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P. van Valenberg FJ, van der Heijden AG, Cutie CJ, Bhanvadia S, Keegan KA, Hampras S, Sweiti H, Maffeo JC, Jin S, Chau A, Reynolds DL, Iarossi C, Kelley A, Li X, Stromberg KA, Michiel Sedelaar J, Steenbruggen JJ, Somford DM, Alfred Witjes J. The Safety, Tolerability, and Preliminary Efficacy of a Gemcitabine-releasing Intravesical System (TAR-200) in American Urological Association-defined Intermediate-risk Non-muscle-invasive Bladder Cancer Patients: A Phase 1b Study. EUR UROL SUPPL 2024; 62:8-15. [PMID: 38585206 PMCID: PMC10998271 DOI: 10.1016/j.euros.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 04/09/2024] Open
Abstract
Background and objective Patients with intermediate-risk non-muscle-invasive bladder cancer (IR NMIBC) have a high risk of recurrence and need effective therapies to reduce the risk of disease recurrence or progression. This phase 1b study (NCT02720367) assessed the safety and tolerability of TAR-200, an intravesical drug delivery system, in participants with IR NMIBC. Methods Participants with recurrent IR NMIBC were eligible. Participants received either two 7-d or two 21-d TAR-200 dosing cycles over a 4-6-wk period in a marker lesion/ablation design. TAR-200 was placed in the window between the cystoscopy showing recurrent papillary disease and the subsequent complete transurethral resection of the bladder tumour. The primary endpoint was TAR-200 safety. The secondary endpoints included TAR-200 tolerability, pharmacokinetics, and preliminary efficacy. Key findings and limitations Twelve participants received TAR-200 treatment. No TAR-200-related serious or grade ≥ 3 treatment-emergent adverse events (TEAEs) occurred. Nine participants had grade ≤ 2 TAR-200-related TEAEs, with urgency, dysuria, and haematuria being most common. Two participants refused a second dosing cycle due to urinary urgency and frequency. Insertion and removal of TAR-200 was successful in all cases. Plasma gemcitabine concentrations remained below the lower limit of detection. Five participants (42%) had complete response (CR): four had pathological CR and one had CR based on visual assessment. Conclusions and clinical implications TAR-200 appears to be safe and well tolerated, with encouraging preliminary efficacy in participants with IR NMIBC. This study lays the groundwork for the multiple phase 2 and 3 global studies that are currently on-going for TAR-200. Patient summary In this study, researchers evaluated the safety of the novel drug delivery system TAR-200 in participants with intermediate-risk non-muscle-invasive bladder cancer. They concluded that TAR-200 was safe and well tolerated with promising antitumour activity.
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Affiliation(s)
- F. Johannes P. van Valenberg
- Department of Urology, Radboudumc, Nijmegen, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | | | | | - Kirk A. Keegan
- Janssen Research & Development, Lexington, MA, USA
- Department of Urology, Vanderbilt University, Nashville, TN, USA
| | | | | | | | - Shu Jin
- Janssen Research & Development, Lexington, MA, USA
| | | | | | | | - April Kelley
- Janssen Research & Development, Lexington, MA, USA
| | - Xiang Li
- Janssen Research & Development, Raritan, NJ, USA
| | | | | | | | - Diederik M. Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Yanagisawa T, Quhal F, Kawada T, Mostafaei H, Motlagh RS, Laukhtina E, Rajwa P, Deimling MV, Bianchi A, Pallauf M, Majdoub M, Pradere B, Moschini M, Karakiewicz PI, Teoh JYC, Miki J, Kimura T, Shariat SF. A Systematic Review and Meta-analysis of Chemoablation for Non–muscle-invasive Bladder Cancer. Eur Urol Focus 2022:S2405-4569(22)00287-5. [DOI: 10.1016/j.euf.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
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Ward K, Kitchen MO, Mathias SJ, Khanim FL, Bryan RT. Novel intravesical therapeutics in the treatment of non-muscle invasive bladder cancer: Horizon scanning. Front Surg 2022; 9:912438. [PMID: 35959122 PMCID: PMC9360612 DOI: 10.3389/fsurg.2022.912438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/07/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Non-muscle-invasive bladder cancer (NMIBC) is a common and heterogeneous disease; many patients develop recurrent or progress to muscle-invasive disease. Intravesical drug therapy is a pillar in the current management of NMIBC; notwithstanding, Mitomycin C (MMC) and Bacillus Calmette-Guérin (BCG) have numerous limitations including international supply issues, and local and systemic toxicity. Here we review novel intravesical therapeutic options and drug delivery devices with potential for clinical use in the treatment of NMIBC. Methods PubMed, ClinicalTrials.gov and Cochrane Library searches were undertaken. Systematic reviews, meta-analyses, randomised controlled trials, single-arm clinical trials and national/international conference proceedings were included. Results Novel intravesical drugs, including chemotherapeutic agents, immune checkpoint inhibitors, monoclonal antibodies and gene therapies, have demonstrated varying efficacy in the treatment of NMIBC. Current evidence for the majority of treatments is mostly limited to single-arm trials in patients with recurrent NMIBC. Various novel methods of drug delivery have also been investigated, with encouraging preliminary results supporting the intravesical delivery of hyperthermic MMC and MMC hydrogel formulations. Conclusions Novel therapeutic agents and drug delivery systems will be important in the future intravesical management of NMIBC. As our understanding of the molecular diversity of NMIBC develops, molecular subtyping will become fundamental in the personalisation of intravesical treatments. Further randomised studies are urgently required to investigate the efficacy of novel intravesical treatments and novel regimens, in comparison to current standards-of-care, particularly in the context of international BCG shortages.
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Affiliation(s)
- Kelly Ward
- The Bladder Cancer Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Mark O Kitchen
- School of Medicine, Keele University, Stoke-on-Trent, United Kingdom
| | - Suresh-Jay Mathias
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Farhat L Khanim
- The Bladder Cancer Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Richard T Bryan
- The Bladder Cancer Research Centre, University of Birmingham, Birmingham, United Kingdom
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Daneshmand S, Brummelhuis IS, Pohar KS, Steinberg GD, Aron M, Cutie CJ, Keegan KA, Maffeo JC, Reynolds DL, Raybold B, Chau A, Witjes JA. The safety, tolerability, and efficacy of a neoadjuvant gemcitabine intravesical drug delivery system (TAR-200) in muscle-invasive bladder cancer patients: a phase I trial. Urol Oncol 2022; 40:344.e1-344.e9. [DOI: 10.1016/j.urolonc.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/13/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
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Korkes F, Spiess PE, Garcia-Perdomo HA, Necchi A. Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review. Int Braz J Urol 2022; 48:397-405. [PMID: 34156188 PMCID: PMC9060175 DOI: 10.1590/s1677-5538.ibju.2021.0259] [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: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To describe the current scientific knowledge and clinical experience in low-grade-non-muscle-invasive bladder cancer (LG-NMIBC) patients in challenging scenarios. MATERIALS AND METHODS Medline, Embase, Google Scholar, and Cochrane Central were searched until March 2021. RESULTS A total of 841 studies were identified, and abstracts were analyzed. Twenty-one relevant studies were then identified and reviewed. After all, information was gathered from 16 studies, the authors discussed the specific topics, and expert opinions were also included in the discussion. There have been some studies that can help us to have some insights on how to manage these patients. Very distinctive strategies have been reported in the literature, mainly anecdotally or in small randomized studies. Some of these treatments outlined in the present manuscript include repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, chemotherapy, and future perspectives. In the current manuscript, we have combined these strategies in a proposed algorithm. CONCLUSION For those LG-NMIBC patients in challenging scenarios, we have found repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, and chemotherapy are attractive modalities to treat them effectively. Also, the current manuscript proposes an algorithm to overcome these challenges.
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Affiliation(s)
- Fernando Korkes
- Faculdade de Medicina do ABCDisciplina de UrologiaSanto AndreSPBrasilDisciplina de Urologia, Faculdade de Medicina do ABC - FMABC, Santo Andre, SP, Brasil
- Hospital Israelita Albert EinsteinDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Phillipe E. Spiess
- H. Lee Moffitt Cancer Center and Research InstituteDepartment of Genito-Urinary OncologyTampaFLEUADepartment of Genito-Urinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, EUA
- University of South Florida University of South FloridaDepartment of Urology and OncologyTampaFLEUADepartment of Urology and Oncology, University of South Florida University of South Florida, Tampa, FL, EUA
| | - Herney Andres Garcia-Perdomo
- Universidad Del ValleSchool of MedicineDepartment of SurgeryCaliColômbiaDivision of Urology / Urooncology, Department of Surgery, School of Medicine, Research Group - UROGIV, Universidad Del Valle, Cali, Colômbia
| | - Andrea Necchi
- University Vita-Salute San RaffaeleDiscipline of UrologyMilanItalyDiscipline of Urology, University Vita-Salute San Raffaele, Milan, Italy
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Shi X, Feng D, Wei W. A Systematic Review and Meta-Analysis Protocol of Chemoablation vs. Transurethral Resection of Bladder Tumor in Patients With Non-Muscle-Invasive Bladder Cancer. Front Surg 2021; 8:753547. [PMID: 34869561 PMCID: PMC8634134 DOI: 10.3389/fsurg.2021.753547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/14/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Bladder cancer is the second-ranked tumor of the genitourinary system. Transurethral resection of bladder tumor (TURBT) is currently the most important diagnosis and treatment method for non-muscular invasive bladder cancer (NMIBC). However, due to its high recurrence and progression rate, as well as high cost and inapplicability to some patients, intravesical chemoablation as an alternative to TURBT may be promising for NMIBC patients. However, there are very little data comparing its effectiveness, safety, best effective drug type, dosage selection, and cost with TURBT at present, which deserves further evaluation. The present study was designed in order to discuss which treatment is superior to another between chemoablation and TURBT in patients with NMIBC. Methods and Analysis: Databases including PubMed, MEDLINE, EMBASE, and Cochrane Library databases, as well as Chinese databases including CNKI (China national knowledge infrastructure), Wan Fang database, and Chinese Clinical Trial Registry, from August 1994 to the time when the official submission of this review was published was included in this review and screened by two reviewers (XS and DCF) independently. There were no language limitations. The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data was analyzed using RevMan and Stata software. The primary aims were the clinical effectiveness, including response rate, complete response OS, CSM, recurrence rate, time to recurrent, progression rate, and time to progression, among others. The secondary aims mainly included safety and tolerability, including costs, operation time, hospital stay, bleeding volume, and complications, among others. Study Registration: This study is registered as PROSPERO CRD42021271124.
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Affiliation(s)
- Xu Shi
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dechao Feng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Wuran Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Han MA, Maisch P, Jung JH, Hwang JE, Narayan V, Cleves A, Hwang EC, Dahm P. Intravesical gemcitabine for non-muscle invasive bladder cancer. Cochrane Database Syst Rev 2021; 6:CD009294. [PMID: 34125951 PMCID: PMC8202966 DOI: 10.1002/14651858.cd009294.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND It remains unclear whether people with non-muscle invasive bladder cancer (NMIBC) benefit from intravesical gemcitabine compared to other agents in the primary or recurrent setting following transurethral resection of a bladder tumor. This is an update of a Cochrane Review first published in 2012. Since that time, several randomized controlled trials (RCTs) have been reported, making this update relevant. OBJECTIVES: To assess the comparative effectiveness and toxicity of intravesical gemcitabine instillation for NMIBC. SEARCH METHODS We performed a comprehensive literature search of the Cochrane Library, MEDLINE, Embase, four other databases, trial registries, and conference proceedings to 11 September 2020, with no restrictions on the language or status of publication. SELECTION CRITERIA We included RCTs in which participants received intravesical gemcitabine for primary or recurrent NMIBC. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the included studies and extracted data for the primary outcomes: time to recurrence, time to progression, grade III to V adverse events determined by the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0), and the secondary outcomes: time to death from bladder cancer, time to death from any cause, grade I or II adverse events determined by the CTCAE v5.0 and disease-specific quality of life. We performed statistical analyses using a random-effects model and rated the certainty of the evidence using GRADE. MAIN RESULTS We included seven studies with 1222 participants with NMIBC across five comparisons. This abstract focuses on the primary outcomes of the three most clinically relevant comparisons. 1. Gemcitabine versus saline: based on two years' to four years' follow-up, gemcitabine may reduce the risk of recurrence over time compared to saline (39% versus 47% recurrence rate, hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.54 to 1.09; studies = 2, participants = 734; I2 = 49%; low-certainty evidence), but the CI included the possibility of no effect. Gemcitabine may result in little to no difference in the risk of progression over time compared to saline (4.6% versus 4.8% progression rate, HR 0.96, 95% CI 0.19 to 4.71; studies = 2, participants = 654; I2 = 53%; low-certainty evidence). Gemcitabine may result in little to no difference in the CTCAE grade III to V adverse events compared to saline (5.9% versus 4.7% adverse events rate, risk ratio [RR] 1.26, 95% CI 0.58 to 2.75; studies = 2, participants = 668; I2 = 24%; low-certainty evidence). 2. Gemcitabine versus mitomycin: based on three years' follow-up (studies = 1, participants = 109), gemcitabine may reduce the risk of recurrence over time compared to mitomycin (17% versus 40% recurrence rate, HR 0.36, 95% CI 0.19 to 0.69; low-certainty evidence). Gemcitabine may reduce the risk of progression over time compared to mitomycin (11% versus 18% progression rate, HR 0.57, 95% CI 0.32 to 1.01; low-certainty evidence), but the CI included the possibility of no effect. We are very uncertain about the effect of gemcitabine on the CTCAE grade III to V adverse events compared to mitomycin (RR 0.51, 95% CI 0.13 to 1.93; very low-certainty evidence). The analysis was only based on recurrent NMIBC. 3. Gemcitabine versus Bacillus Calmette-Guérin (BCG) for recurrent (one-course BCG failure) high-risk NMIBC: based on 6 months' to 22 months' follow-up (studies = 1, participants = 80), gemcitabine may reduce the risk of recurrence compared to BCG (41% versus 97% recurrence rate, HR 0.15, 95% CI 0.09 to 0.26; low-certainty evidence) and progression over time (16% versus 33% progression rate, HR 0.45, 95% CI 0.27 to 0.76; low-certainty evidence). We are very uncertain about the effect of gemcitabine on the CTCAE grade III to V adverse events compared to BCG (RR 1.00, 95% CI 0.21 to 4.66; very low-certainty evidence). In addition, the review provides information on the comparison of gemcitabine versus BCG and gemcitabine versus one-third dose BCG. AUTHORS' CONCLUSIONS: Based on findings of this review, gemcitabine may have a more favorable impact on recurrence and progression-free survival than mitomycin but we are very uncertain as to how major adverse events compare. The same is true when comparing gemcitabine to BCG in individuals with high risk disease who have previously failed BCG. The underlying low- to very low-certainty evidence indicates that our confidence in these results is limited; the true effects may be substantially different from these findings; therefore, better quality studies are needed.
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Affiliation(s)
- Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea, South
| | - Philipp Maisch
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | - Jun Eul Hwang
- Department of Hematology-Oncology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
| | - Vikram Narayan
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anne Cleves
- Velindre NHS Trust, Cardiff University Library Services, Cardiff, UK
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Alsyouf M, Pierorazio P, Groegler J, Hu B. Chemoablation in Urothelial Carcinoma: A Systematic Review and Future Perspectives. Urology 2020; 144:28-37. [PMID: 32540302 DOI: 10.1016/j.urology.2020.05.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
Chemoablation is an emerging treatment for urothelial carcinomas. This review provides an overview of the evidence for intracavitary chemoablation in the treatment of urothelial carcinomas. The benefits of such agents include a reduction in morbidity and diseased organ preservation. While numerous agents have shown promise, research is limited due to small patient cohorts, varying follow-up, and no standardized methodology to assess response. Therefore, to date, chemoablation has not been widely adopted. This may change as a novel mitomycin formulation has recently been approved for treating low-grade upper tract urothelial carcinoma. Future studies are ongoing which evaluate other promising chemoablation options in urothelial carcinoma.
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Affiliation(s)
- Muhannad Alsyouf
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - Phillip Pierorazio
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jason Groegler
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - Brian Hu
- Department of Urology, Loma Linda University Health, Loma Linda, CA.
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9
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What to do during Bacillus Calmette–Guérin shortage? Valid strategies based on evidence. Curr Opin Urol 2018; 28:570-576. [DOI: 10.1097/mou.0000000000000544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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10
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Şanlı Ö, Lotan Y. Alternative therapies in patients with non-muscle invasive bladder cancer. Turk J Urol 2017; 43:414-424. [PMID: 29201501 DOI: 10.5152/tud.2017.64624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/19/2017] [Indexed: 12/20/2022]
Abstract
Bladder cancer (BC) is one of the leading causes of cancer-related deaths worldwide. Despite, the majority of the cases were diagnosed as non-muscle invasive bladder cancer (NMIBC) with favorable prognosis, it has tendency to recur or progress to a higher grade or stage. The first line treatment of patients with NMIBC is transurethral resection with adjuvant therapies primarily intravesical Bacillus Calmette-Guérin (BCG) immunotherapy. However, in a portion of patients whose BCG treatment failed, alternative treatments may be required. Furthermore, intravesical BCG may be contraindicated in or untolerated by a group of patients. For these patients, some treatment options are readily available and a variety of them are currently under clinical investigation. In this review, these alternative therapies have been summarized.
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Affiliation(s)
- Öner Şanlı
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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11
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Intravesikales Gemcitabin für nicht-muskelinvasive Harnblasenkarzinome. Urologe A 2015; 54:402-5. [DOI: 10.1007/s00120-015-3779-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Bellmunt J, Werner L, Bamias A, Fay AP, Park RS, Riester M, Selvarajah S, Barletta JA, Berman DM, de Muga S, Salido M, Gallardo E, Rojo F, Guancial EA, Bambury R, Mullane SA, Choueiri TK, Loda M, Stack E, Rosenberg J. HER2 as a target in invasive urothelial carcinoma. Cancer Med 2015; 4:844-52. [PMID: 25720673 PMCID: PMC4472207 DOI: 10.1002/cam4.432] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/09/2022] Open
Abstract
We evaluated primary tumors from two cohorts, Spain (N = 111) and Greece (N = 102), for patients who were treated with platinum-based chemotherapy. Patients were tested for HER2 status (IHC score of 3+ or FISH ratio of ≥ 2.2) by immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), DNA copy number, mRNA expression, and mutation status in patients with metastatic urothelial carcinoma (UC), and its impact on survival. ERBB2 mutation was determined by hotspot sequencing. mRNA expression was assessed using NanoString counting. Association of overall survival (OS) and HER2 status was assessed by a Cox regression model. NIH-3T3 cells containing HER2 V777L were assessed for growth, invasion, and HER2 kinase activation. In all, 22% of Spanish and 4% of Greek cohorts had 3+ HER2 staining by IHC. FISH amplification was identified in 20% of Spanish and 4% of Greek cohorts. Kappa coefficient between FISH and IHC was 0.47. HER2 status was not associated with OS in univariate (Spanish P = 0.34; Greek P = 0.11) or multivariate (Spanish P = 0.49; Greek P = 0.12) analysis. HER2-positive tumors expressed higher levels of HER2 mRNA than HER2-negative tumors (P < 0.001). HER2 mutations (V777L and L755S) were identified in two (2%) patients. In vitro analysis of V777L results in transformation of NIH-3T3 cells, leading to increased growth, invasion on soft agar, and HER2 kinase constitutive activation. In summary, HER2 overexpression or amplification in the primary tumor did not predict OS in patients with metastatic UC. HER2 positivity rates can differ between different populations. Further trials in genomically screened patients are needed to assess HER2-targeted therapies in UC.
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Affiliation(s)
- Joaquim Bellmunt
- Bladder Cancer Center, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medical Oncology, University Hospital de Mar-IMIM, Barcelona, Spain
| | - Lillian Werner
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Aristotle Bamias
- University of Athens and Hellenic Co-operative Oncology Group, Athens, Greece
| | - André P Fay
- Bladder Cancer Center, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rachel S Park
- Bladder Cancer Center, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Markus Riester
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shamini Selvarajah
- Center for Molecular Oncologic Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David M Berman
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Silvia de Muga
- Hospital de Mar Research Institute-IMIM, Barcelona, Spain
| | - Marta Salido
- Hospital de Mar Research Institute-IMIM, Barcelona, Spain
| | | | - Federico Rojo
- Hospital de Mar Research Institute-IMIM, Barcelona, Spain.,IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Elizabeth A Guancial
- Bladder Cancer Center, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Richard Bambury
- Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Stephanie A Mullane
- Bladder Cancer Center, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Toni K Choueiri
- Bladder Cancer Center, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Massimo Loda
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edward Stack
- Center for Molecular Oncologic Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jonathan Rosenberg
- Bladder Cancer Center, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Memorial Sloan Kettering Cancer Center, New York City, New York
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13
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Skinner EC, Goldman B, Sakr WA, Petrylak DP, Lenz HJ, Lee CT, Wilson SS, Benson M, Lerner SP, Tangen CM, Thompson IM. SWOG S0353: Phase II trial of intravesical gemcitabine in patients with nonmuscle invasive bladder cancer and recurrence after 2 prior courses of intravesical bacillus Calmette-Guérin. J Urol 2013; 190:1200-4. [PMID: 23597452 PMCID: PMC4113593 DOI: 10.1016/j.juro.2013.04.031] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Prior phase II studies of intravesical gemcitabine have shown it to be active and well tolerated, but durable responses in patients with nonmuscle invasive bladder cancer who have experienced recurrence after bacillus Calmette-Guérin treatment are uncommon. We performed a multi-institutional phase II study within the SWOG (Southwest Oncology Group) cooperative group to evaluate the potential role of gemcitabine induction plus maintenance therapy in this setting. MATERIALS AND METHODS Eligible patients had recurrent nonmuscle invasive bladder cancer, stage Tis (carcinoma in situ), T1, Ta high grade or multifocal Ta low grade after at least 2 prior courses of bacillus Calmette-Guérin. Patients were treated with 2 gm gemcitabine in 100 cc normal saline intravesically weekly × 6 and then monthly to 12 months. Cystoscopy and cytology were performed every 3 months, with biopsy at 3 months and then as clinically indicated. Initial complete response was defined as negative cystoscopy, cytology and biopsy at 3 months. RESULTS A total of 58 patients were enrolled in the study and 47 were evaluable for response. Median patient age was 70 years (range 50 to 88). Of the evaluable patients 42 (89%) had high risk disease, including high grade Ta in 12 (26%), high grade T1 in 2 (4%) and carcinoma in situ in 28 (60%) with or without papillary lesions. At the initial 3-month evaluation 47% of patients were free of disease. At 1 year disease had not recurred in 28% of the 47 patients, all except 2 from the high risk group, and at 2 years disease had not recurred in 21%. CONCLUSIONS Intravesical gemcitabine has activity in high risk nonmuscle invasive bladder cancer and offers an option for patients with recurrence after bacillus Calmette-Guérin who are not suitable for cystectomy. However, less than 30% of patients had a durable response at 12 months even with maintenance therapy.
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Shelley MD, Jones G, Cleves A, Wilt TJ, Mason MD, Kynaston HG. Intravesical gemcitabine therapy for non-muscle invasive bladder cancer (NMIBC): a systematic review. BJU Int 2012; 109:496-505. [DOI: 10.1111/j.1464-410x.2011.10880.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Jones G, Cleves A, Wilt TJ, Mason M, Kynaston HG, Shelley M. Intravesical gemcitabine for non-muscle invasive bladder cancer. Cochrane Database Syst Rev 2012; 1:CD009294. [PMID: 22259002 DOI: 10.1002/14651858.cd009294.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intravesical immunotherapy or chemotherapy for non-muscle invasive bladder cancer is a well established treatment for preventing or delaying tumour recurrence following tumour resection. However, up to 70% of patients may fail and new intravesical agents with improved effectiveness are needed. Gemcitabine is a relatively new anticancer drug that has shown activity against bladder cancer. OBJECTIVES To evaluate the effectiveness and toxicity of intravesical gemcitabine in preventing tumour recurrence and progression in non-muscle invasive bladder cancer (NMIBC). SEARCH METHODS A search strategy was developed for MEDLINE to identify randomised trials of intravesical gemcitabine for the treatment of non-muscle invasive bladder cancer. The searches were from 1947 to May 2011. Other databases searched included EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, LILACS, SCOPUS, BNI, Biomed Central, Web of Science and BIOSIS. Handsearching of meeting proceedings, international guidelines and trial registries was also carried out. SELECTION CRITERIA The titles and abstracts of the combined electronic and handsearching were manually screened by three authors independently to determine if they met the inclusion criteria for this review. Studies were selected if they were randomised, controlled trials or quasi-randomised clinical trials that included intravesical gemcitabine in at least one arm of a comparative study. DATA COLLECTION AND ANALYSIS Data extraction was carried out by three reviewers. The information retrieved included the author's details, the study design, the characteristics of the recruited patients, details of the interventions and data relating to the primary, and secondary outcome measures. MAIN RESULTS Six relevant randomised trials were identified with the number of patients randomised in each trial varying from 30 to 341 (total 704). All trials compared gemcitabine to active controls and varied in the reporting of outcomes. One study compared a single post-operative instillation of intravesical gemcitabine with a saline placebo in 341 patients and found no significant difference in the rates of tumour recurrence (28% versus 39%, respectively) or recurrence-free survival (HR (hazard ratio) 0.95, 95% CI 0.64 to1.39, P = 0.77). The rate of progression to invasive disease was greater with gemcitabine (2.4% versus 0.8%). A further trial compared gemcitabine with intravesical mitomycin C and demonstrated that the rates of recurrence (28% versus 39%) and progression (11% versus 18%) were lower with gemcitabine but did not reach statistical significance. The global incidence of adverse events was significantly less with gemcitabine (38.8% versus 72.2%, P = 0.02).Three trials compared gemcitabine with intravesical BCG but a meta-analysis was not possible due to clinical heterogeneity. In untreated patients at intermediate risk of recurrence (primary Ta-T1 no CIS) one trial showed that gemcitabine and BCG were similar with respective recurrence rates of 25% and 30% (P = 0.92) and overall progression equal (P = 1.0). Dysuria (12.5% versus 45%, P < 0.05) and frequency (10% versus 45%, P < 0.001) were significantly less with gemcitabine. In a second trial of high risk patients the recurrence rate was significantly greater with gemcitabine compared to BCG (53.1% and 28.1%, P = 0.04) and the time to recurrence significantly shorter with gemcitabine (25.5 versus 39.4 months, P = 0.042). Finally in a third trial of high risk patients who had failed previous intravesical BCG therapy, gemcitabine was associated with significantly fewer recurrences (52.5% versus 87.5%, P = 0.002) and a longer time to recurrence (3.9 versus 3.1 months, P = 0.9) compared to BCG. Progression rates were similar in both groups (33% versus 37.5%, P = 0.12) with no significant differences in grade 2 or 3 toxicities.The final trial was a marker lesion study which reported greater response rates when intravesical gemcitabine (2 g) was given as three bi-weekly doses (36%) or six weekly doses (40%) compared to a single dose (9%). AUTHORS' CONCLUSIONS A single dose immediately following surgery is ineffective based on one study. Gemcitabine may be more active than mitomycin C with a lower toxicity profile. Compared to intravesical BCG therapy, gemcitabine had similar effects in intermediate risk patients, less effective in high risk patient and superior in BCG refractory patients. However, each randomised trial identified represents a different clinical setting in NMIBC and therefore the evidence base is limited. Consequently these data should be interpreted with caution until further corroborative evidence becomes available. The aim of intravesical therapy in NMIBC is to prevent tumour recurrence and progression and to avoid the morbidity associated with cystectomy. Intravesical gemcitabine is a promising drug that may add to the urologist's options in achieving this goal.
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Affiliation(s)
- Gabriel Jones
- Cochrane ProstaticDiseases and Urological Cancers Unit, Research Department, Velindre NHS Trust, Cardiff, UK
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Brausi MA, Gontero P, Altieri V, Colombo R, Conti I, Bono AV. Can gemcitabine instillation ablate solitary low-risk non-muscle-invasive bladder cancer? Results of a phase II marker lesion study. Urol Int 2011; 87:470-4. [PMID: 22086229 DOI: 10.1159/000331727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 06/26/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this phase II study was to evaluate whether low-risk non-muscle-invasive bladder cancer can be ablated with intravesical gemcitabine in a marker lesion study. PATIENTS AND METHODS The study had a Simon II-stage design. Thirteen patients were to be recruited for stage I. In the event of ≥4 responses, another 30 patients were to be recruited. Patients were given gemcitabine 2,000 mg intravesically once per week for 6 weeks and the response was assessed with endoscopic, histological, and urine cytological findings. RESULTS Fourteen patients evaluated for efficacy completed the study; complete responses were achieved by 2 patients (14.3%), both of these patients had lesions of <1 cm. Eleven patients (78.6%) were non-responders and 1 patient (7.1%) had progressive disease. Since the response rate in stage I was below the minimal pre-defined limit, the study was stopped. CONCLUSIONS This study shows that intravesical gemcitabine does not merit further study in this patient population. A tumor size of >1 cm may be a critical factor in accounting for the low response rate.
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Shelley M, Cleves A, Wilt TJ, Mason M. Gemcitabine for unresectable, locally advanced or metastatic bladder cancer. Cochrane Database Syst Rev 2011:CD008976. [PMID: 21491413 DOI: 10.1002/14651858.cd008976.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prognosis for unresectable, locally advanced or metastatic transitional cell carcinoma of the bladder is poor with most patients succumbing to their disease within 2 to 3 years. Clinical management at this stage of the disease is palliative with systemic chemotherapy the main treatment of choice. A number of cytotoxic agents have shown activity in metastatic disease including cisplatin, methotrexate, doxorubicin and vinblastine. However, response rates still need improving and toxicities may sometimes be severe, and so the search for newer agents with improved benefit-to-risk ratios is constantly being pursued. One such agent that shows promise is gemcitabine. OBJECTIVES Evaluate the effectiveness and toxicity of gemcitabine for the management of unresectable, locally advanced or metastatic bladder cancer. SEARCH STRATEGY A search strategy was developed for MEDLINE to identify randomised trials of gemcitabine for the treatment of unresectable, locally advanced or metastatic bladder cancer. The searches were from 1966 to July 2010. Other databases searched included EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, LILACS, and the Web of Science®. There were no language or location restrictions. SELECTION CRITERIA The titles and abstracts of the combined electronic and hand searching searches were manually screened by two authors to determine if they met the inclusion criteria of this review. Studies were selected if they were randomised, controlled trials or quasi-randomised clinical trials that included gemcitabine in at least one arm of a comparative study. DATA COLLECTION AND ANALYSIS Data extraction was carried out in duplicate by two authors. The information retrieved included the author's details, the study design, the characteristics of the recruited patients, details of the interventions and data relating to the primary and secondary outcomes measures. MAIN RESULTS Three randomised trials used gemcitabine plus cisplatin (GCis) as one of the arms in each trial. The first randomised trial compared GCis with MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) and showed no significant difference in overall survival (hazard ratio1.09, 95% CI 0.88 to 1.34, P = 0.443) however the GCis regime had fewer incidences of neutropenic sepsis (1% versus 12%, P = 0.001) and mucositis (1% versus 22%, P = 0.001). A second randomised trial compared GCis to gemcitabine plus carboplatin (GCarbo) and reported an improved, but non-significant 1-year survival rate with GCis (64% versus 37%). A third randomised trial compared GCis with gemcitabine plus cisplatin plus paclitaxel (GCisPac) and again found no significant difference in overall survival (respective medians 49 weeks versus 61 weeks).One randomised trial evaluated GCarbo against methotrexate plus carboplatin plus vinblastine (MCarboV) in patients "unfit" for cisplatin-based chemotherapy. There were more overall responses (38% versus 20%) and less severe acute toxicities (14% versus 23%) with GCarbo.In one randomised study evaluating 3-weekly gemcitabine plus paclitaxel (GPac3) versus a 2-weekly regimen overall survival was not significantly different (respective medians 13 and 9 months) however toxicities were worse with GPac3 especially alopecia (76% versus 32%).A larger trial compared gemcitabine (1 g/m(2)) (grams per metre squared) plus paclitaxel (175 mg/m(2)) (milligrams per metre squared) as a 3-weekly schedule for 6 cycles with a 2-weekly maintenance schedule. There was no significant difference in response rates, progression-free survival, disease-specific survival, and overall survival. AUTHORS' CONCLUSIONS A review of the published evidence found that one trial reported gemcitabine plus cisplatin had a better safety profile than MVAC and may be considered the first choice for treatment of metastatic bladder cancer. However, the data are limited to one trial only. Patients unable to tolerate cisplatin may benefit from gemcitabine plus carboplatin.
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Affiliation(s)
- Mike Shelley
- Cochrane Prostatic Diseases and Urological Cancers Unit, Research Dept, Velindre NHS Trust, Velindre Road, Whitchurch, Cardiff, Wales, UK, CF4 7XL
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Gontero P, Cattel L, Paone TC, Milla P, Berta G, Fiorito C, Carbone F, Medana C, Tizzani A. Pharmacokinetic study to optimize the intravesical administration of gemcitabine. BJU Int 2010; 106:1652-6. [DOI: 10.1111/j.1464-410x.2010.09496.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Manners S, Galettis P, Souza PD. Conditions causing gemcitabine crystallization. J Oncol Pharm Pract 2010; 17:395-9. [PMID: 20858635 DOI: 10.1177/1078155210385033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Intravesical delivery of chemotherapy agents is used very commonly for the treatment of superficial bladder cancer. We recently completed a phase II study of intravesical gemcitabine in which an alkaline adjusted gemcitabine preparation was used initially, based on very early phase I studies. However, crystallization was noted in some of the pre-prepared syringes, which prompted us to investigate the conditions under which gemcitabine crystallized. METHODS Gemcitabine was prepared in syringes in triplicate and conditions were varied with respect to pH, temperature, and duration. Samples were observed for up to 48 h for the development of crystallization. High-performance liquid chromatography analysis of gemcitabine concentrations was undertaken for all samples. RESULTS Crystallization of gemcitabine was favored under conditions of bicarbonate treatment and lowering of temperature. However, the process was reversible, as demonstrated by recovery of gemcitabine concentrations in samples brought back to room temperature. Crystallization resulted in reduction of gemcitabine concentrations in the pre-prepared syringes. CONCLUSIONS Gemcitabine solutions may be associated with crystallization if the native pH is increased with the addition of sodium bicarbonate, and samples are stored in a cold environment.
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Affiliation(s)
- Susan Manners
- Cancer Pharmacology and Therapeutics Laboratory, St. George Hospital Clinical School, University of New South Wales, Kogarah, New South Wales, Australia
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Malmström PU. Re: Randomized Phase III Trial on Gemcitabine Versus Mytomicin in Recurrent Superficial Bladder Cancer: Evaluation of Efficacy and Tolerance. Eur Urol 2010; 58:178. [DOI: 10.1016/j.eururo.2010.04.013] [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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Marker Lesion Experiments in Bladder Cancer—What Have We Learned? J Urol 2010; 183:1678-84. [DOI: 10.1016/j.juro.2009.12.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Indexed: 11/18/2022]
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Tsai YH, Hsieh YH, Huang YB, Chang JS, Huang CT, Wu PC. Microemulsions for Intravesical Delivery of Gemcitabine. Chem Pharm Bull (Tokyo) 2010; 58:1461-5. [DOI: 10.1248/cpb.58.1461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yi-Hung Tsai
- Graduate Institute of Clinical Pharmacy, Kaohsiung Medical University
| | | | - Yaw-Bin Huang
- Graduate Institute of Clinical Pharmacy, Kaohsiung Medical University
| | | | - Chi-Te Huang
- School of Pharmacy, Kaohsiung Medical University
| | - Pao-Chu Wu
- School of Pharmacy, Kaohsiung Medical University
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Aloisi A, Ruggera L, Beltrami P, Cerruto M, Zattoni F. Second-Line Intravesical Gemcitabine in High Risk Superficial Bladder Cancer: Our Experience. Urologia 2009. [DOI: 10.1177/039156030907600302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose Intravesical instillation of Gemcitabine may represent a useful second-line chemotherapy in case of non-muscle-invasive bladder cancer. Herein, we reported our experience with intravesical Gemcitabine in a group of patients affected by high-grade transitional cell carcinoma (TCC) of the bladder. Materials and Methods We retrospectively analyzed a total of 17 patients (15 males and 2 females), affected by high-risk superficial bladder cancer, who were refractory, intolerant or not eligible to intravesical BCG immunotherapy. Each patient received 2000 mg of Gemcitabine diluted in 100 mL of 0.9% saline solution, administered twice a week for 6 weeks. At start, TCC stage and grade were: CIS in 10 patients, TaG3 in 5 and T1G3 in the remaining 2 cases. Those with no macroscopic lesion and negative cytology and histology were considered as complete responders; those with only positive cytology as partial responders, and those with positive biopsy or evidence of macroscopic lesions as non-responders. Results Patients’ mean age was 71.5 yrs (± 7.3 yrs standard deviation). Overall, median follow-up was 12 months [interquartile range (IQR) 9–15 months]. A complete remission was achieved in 10 cases (58.8%), a partial response in 2 (11.8%), while 5 patients (29.4%) were considered as non-responders. Tumor stage and/or grade progression was observed in 26.7% of the cases. Overall, the 6-month recurrence-free survival was 33.3%. Drug toxicity was relatively low: 2 patients developed a grade II dysuria (NCI-CTC criteria); fever >38° was observed in 1 case. Conclusions Although our experience and follow-up are still rather limited to formulate any conclusive assessment, our study seems to confirm that Gemcitabine could be used as a safe and efficient intravesical chemotherapy agent even in high grade TCCs, representing a promising second-line option in those cases who failed, were intolerant or not eligible to BCG therapy. (Urologia 2009; 76: 178–84)
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Affiliation(s)
- A. Aloisi
- Cattedra e Divisione Clinicizzata di Urologia, Università degli Studi di Verona
| | - L. Ruggera
- Cattedra e Divisione Clinicizzata di Urologia, Università degli Studi di Verona
| | - P. Beltrami
- Cattedra e Divisione Clinicizzata di Urologia, Università degli Studi di Verona
| | - M.A. Cerruto
- Cattedra e Divisione Clinicizzata di Urologia, Università degli Studi di Verona
| | - F. Zattoni
- Cattedra e Divisione Clinicizzata di Urologia, Università degli Studi di Verona
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Böhle A, Leyh H, Frei C, Kühn M, Tschada R, Pottek T, Wagner W, Knispel HH, von Pokrzywnitzki W, Zorlu F, Helsberg K, Lübben B, Soldatenkova V, Stoffregen C, Büttner H. Single postoperative instillation of gemcitabine in patients with non-muscle-invasive transitional cell carcinoma of the bladder: a randomised, double-blind, placebo-controlled phase III multicentre study. Eur Urol 2009; 56:495-503. [PMID: 19560257 DOI: 10.1016/j.eururo.2009.06.010] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 06/09/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recurrence prophylaxis with intravesical gemcitabine (GEM) was effective and safe in patients with non-muscle-invasive bladder cancer (NMIBC); efficacy as single-shot instillation remains to be proved. OBJECTIVE To compare the efficacy of a single GEM instillation versus placebo (PBO) immediately after transurethral resection (TUR) of tumour in patients with histologically confirmed NMIBC (pTa/pT1,G1-3). DESIGN, SETTING, AND PARTICIPANTS This was a double-blind, randomised, PBO-controlled study in patients with clinical evidence of primary or recurrent NMIBC (Ta/T1,G1-3). Of 355 patients randomised at 24 urologic centres, 328 underwent TUR and received instillation (92.4%; GEM/PBO: 166/162). In case of nonmalignancy, carcinoma in situ (CIS), > or = pT2 disease, or intraoperative complications, patients were discontinued. INTERVENTION We used a single, postoperative 30-40-min instillation of GEM (2000 mg/100 ml of saline) or PBO (100 ml of saline) followed by continuous bladder irrigation for > or = 20 h. A second TUR (no instillation) and adjuvant bacillus Calmette-Guérin (BCG) instillations were allowed. MEASUREMENTS Primary outcome was recurrence-free survival (RFS). Secondary outcomes included type of recurrence and adverse events. To detect a difference in RFS, 191 recurrences were required (80% power, log-rank-test, alpha = 0.050). RESULTS AND LIMITATIONS Two hundred forty-eight patients (69.9%, GEM, PBO: 124, 124) had histologically confirmed pTa/pT1 G1-3 Gx tumour and were eligible for efficacy (GEM: 76.6% male; median age: 65 yr; PBO: 83.1% male; median age: 67 yr). Treatment groups were balanced (pTa: 75.0%, 71.0%; G1-G2: 85.5%, 87.9%; recurrent tumour: 24.2%, 21.0%; BCG: 10.5%, 16.9%). After a median follow-up of 24 mo, there were only 94 recurrences and 11 deaths. The study was terminated early based on predefined decision criteria. RFS was high in both groups (12-mo RFS [95% confidence interval (CI)]: GEM: 77.7% [68.8-84.3]; PBO: 75.3% [66.3-82.3]). There was no significant group difference (hazard ratio [HR]: 0.946 [0.64-1.39], log-rank test, p=0.777). CONCLUSIONS In this study of NMIBC, the immediate single instillation of GEM 2000 mg/100 ml of saline after TUR was not superior to PBO in terms of RFS. Rigid continuous irrigation and improved TUR/cystoscopy techniques may have contributed to the high RFS in both groups.
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Affiliation(s)
- Andreas Böhle
- Department of Urology, Helios Agnes Karll Hospital, Bad Schwartau, Germany
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Beyond BCG: Gemcitabine. Bladder Cancer 2009. [DOI: 10.1007/978-1-59745-417-9_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Witjes JA, Kolli PS. Apaziquone for non-muscle invasive bladder cancer: a critical review. Expert Opin Investig Drugs 2008; 17:1085-96. [DOI: 10.1517/13543784.17.7.1085] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J Alfred Witjes
- Radboud University Nijmegen Medical Centre, Department of Urology (659), PO Box 9101, 6500 H.B Nijmegen, The Netherlands ;
| | - Prasad S Kolli
- Spectrum Pharmaceuticals, Department of biopharmaceuticals, Irvine, California, USA
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Kim JW, Cho DY, Yeo JK, Park HS, Yoon DK. Initial Experiences of Intravesical Gemcitabine Instillation Followed by Bacillus Calmette-Guerin (BCG) Therapy for Treating Intermediate or High Risk Patients with Superficial Bladder Cancer. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.4.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jong Wook Kim
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Dae Yeon Cho
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Jeong Kyun Yeo
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Hong Seok Park
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Duck Ki Yoon
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
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Hendricksen K, Witjes JA. Treatment of Intermediate-Risk Non–Muscle-Invasive Bladder Cancer (NMIBC). ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.eursup.2007.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
PURPOSE OF REVIEW Nonmuscle-invasive bladder cancer is a common malignancy, standardly treated by transurethral resection and adjuvant intravesical instillations of chemotherapy or immunotherapy. Adjuvant instillations are needed to reduce recurrence and/or progression. With currently existing adjuvant treatments, however, recurrences still occur, progression is hardly influenced and these treatments induce local or systemic side effects. In search for efficacy improvement and side effect reduction, we reviewed the promising properties of the relatively new intravesical drug, gemcitabine. RECENT FINDINGS The safety of gemcitabine is tested in different instillation schemes, drug concentrations and administered volumes. Its safety profile is excellent, with good tolerability and minimal toxicity up to 2000 mg/50 ml for 2-h instillations. In comparison with other drugs, the ablative efficacy of gemcitabine is good. The first studies on prophylactic efficacy in intermediate-risk, high-risk and bacillus Calmette-Guerin-refractory patients are promising but limited by the small number of patients studied. SUMMARY The available literature underlines the promising properties of gemcitabine for the intravesical use against nonmuscle-invasive bladder cancer. Exploring phase-II and comparative randomized phase-III studies should provide additional information on gemcitabine and its benefit to clinical practice.
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Affiliation(s)
- Kees Hendricksen
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Bibliography. Current world literature. Bladder cancer. Curr Opin Urol 2006; 16:386-9. [PMID: 16905987 DOI: 10.1097/01.mou.0000240314.93453.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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