oncogenic environment and poor antitumor host response, we hypothesized that a high NLR would be associated with a poor response to NAC and would remain a poor prognostic indicator in patients receiving NAC. METHODS A retrospective analysis was performed on patients with nonmetastatic MIBC (cT2-4aN0M0) who received NAC prior to RC between 2000 and 2013 at 1 of 19 centers across Europe and North America. The pre-NAC NLR was used to split patients into a low (NLR ≤ 3) and high (NLR > 3) group. Demographic and clinical parameters were compared between the groups using Student's t test, chi-squared, or Fisher's exact test. Putative risk factors for disease-specific and overall survival were analyzed using Cox regression, while predictors of response to NAC (defined as absence of MIBC in RC specimen) were investigated using logistic regression. RESULTS Data were available for 340 patients (199 NLR ≤ 3, 141 NLR > 3). Other than age and rate of lymphovascular invasion, demographic and pretreatment characteristics did not differ significantly. More patients in the NLR > 3 group had residual MIBC after NAC than the NLR ≤ 3 group (70.8% vs. 58.3%, P = 0.049). NLR was the only significant predictor of response (odds ratio: 0.36, P = 0.003) in logistic regression. NLR was a significant risk factor for both disease-specific (hazard ratio (HR): 2.4, P = 0.006) and overall survival (HR:1.8, P = 0.02). CONCLUSION NLR > 3 was associated with a decreased response to NAC and shorter disease-specific and overall survival. This suggests that NLR is a simple tool that can aid in MIBC risk stratification in clinical practice.
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Affiliation(s)
- Anna J Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Homayoun Zargar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Western Health, Melbourne, Australia
| | - Kamran Zargar-Shoshtari
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa FL; University of Auckland, Auckland, New Zealand
| | | | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Colin P Dinney
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | - Maria C Mir
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, University of Münster, Münster, Germany
| | - Michael S Cookson
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK
| | | | - Joshua Griffin
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | | | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Evan Y Yu
- Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY; Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Nicholas J Campain
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Wassim Kassouf
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - Marc A Dall'Era
- Department of Urology, University of California at Davis, Davis Medical Center, Sacramento, CA
| | - Jo-An Seah
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Cesar E Ercole
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - John S McGrath
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Jonathan Aning
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Shahrokh F Shariat
- Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY; Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | | | - Andrew C Thorpe
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Todd M Morgan
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | | | - Trinity J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Scott North
- Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, AB, Canada
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic
| | | | - Jay B Shah
- Department of Urology, MD Anderson Cancer Center, Houston, TX; Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Bas W van Rhijn
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa FL
| | - Siamak Daneshmand
- USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, CA
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
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Zamboni S, Moschini M, Antonelli A, Simeone C, Belotti S, Cristinelli L, Montorsi F, Briganti A, Gallina A, Salonia A, Colombo R, Mordasini L, Mattei A, Baumeister P. How to improve patient selection for neoadjuvant chemotherapy in bladder cancer patients candidate for radical cystectomy and pelvic lymph node dissection. World J Urol 2019; 38:1229-1233. [DOI: 10.1007/s00345-019-02916-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/20/2019] [Indexed: 12/01/2022] Open
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Grossman HB, Bellmunt J, Black PC. Can Biomarkers Guide the Use of Neoadjuvant Chemotherapy in T2 Bladder Cancer? Eur Urol Oncol 2019; 2:597-602. [PMID: 31279815 DOI: 10.1016/j.euo.2019.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 12/20/2022]
Abstract
Current guidelines recommend cisplatin-based neoadjuvant chemotherapy prior to radical cystectomy as the preferred treatment of muscle-invasive bladder cancer. Nevertheless, for multiple reasons compliance with this guideline recommendation is low. This is particularly evident in clinical T2 bladder cancer, where controversy exists regarding the role of proceeding with radical cystectomy alone. Novel biomarkers such as molecular phenotype and DNA damage repair and response gene alterations may be able to predict who will respond to cisplatin-based neoadjuvant chemotherapy. This clinical problem is discussed, and a recommendation is made given the current state of the art. PATIENT SUMMARY: Neoadjuvant chemotherapy improves survival for patients with muscle-invasive bladder cancer. In the future, perhaps validated biomarkers may predict who should and should not receive this treatment.
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Affiliation(s)
| | | | - Peter C Black
- The University of British Columbia, Vancouver, Canada
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Sherif A. The risk of oversimplification in risk-stratification of neoadjuvant chemotherapy-responses in muscle invasive bladder cancer. Transl Androl Urol 2019; 8:S337-S340. [PMID: 31392163 DOI: 10.21037/tau.2019.05.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
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Ghandour R, Singla N, Lotan Y. Treatment Options and Outcomes in Nonmetastatic Muscle Invasive Bladder Cancer. Trends Cancer 2019; 5:426-439. [PMID: 31311657 DOI: 10.1016/j.trecan.2019.05.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/23/2019] [Accepted: 05/30/2019] [Indexed: 12/26/2022]
Abstract
Muscle-invasive bladder cancer (MIBC) represents 25% of newly diagnosed bladder cancer. MIBC is aggressive and requires timely management. The current standard of care is neoadjuvant chemotherapy followed by radical cystectomy, an approach that could result in significant morbidities. Modifications in the chemotherapy regimens, as well as in perioperative care and surgical approach, have resulted in better overall toxicity profile and faster recovery. However, bladder-preservation in carefully selected patients can lead to acceptable oncological outcomes and better quality of life. Optimization of bladder-preservation protocols and proper identification of patients who tolerate and respond to various treatment modalities will significantly impact patient survival in the coming future.
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Affiliation(s)
- Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
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Hupe MC, Gakis G, Seiler R. [Molecular tumor board-urothelial cancer]. Urologe A 2019; 58:760-767. [PMID: 31172245 DOI: 10.1007/s00120-019-0967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Molecular tumor boards (MTB) are becoming more common. There are several molecular alterations in urothelial cancer a molecular tumor board can potentially rely on. OBJECTIVES The aim is to specify molecular alterations and their correlations with different clinical endpoints and to highlight potential questions addressed to a MTB for urothelial cancer. MATERIALS AND METHODS Descriptive review of the literature based on PubMed. RESULTS The landscape of molecular alterations in urothelial cancer is heterogeneous. Thus, recent biomarker research has been focusing on biomarker panels and classifiers instead of single biomarkers. Recently, molecular subtypes of urothelial cancer have been identified and correlated with different clinical endpoints. Furthermore, circulating tumor cells and tumor DNA are under investigation as potential biomarkers. In addition to treatment response and prognosis, molecular markers are also needed to improve clinical staging prior to radical cystectomy or for proper patient selection for neoadjuvant chemotherapy. Erdafitinib is the first targeted therapy (fibroblast growth factor receptor [FGFR] alteration) in urothelial cancer that was recently approved (in the USA). CONCLUSIONS Due to the lack of external validation, none of the identified biomarkers is currently established in clinical routine. In addition, there is no single driver mutation in urothelial cancer that facilitates the development of biomarkers and targeted therapies.
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Affiliation(s)
- M C Hupe
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - G Gakis
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - R Seiler
- Departement für Urologie, Inselspital Bern, 3010, Bern, Schweiz
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Duplisea JJ, Dinney CPN. Should chemotherapy still be used to treat all muscle invasive bladder cancer in the "era of immunotherapy"? Expert Rev Anticancer Ther 2019; 19:543-545. [PMID: 31164019 DOI: 10.1080/14737140.2019.1625773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jonathan J Duplisea
- a Department of Urology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Colin P N Dinney
- a Department of Urology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Zamboni S, Moschini M, Gallina A, Colombo R, Montorsi F, Briganti A, Salonia A, Antonelli A, Simeone C, Belotti S, Cristinelli L, Mattei A, Baumeister P. The impact of completeness of last transurethral resection of bladder tumors on the outcomes of radical cystectomy. World J Urol 2019; 37:2707-2714. [DOI: 10.1007/s00345-019-02734-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/15/2019] [Indexed: 01/03/2023] Open
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Kulkarni GS, Black PC, Sridhar SS, Kapoor A, Zlotta AR, Shayegan B, Rendon RA, Chung P, van der Kwast T, Alimohamed N, Fradet Y, Kassouf W. Canadian Urological Association guideline: Muscle-invasive bladder cancer. Can Urol Assoc J 2019; 13:230-238. [PMID: 30763236 DOI: 10.5489/cuaj.5902] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Srikala S Sridhar
- Division of Hematology and Medical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- Section of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bobby Shayegan
- Section of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Nimira Alimohamed
- Division of Medical Oncology, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Yves Fradet
- Division of Urology, Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, QC, Canada
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Arianayagam R, Sharma A, Vasdev N. Is it oncologically and clinically safe to adopt a bladder sparing approach in complete responders following neoadjuvant chemotherapy alone without proceeding to a radical cystectomy? Transl Androl Urol 2019; 7:S741-S743. [PMID: 30687613 PMCID: PMC6323285 DOI: 10.21037/tau.2018.08.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ranjan Arianayagam
- Department of Urology and Surgery, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
| | - Anand Sharma
- Department of Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Nikhil Vasdev
- Department of Urology and Surgery, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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45
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Fransen van de Putte EE, Burger M, van Rhijn BWG. Risk Stratification and Prognostication of Bladder Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Peri-operative Chemotherapy for Muscle-Invasive Bladder Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schardt J, Roth B, Seiler R. Forty years of cisplatin-based chemotherapy in muscle-invasive bladder cancer: are we understanding how, who and when? World J Urol 2018; 37:1759-1765. [PMID: 30392011 DOI: 10.1007/s00345-018-2544-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/22/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE For 40 years cisplatin-based chemotherapy has been administered to patients with muscle-invasive bladder cancer (MIBC). The best evidence of its efficacy is found in the context of neoadjuvant chemotherapy (NAC). However, the benefit to the patient is modest, with an improvement in 5-year overall survival of only 5-8%. Approximately 60% of patients still have muscle-invasive disease at cystectomy despite NAC. Selecting patients based on the likelihood of response appears to be a promising strategy to improve on this modest benefit. To realize this promise, researchers are investigating biomarkers for identifying responders and non-responders prior to NAC. METHODS In this review, we discuss a number of tissue- and liquid-based biomarkers associated with the response to NAC. RESULTS AND CONCLUSIONS We elaborate biomarkers at the methylation, DNA, RNA and protein levels and give their current status in clinical trials and/or their implementation in daily clinical practice. In particular, detection of alterations in DNA damage repair pathways as well as molecular subtypes seems to be a promising method for identifying responders to NAC. Furthermore, we illustrate liquid-based biomarkers. Circulating tumor DNA (ctDNA) in patient blood and urine appear to offer an elegant way for biological characterization of MIBC. Recent data show that the presence of ctDNA is limited in patients with localized MIBC being considered for NAC. At this disease stage, ctDNA in patient urine may be more promising for the genomic characterization of MIBC. However, ctDNA in blood or urine has not yet been rigorously investigated in this clinical context.
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Affiliation(s)
- Julian Schardt
- Department of Medical Oncology, University of Bern, Bern, Switzerland
| | - Beat Roth
- Department of Urology, University of Bern, 3010, Bern, Switzerland
| | - Roland Seiler
- Department of Urology, University of Bern, 3010, Bern, Switzerland.
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El-Achkar A, Souhami L, Kassouf W. Bladder Preservation Therapy: Review of Literature and Future Directions of Trimodal Therapy. Curr Urol Rep 2018; 19:108. [PMID: 30392150 DOI: 10.1007/s11934-018-0859-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW This review targets the latest literature on bladder preservation therapy with emphasis on trimodal therapy (TMT), highlighting its role in the management of muscle invasive bladder cancer (MIBC) and outlining future directions in bladder preservation research. RECENT FINDINGS TMT is the most promising bladder preservation treatment modality. Comparable results to contemporary radical cystectomy series are seen in properly selected patients. A multidisciplinary team approach is critical in the management of these patients. Future research is directed at the integration of immunotherapy into the treatment protocol. TMT, involving maximal transurethral resection followed by chemoradiation, is an attractive alternative to radical cystectomy with urinary diversion in carefully selected patients with muscle invasive disease. In the absence of randomized trial (RCT), comparison between TMT and cystectomy, based on retrospective data from large centers, suggests comparable oncological outcomes, with a favorable impact on quality of life.
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Affiliation(s)
- Adnan El-Achkar
- Experimental surgery, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Luis Souhami
- Department of Radiation Oncology, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Wassim Kassouf
- Department of Surgery, McGill University Health Center, McGill University, 1001 Decarie Blvd, D02.7210, Montreal, QC, H4A 3J1, Canada.
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Lyon TD, Frank I, Sharma V, Shah PH, Tollefson MK, Thompson RH, Karnes RJ, Thapa P, Cheville JC, Boorjian SA. A risk-stratified approach to neoadjuvant chemotherapy in muscle-invasive bladder cancer: implications for patients classified with low-risk disease. World J Urol 2018; 37:1605-1613. [DOI: 10.1007/s00345-018-2551-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022] Open
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Hermans TJN, Voskuilen CS, Deelen M, Mertens LS, Horenblas S, Meijer RP, Boormans JL, Aben KK, van der Heijden MS, Pos FJ, de Wit R, Beerepoot LV, Verhoeven RHA, van Rhijn BWG. Superior efficacy of neoadjuvant chemotherapy and radical cystectomy in cT3-4aN0M0 compared to cT2N0M0 bladder cancer. Int J Cancer 2018; 144:1453-1459. [PMID: 30155893 DOI: 10.1002/ijc.31833] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/09/2018] [Accepted: 07/26/2018] [Indexed: 11/09/2022]
Abstract
In this study, we compared complete pathological downstaging (pCD, ≤(y)pT1N0) and overall survival (OS) in patients with cT2 versus cT3-4aN0M0 UC of the bladder undergoing radical cystectomy (RC) with or without neoadjuvant chemo- (NAC) or radiotherapy (NAR). A population-based sample of 5,517 patients, who underwent upfront RC versus NAC + RC or NAR + RC for cT2-4aN0M0 UC between 1995-2013, was identified from the Netherlands Cancer Registry. Data were retrieved from individual patient files and pathology reports. pCD-rates were compared using Chi-square tests and OS was estimated by Kaplan-Meier analyses. Multivariable analyses were conducted to determine odds (OR) and hazard ratios (HR) for pCD-status and OS, respectively. We included 4,504 (82%) patients with cT2 and 1,013 (18%) with cT3-4a UC. Median follow-up was 9.2 years. In cT2 UC, pCD-rate was 25% after upfront RC versus 43% (p < 0.001) and 33% (p = 0.130) after NAC + RC and NAR + RC, respectively. In cT3-4a UC, pCD-rate was 8% after upfront RC versus 37% (p < 0.001) and 16% (p = 0.281) after NAC + RC and NAR + RC, respectively. In cT2 UC, 5-year OS was 57% and 51% for NAC + RC and upfront RC, respectively (p = 0.135), whereas in cT3-4a UC, 5-year OS was 55% for NAC + RC versus 36% for upfront RC (p < 0.001). In multivariable analysis for OS, NAC was beneficial in cT3-4a UC (HR: 0.67, 95%CI 0.51-0.89) but not in cT2 UC (HR: 0.91, 95%CI 0.72-1.15). NAR did not influence OS. In conclusion, NAC + RC was associated with superior pCD compared to RC alone and NAR + RC. Superior OS for NAC + RC compared to RC alone was especially evident in cT3-4a disease.
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Affiliation(s)
- T J N Hermans
- Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C S Voskuilen
- Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M Deelen
- Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - L S Mertens
- Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S Horenblas
- Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - R P Meijer
- Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J L Boormans
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - K K Aben
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.,Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M S van der Heijden
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - F J Pos
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - R de Wit
- Department of Medical Oncology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - L V Beerepoot
- Department of Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - B W G van Rhijn
- Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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