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Mercinelli C, Moschini M, Cigliola A, Mattorre B, Tateo V, Basile G, Cogrossi LL, Maiorano BA, Patanè DA, Raggi D, Pastorino GL, Re C, Colecchia M, Lucianò R, Colombo R, Brembilla G, De Cobelli F, Briganti A, Pavlick DC, Ross JS, Montorsi F, Bellone M, Necchi A. First Results of NURE-Combo: A Phase II Study of Neoadjuvant Nivolumab and Nab-Paclitaxel, Followed by Postsurgical Adjuvant Nivolumab, for Muscle-Invasive Bladder Cancer. J Clin Oncol 2024:JCO2400576. [PMID: 39241203 DOI: 10.1200/jco.24.00576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/13/2024] [Accepted: 07/09/2024] [Indexed: 09/08/2024] Open
Abstract
PURPOSE To evaluate the activity and safety of nivolumab with nab-paclitaxel as neoadjuvant therapy, followed by radical cystectomy (RC) and postsurgical adjuvant nivolumab in patients with muscle-invasive bladder cancer (MIBC). PATIENTS AND METHODS Eligible patients had an Eastern Cooperative Oncology Group performance status of ≤1 and a T2-4aN0-1M0 stage with >50% urothelial carcinoma histology and were ineligible for or refused cisplatin-based chemotherapy. Patients received four cycles of nivolumab 360 mg once every 3 weeks + nab-paclitaxel 125 mg/m2 once on days 1 and 8, every 3 weeks, followed by RC, and then adjuvant nivolumab 360 mg once every 3 weeks × 13 cycles. The primary end point was the pathologic complete response (CR) rate (ypT0N0). Secondary end points were major pathologic response (ypT≤1N0), safety, event-free survival (EFS), and overall survival. RESULTS Thirty-one patients were enrolled from December 2021 to June 2023; 19 (61.3%) had a cT2 stage, two (6.5%) had N1 stage, and 16 (51.6%) had a variant histology. Five patients (16.1%) received less than four full courses of neoadjuvant treatment because of treatment-related adverse events (TRAEs). Grade 3/4 TRAEs occurred in eight patients (25.8%). Twenty-eight patients underwent RC, and three refused RC after evidence of clinical CR and received a redo transurethral resection of the bladder tumor (reTURBT). The trial met its primary end point: 10 patients (32.3%; 95% CI, 16.7 to 51.4) achieved an ypT0N0 response. By including those who underwent reTURBT, 22 (70.9%; 95% CI, 55 to 87) achieved an ypT≤1N0-x response. After a median follow-up of 12 months (range, 5-22), two patients had a disease relapse after surgery. The 12-month EFS was 89.8% (95% CI, 79.5 to 100). CONCLUSION To our knowledge, the first results from NURE-Combo trial suggest that this combination could expand the therapeutic opportunities of immune-chemotherapy in patients with MIBC.
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Affiliation(s)
- Chiara Mercinelli
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Antonio Cigliola
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Benedetta Mattorre
- Cellular Immunology Unit, Division of Immunology, Transplantation, and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Valentina Tateo
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giuseppe Basile
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Laura L Cogrossi
- Cellular Immunology Unit, Division of Immunology, Transplantation, and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Brigida A Maiorano
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Damiano A Patanè
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Daniele Raggi
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Chiara Re
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maurizio Colecchia
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Pathology and Laboratory Medicine, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberta Lucianò
- Department of Pathology and Laboratory Medicine, IRCCS San Raffaele Hospital, Milan, Italy
| | - Renzo Colombo
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Jeffrey S Ross
- Foundation Medicine, Inc, Cambridge, MA
- SUNY Upstate Medical University, Syracuse, NY
| | - Francesco Montorsi
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Bellone
- Cellular Immunology Unit, Division of Immunology, Transplantation, and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Wang AJY, Yan C, Reike MJ, Black PC, Contreras-Sanz A. A systematic review of nanocarriers for treatment of urologic cancers. Urol Oncol 2024; 42:75-101. [PMID: 38161104 DOI: 10.1016/j.urolonc.2023.11.022] [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: 08/28/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
Nanocarriers (NCs) are a form of nanotechnology widely investigated in cancer treatment to improve the safety and efficacy of systemic therapies by increasing tumor specificity. Numerous clinical trials have explored the use of NCs in urologic cancers since the approval of the first NCs for cancer treatment over 20 years ago. The objective of this systematic review is to examine the effectiveness and safety of NCs in treating urological cancers. This paper summarizes the state of the field by investigating peer-reviewed, published results from 43 clinical trials involving the use of NCs in bladder, prostate, and kidney cancer patients with a focus on safety and efficacy data. Among the 43 trials, 16 were phase I, 20 phase II, and 4 phase I/II. No phase III trials have been reported. While both novel and classic NCs have been explored in urologic cancers, NCs already approved for the treatment of other cancers were more widely represented. Trials in prostate cancer and mixed trials involving both urologic and non-urologic cancer patients were the most commonly reported trials. Although NCs have demonstrable efficacy with adequate safety in non-urologic cancer patient populations, current clinical stage NC options appear to be less beneficial in the urologic cancer setting. For example, nab-paclitaxel and liposomal doxorubicin have proven ineffective in the treatment of urologic cancers despite successes in other cancers. However, several ongoing pre-clinical studies using targeted and locally applied improved NCs may eventually improve their utility.
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Affiliation(s)
- Amy J Y Wang
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cathy Yan
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Moritz J Reike
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter C Black
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada..
| | - Alberto Contreras-Sanz
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada..
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Song FX, Xu X, Ding H, Yu L, Huang H, Hao J, Wu C, Liang R, Zhang S. Recent Progress in Nanomaterial-Based Biosensors and Theranostic Nanomedicine for Bladder Cancer. BIOSENSORS 2023; 13:106. [PMID: 36671940 PMCID: PMC9855444 DOI: 10.3390/bios13010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Bladder cancer (BCa) is one of the most expensive and common malignancies in the urinary system due to its high progression and recurrence rate. Although there are various methods, including cystoscopy, biopsy, and cytology, that have become the standard diagnosis methods for BCa, their intrinsic invasive and inaccurate properties need to be overcome. The novel urine cancer biomarkers are assisted by nanomaterials-based biosensors, such as field-effect transistors (FETs) with high sensitivity and specificity, which may provide solutions to these problems. In addition, nanomaterials can be applied for the advancement of next-generation optical imaging techniques and the contrast agents of conventional techniques; for example, magnetic resonance imaging (MRI) for the diagnosis of BCa. Regarding BCa therapy, nanocarriers, including mucoadhesive nanoparticles and other polymeric nanoparticles, successfully overcome the disadvantages of conventional intravesical instillation and improve the efficacy and safety of intravesical chemotherapy for BCa. Aside from chemotherapy, nanomedicine-based novel therapies, including photodynamic therapy (PDT), photothermal therapy (PTT), chemodynamic therapy (CDT), sonodynamic therapy (SDT), and combination therapy, have afforded us new ways to provide BC therapy and hope, which can be translated into the clinic. In addition, nanomotors and the nanomaterials-based solid tumor disassociation strategy provide new ideas for future research. Here, the advances in BCa diagnosis and therapy mentioned above are reviewed in this paper.
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Affiliation(s)
- Fan-Xin Song
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou 215123, China
- College of Nano Science & Technology (CNST), Soochow University, Suzhou 215123, China
| | - Xiaojian Xu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Hengze Ding
- Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou 215123, China
- College of Nano Science & Technology (CNST), Soochow University, Suzhou 215123, China
| | - Le Yu
- Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou 215123, China
- College of Nano Science & Technology (CNST), Soochow University, Suzhou 215123, China
| | - Haochen Huang
- Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou 215123, China
- College of Nano Science & Technology (CNST), Soochow University, Suzhou 215123, China
| | - Jinting Hao
- Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou 215123, China
- College of Nano Science & Technology (CNST), Soochow University, Suzhou 215123, China
| | - Chenghao Wu
- Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou 215123, China
- College of Nano Science & Technology (CNST), Soochow University, Suzhou 215123, China
| | - Rui Liang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Shaohua Zhang
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
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Sarkis J, Vannier E, Mjaess G, Pochet C, Albisinni S, Quackels T, Roumeguère T. Neoadjuvant immunochemotherapy in the treatment of nonmetastatic muscle-invasive bladder cancer: a systematic review. Immunotherapy 2022; 14:1407-1417. [PMID: 36448639 DOI: 10.2217/imt-2022-0039] [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: 12/03/2022] Open
Abstract
Introduction: Multiple trials are currently studying the additional effect of immunotherapy on neoadjuvant chemotherapy (NAC) in nonmetastatic muscle-invasive bladder cancer. Methods: We performed a systematic review of the literature that summarizes all ongoing trials, with their results when available. Results: From an initial 269 trials identified, 17 were included. Pathological response and pathological complete response rates of the immunotherapy + NAC combination in the cisplatin-eligible population varied between 56.6-75% and 34.0-66.7%, respectively. Two studies published their results in the cisplatin-ineligible population, with pathological complete response rates of 18 and 45.2%. Conclusion: Neoadjuvant immunochemotherapy in platinum-eligible patients results in response rates higher than those reported for NAC alone. Strong preliminary results are still lacking in the platinum-ineligible population.
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Affiliation(s)
- Julien Sarkis
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Enguerrand Vannier
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Corentin Pochet
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Surgical Sciences, Urology Unit, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Thierry Quackels
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Kong C, Zhang S, Lei Q, Wu S. State-of-the-Art Advances of Nanomedicine for Diagnosis and Treatment of Bladder Cancer. BIOSENSORS 2022; 12:bios12100796. [PMID: 36290934 PMCID: PMC9599190 DOI: 10.3390/bios12100796] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 06/13/2023]
Abstract
Bladder cancer is a common malignant tumor of the urinary system. Cystoscopy, urine cytology, and CT are the routine diagnostic methods. However, there are some problems such as low sensitivity and difficulty in staging, which must be urgently supplemented by novel diagnostic methods. Surgery, intravesical instillation, systemic chemotherapy, and radiotherapy are the main clinical treatments for bladder cancer. It is difficult for conventional treatment to deal with tumor recurrence, progression and drug resistance. In addition, the treatment agents usually have the defects of poor specific distribution ability to target tumor tissues and side effects. The rapid development of nanomedicine has brought hope for the treatment of bladder cancer in reducing side effects, enhancing tumor inhibition effects, and anti-drug resistance. Overall, we review the new progression of nano-platforms in the diagnosis and treatment of bladder cancer.
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Affiliation(s)
- Chenfan Kong
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Shaohua Zhang
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
| | - Qifang Lei
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
| | - Song Wu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
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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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7
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Programmed cell death, redox imbalance, and cancer therapeutics. Apoptosis 2021; 26:385-414. [PMID: 34236569 DOI: 10.1007/s10495-021-01682-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 02/06/2023]
Abstract
Cancer cells are disordered by nature and thus featured by higher internal redox level than healthy cells. Redox imbalance could trigger programmed cell death if exceeded a certain threshold, rendering therapeutic strategies relying on redox control a possible cancer management solution. Yet, various programmed cell death events have been consecutively discovered, complicating our understandings on their associations with redox imbalance and clinical implications especially therapeutic design. Thus, it is imperative to understand differences and similarities among programmed cell death events regarding their associations with redox imbalance for improved control over these events in malignant cells as well as appropriate design on therapeutic approaches relying on redox control. This review addresses these issues and concludes by bringing affront cold atmospheric plasma as an emerging redox controller with translational potential in clinics.
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Narain TA, Tosh JM, Gautam G, Talwar HS, Panwar VK, Mittal A, Mandal AK. Neoadjuvant Therapy for Cisplatin Ineligible Muscle Invasive Bladder Cancer Patients: A Review of Available Evidence. Urology 2021; 154:8-15. [PMID: 33775784 DOI: 10.1016/j.urology.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
Neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for muscle invasive non-metastatic bladder cancer patients. While cisplatin based neoadjuvant chemotherapy has been recommended, systemic therapy in a neoadjuvant setting for cisplatin ineligible patients still needs to be addressed. Various strategies like split dosing cisplatin chemotherapy, carboplatin based chemotherapy and taxanes based chemotherapy have been tried as neoadjuvant therapy for cisplatin ineligible patients. Immunotherapy is a promising tool in this regard with a need for the development of predictive and prognostic biomarkers which can bring out the true potential of these immunotherapeutic agents.
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Affiliation(s)
- Tushar Aditya Narain
- Robotic Pelvic Oncology, Department of Urology, University College London Hospital, London
| | | | - Gagan Gautam
- Urological Oncology and Robotic Surgery, Max Institute of Cancer Care, Saket, New Delhi.
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Chen Y, Li J, Chen S, Zhang Y, Hu Y, Zhang G, Yan X, Jiao S. Nab-Paclitaxel in combination with Cisplatin Versus Docetaxel Plus Cisplatin as First-Line Therapy in Non-small Cell Lung Cancer. Sci Rep 2017; 7:10760. [PMID: 28883517 PMCID: PMC5589896 DOI: 10.1038/s41598-017-11404-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
Albumin-bound paclitaxel (nab-PC) and docetaxel both produced favorable efficacy and safety as first-line therapy in advanced non-small cell lung cancer (NSCLC). However, the comparison between nab-PC and docetaxel remained unclear until now. This retrospective study aimed to compare the efficacy and safety of nab-PC/cisplatin with docetaxel/cisplatin as first-line therapy in advanced NSCLC. 271 patients with advanced NSCLC, who received either nab-PC (55 patients) or docetaxel (216 patients) were reviewed from 2012 to 2016. The primary endpoint was objective overall response rate (ORR). The secondary endpoints were disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and safety profiles. Nab-PC presented a significantly higher ORR than docetaxel (47.3% vs 31.9%; P = 0.033). The difference of ORR was more significantly remarkable in patients with squamous histology (58.3% vs 29.0%; P = 0.007). Additionally, the DCR of nab-PC was significantly higher than docetaxel. Patients in nab-PC group had a trend toward improved PFS and OS compared with patients in docetaxel group, but this didn't reach statistical significance. Grade ≥ 3 neutropenia was less in nab-PC group, while Grade ≥ 3 anemia and thrombocytopenia were less in docetaxel group. Nab-PC/cisplatin as first-line therapy, produced significantly higher efficacy and reduced neutropenia than docetaxel/cisplatin in advanced NSCLC.
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Affiliation(s)
- Yi Chen
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jinyu Li
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | - Shixue Chen
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | - Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yi Hu
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | - Guoqing Zhang
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | - Xiang Yan
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | - Shunchang Jiao
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China.
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Cumberbatch K, He T, Thorogood Z, Gartrell BA. Emerging drugs for urothelial (bladder) cancer. Expert Opin Emerg Drugs 2017; 22:149-164. [PMID: 28556678 DOI: 10.1080/14728214.2017.1336536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Metastatic urothelial carcinoma has been associated with poor prognosis and a median survival of approximately 12-14 months with standard therapy. Treatment options for decades have been limited to platinum based chemotherapy as first line with few therapeutic options available to the majority who will ultimately progress beyond platinum. Areas covered: This review focuses on the various targeted, antiangiogenic, chemotherapeutic and immunotherapeutic agents currently being developed for the treatment of urothelial carcinoma. Expert opinion: Incorporation of systemic immunotherapy into the treatment of urothelial carcinoma has already fundamentally changed the treatment of this disease. The landscape is rapidly changing and it is likely that immunotherapy will be incorporated into therapy in earlier disease states and in novel combinations. Outcomes in urothelial carcinoma have improved and likely to improve further with ongoing and future clinical research that is discussed in this review.
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Affiliation(s)
- Kerwin Cumberbatch
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| | - Tianfang He
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| | - Zachary Thorogood
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| | - Benjamin A Gartrell
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
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Funt SA, Rosenberg JE. Systemic, perioperative management of muscle-invasive bladder cancer and future horizons. Nat Rev Clin Oncol 2017; 14:221-234. [PMID: 27874062 PMCID: PMC6054138 DOI: 10.1038/nrclinonc.2016.188] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Many patients diagnosed with muscle-invasive bladder cancer (MIBC) will develop distant metastatic disease. Over the past three decades, perioperative cisplatin-based chemotherapy has been investigated for its ability to reduce the number of deaths from bladder cancer. Insufficient evidence is available to fully support the use of such chemotherapy in the adjuvant setting; however, neoadjuvant cisplatin-based combination chemotherapy has become a standard of care for eligible patients based on the improved disease-specific and overall survival demonstrated in two randomized phase III trials, compared with surgery alone. For patients with disease downstaging to non-MIBC at the time of radical cystectomy as a result of neoadjuvant chemotherapy, outcomes are outstanding, with 5-year overall survival of 80-90%. Nevertheless, the inability to define before treatment the patients who will and those who will not achieve such a response has impeded the achievement of better outcomes for patients with MIBC. High-throughput DNA and RNA profiling technologies might help to overcome this barrier and enable a more-personalized approach to the use of cytotoxic neoadjuvant chemotherapy. In the past 2 years, trial results have demonstrated the unprecedented ability of immune- checkpoint blockade to induce durable remissions in patients with metastatic disease that has progressed after chemotherapy; studies are now urgently needed to determine how best to incorporate this powerful therapeutic modality into the care of patients with MIBC. Herein, we review the evolution of chemotherapy and immunotherapy for muscle-invasive bladder cancer.
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Affiliation(s)
- Samuel A Funt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
| | - Jonathan E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
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Galsky MD, Stensland K, Sfakianos JP, Mehrazin R, Diefenbach M, Mohamed N, Tsao CK, Boffetta P, Wiklund P, Oh WK, Mazumdar M, Ferket B. Comparative Effectiveness of Treatment Strategies for Bladder Cancer With Clinical Evidence of Regional Lymph Node Involvement. J Clin Oncol 2016; 34:2627-35. [PMID: 27269939 DOI: 10.1200/jco.2016.67.5033] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Patients with bladder cancer with clinical lymph node involvement (cN+) are at high risk for distant metastases, but are potentially curable. Such patients are excluded from neoadjuvant chemotherapy trials and pooled with patients with distant metastases in first-line chemotherapy trials not suited to define the role of combined-modality therapy. To address this evidence void, we performed a comparative effectiveness analysis. METHODS We included cTanyN1-3M0 bladder cancer patients from the National Cancer Data Base (2003-2012) treated with chemotherapy and/or cystectomy. We used multistate survival analysis, allowing for delayed entry, to assess overall survival (OS) according to various treatment strategies. Effectiveness was estimated with multivariable adjustment for tumor-, patient-, and facility-level characteristics. RESULTS Among 1,739 patients (cN1, 48%; cN2, 45%; cN3, 7%), 1,104 underwent cystectomy and 635 were treated with chemotherapy alone. Of the cystectomy patients, 363 received preoperative and 328 received adjuvant chemotherapy. The crude 5-year OS for chemotherapy alone, cystectomy alone, preoperative chemotherapy followed by cystectomy, and cystectomy followed by adjuvant chemotherapy was 14% (95% CI, 11% to 17%), 19% (95% CI, 15% to 24%), 31% (95% CI, 25% to 38%), and 26% (95% CI, 21% to 34%), respectively. Compared with cystectomy alone, preoperative chemotherapy was associated with a significant improvement in OS (hazard ratio, 0.80; 95% CI, 0.66 to 0.97). Adjuvant chemotherapy was also associated with a significant improvement in survival compared with cystectomy alone. The survival of patients treated with chemotherapy alone was worse than those treated with cystectomy alone. CONCLUSION A subset of patients with cN+ bladder cancer achieves long-term survival. Combined-modality therapy, with chemotherapy and cystectomy, is associated with the best outcomes.
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Affiliation(s)
- Matthew D Galsky
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden.
| | - Kristian Stensland
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - John P Sfakianos
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - Reza Mehrazin
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - Michael Diefenbach
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - Nihal Mohamed
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - Che-Kai Tsao
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - Paolo Boffetta
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - Peter Wiklund
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - William K Oh
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - Madhu Mazumdar
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
| | - Bart Ferket
- Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden
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13
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Sonpavde G, Gordetsky JB, Lockhart ME, Nix JW. Chemotherapy for Muscle-Invasive Bladder Cancer: Better Late Than Never? J Clin Oncol 2016; 34:780-5. [PMID: 26786922 DOI: 10.1200/jco.2015.65.4442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 64-year-old man with a history of cigarette smoking but no significant comorbidities presented with hematuria and dysuria. Computed tomography scans demonstrated a mass and thickening of the bladder wall and no evidence of metastasis. His laboratory evaluation showed normal blood cell counts and comprehensive metabolic panel with a calculated creatinine clearance of more than 60 mL per minute. A transurethral resection of the bladder tumor and biopsy identified transitional cell carcinoma or urothelial carcinoma invading the muscularis propria of the bladder. On the basis of the bladder-confined mass on computed tomography scan, the tumor was assigned a clinical stage of cT2N0. The patient was advised to undergo neoadjuvant chemotherapy followed by radical cystectomy (RC). The patient had multiple concerns regarding neoadjuvant chemotherapy, particularly toxicities, especially the possibility of chronic neurologic and renal toxicities, and the potential harm from delay of RC, especially if the bladder cancer was resistant to chemotherapy. After a discussion of approximately 1 hour, he elected to proceed with upfront RC and extended lymph node dissection in conjunction with construction of a neobladder. Pathology revealed pathologic extravesical urothelial carcinoma, with disease in one of 25 lymph nodes removed (ypT3N1). Four weeks after RC, he returned to discuss further management with the medical oncologist. He exhibited an Eastern Cooperative Oncology Group performance status of 0, normal blood cell counts, and a calculated creatinine clearance of more than 60 mL per minute.
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Affiliation(s)
- Guru Sonpavde
- University of Alabama, Birmingham, School of Medicine and Veterans Affairs Medical Center, Birmingham, AL
| | | | - Mark E Lockhart
- University of Alabama, Birmingham, School of Medicine, Birmingham, AL
| | - Jeffrey W Nix
- University of Alabama, Birmingham, School of Medicine, Birmingham, AL
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14
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Raggi D, Miceli R, Sonpavde G, Giannatempo P, Mariani L, Galsky MD, Bellmunt J, Necchi A. Second-line single-agent versus doublet chemotherapy as salvage therapy for metastatic urothelial cancer: a systematic review and meta-analysis. Ann Oncol 2015; 27:49-61. [PMID: 26487582 DOI: 10.1093/annonc/mdv509] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/12/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The efficacy and safety of a combination of chemotherapeutic agent compared with single-agent chemotherapy in the second-line setting of advanced urothelial carcinoma (UC) are unclear. We aimed to study the survival impact of single-agent compared with doublet chemotherapy as second-line chemotherapy of advanced UC. PATIENTS AND METHODS Literature was searched for studies including single-agent or doublet chemotherapy in the second-line setting after platinum-based chemotherapy. Random-effects models were used to pool trial-level data according to treatment arm, including median progression-free survival (PFS), overall survival (OS), objective response rate (ORR) probability, and grade 3-4 toxicity. Univariable and multivariable analyses, including sensitivity analyses, were carried out, adjusting for the percent of patients with ECOG performance status ≥1 and hepatic metastases. RESULTS Forty-six arms of trials including 1910 patients were selected: 22 arms with single agent (n = 1202) and 24 arms with doublets (n = 708). The pooled ORR with single agents was 14.2% [95% confidence interval (CI) 11.1-17.9] versus 31.9% [95% CI 27.3-36.9] with doublet chemotherapy. Pooled median PFS was 2.69 and 4.05 months, respectively. The pooled median OS was 6.98 and 8.50 months, respectively. Multivariably, the odds ratio for ORR and the pooled median difference of PFS were statistically significant (P < 0.001 and P = 0.002) whereas the median difference in OS was not (P = 0.284). When including single-agent vinflunine or taxanes only, differences were significant only for ORR (P < 0.001) favoring doublet chemotherapy. No statistically significant differences in grade 3-4 toxicity were seen between the two groups. CONCLUSIONS Despite significant improvements in ORR and PFS, doublet regimens did not extend OS compared with single agents for the second-line chemotherapy of UC. Prospective trials are necessary to elucidate the role of combination chemotherapy, with or without targeted agents, in the salvage setting. Currently, improvements in this field should be pursued considering single-agent chemotherapy as the foundation for new more active combinations.
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Affiliation(s)
- D Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Miceli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Sonpavde
- UAB Comprehensive Cancer Center, Birmingham
| | - P Giannatempo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M D Galsky
- Mount Sinai School of Medicine, Tisch Cancer Institute, New York
| | - J Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - A Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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15
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Zhao B, Grivas PD. Contemporary Systemic Therapy for Urologic Malignancies in Geriatric Patients. Clin Geriatr Med 2015; 31:645-65. [PMID: 26476122 DOI: 10.1016/j.cger.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Current data on systemic therapy in geriatric populations with genitourinary malignancies are largely derived from retrospective analyses of prospectively conducted trials or retrospective reviews. Although extrapolation of these data to real-world patients should be cautious, patients aged 65 years or older with good functional status and minimal comorbidities seem to enjoy similar survival benefit from therapy as their younger counterparts. Chronologic age alone should generally not be used to guide management decisions. Comprehensive geriatric assessment tools and prospective studies in older adults integrating comprehensive geriatric assessment can shed light on the optimal management of urologic malignancies in this population.
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Affiliation(s)
- Bo Zhao
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Desk R30, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Petros D Grivas
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Desk R35, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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16
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Quinn DI, Sternberg CN. Neoadjuvant chemotherapy in the treatment of muscle-invasive bladder cancer. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Rudzinski JK, Basappa NS, North S. Perioperative chemotherapy for muscle invasive bladder cancer. Curr Opin Support Palliat Care 2015; 9:249-54. [PMID: 26125306 DOI: 10.1097/spc.0000000000000148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Radical cystectomy with or without systemic chemotherapy is considered a standard of care for patients with muscle invasive bladder cancer (MIBC). The purpose of this review is to provide an update on current and recent literature published within the last 12 months reviewing the evidence for use of perioperative chemotherapy for patients with MIBC. RECENT FINDINGS In the neoadjuvant chemotherapy (NAC) setting, the evidence demonstrates clinical efficacy and lower rate of toxicity with the use of high-dose methotrexate, vinblastine, doxorubicin, and cyclophosphamide (MVAC) compared with standard MVAC. Higher quality evidence for the use of gemcitabine with cisplatin is not yet available. Meta-analysis of cisplatin-based regimens in the adjuvant setting demonstrates significant benefit in overall survival and disease-free survival specifically in patients with lymph-node-positive disease. SUMMARY The available evidence suggests that along with radical cystectomy, cisplatin-based perioperative chemotherapy should be the standard of care in patients with MIBC with a higher quality and quantity of literature in support of the NAC approach. Adoption of perioperative chemotherapy for MIBC is on the rise in North America, which is reassuring. Novel therapeutic approaches for cisplatin-ineligible patients are currently being investigated.
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Affiliation(s)
- Jan K Rudzinski
- aDivision of Urology, Department of Surgery bDivision of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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18
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Burgess EF. Individualized management of advanced bladder cancer: Where do we stand? Urol Oncol 2015; 33:187-95. [DOI: 10.1016/j.urolonc.2013.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/17/2013] [Accepted: 09/20/2013] [Indexed: 12/13/2022]
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Vashistha V, Quinn DI, Dorff TB, Daneshmand S. Current and recent clinical trials for perioperative systemic therapy for muscle invasive bladder cancer: a systematic review. BMC Cancer 2014; 14:966. [PMID: 25515347 PMCID: PMC4301463 DOI: 10.1186/1471-2407-14-966] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/11/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although Muscle Invasive Bladder Cancer (MIBC) is increasing in incidence, treatment has largely remained limited to radical cystectomy with or without cisplatin-based neoadjuvant and/or adjuvant chemotherapy. We reviewed the current and recent clinical trials evaluating perioperative chemotherapy, targeted therapy, and novel therapeutic regimens for MIBC patients undergoing radical cystectomy. METHODS An overview of perioperative MIBC management was conducted initially using MEDLINE. The Clinical Trials Registry and MEDLINE were further searched specifically for perioperative MIBC chemotherapy, targeted therapy, and other novel therapeutic approaches. Trials involving non-perioperative management, operative management other than radical cystectomy, multiple tumors, or purely superficial or metastatic disease were excluded from selection. These criteria were not specifically fulfilled for mTOR inhibitor and immune therapy trials. Only phase III chemotherapy and phase II targeted therapy trials found in the Clinical Trials Registry were selected. MEDLINE searches of specific treatments were limited to January 2009 to January 2014 whereas the Clinical Trials Registry search had no timeline. Systematic MEDLINE searches had no phase restrictions. Trials known by the authors to fulfill search criteria but were not found via searches were also selected. RESULTS Twenty-five trials were selected from the Clinical Trials Registry including 7 phase III chemotherapy trials, 11 Phase II targeted therapy trials, 3 immune therapy trials, 1 mammalian target of rapamycin (mTOR) inhibitor trial, and 3 gene and vaccine therapy trials. Nine trials have been completed and 5 have been terminated early or withdrawn. Nine trials have data available when individually searched using MEDLINE and/or Google. Systematic searches of MEDLINE separately found 12 trials in the past 5 years. Two phase III chemotherapy trials were selected based on knowledge by the authors. No phase III trials of targeted therapy have been registered or published. CONCLUSIONS New trials are currently being conducted that may revolutionize MIBC treatment preceding or following cystectomy. Head-to-head phase III trials of perioperative chemotherapy and further phase II and phase III trials of targeted therapy and other therapeutic approaches are necessary before the current cisplatin-based perioperative chemotherapy paradigm is altered.
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Affiliation(s)
- Vishal Vashistha
- />Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH USA
| | - David I Quinn
- />Division of Oncology, USC/Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA USA
| | - Tanya B Dorff
- />Division of Oncology, USC/Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA USA
| | - Siamak Daneshmand
- />Department of Urology, USC/Norris Comprehensive Cancer Center, USC Institute of Urology, 1441 Eastlake Abe, Suite 7416, Los Angeles, CA 90089 USA
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Sonpavde G, Jones BS, Bellmunt J, Choueiri TK, Sternberg CN. Future directions and targeted therapies in bladder cancer. Hematol Oncol Clin North Am 2014; 29:361-76, x. [PMID: 25836940 DOI: 10.1016/j.hoc.2014.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There are substantial unmet needs for patients with metastatic urothelial carcinoma (UC). First-line cisplatin-based chemotherapy regimens yield a median survival of 12 to 15 months and long-term survival in 5% to 15%. Salvage systemic therapy yields a median survival of 6 to 8 months. Hence, the discovery of novel therapeutic targets is of paramount importance. Recent molecular analyses have provided insights regarding molecular tumor tissue alterations on multiple platforms. A multidisciplinary effort using innovative clinical trial designs and exploiting preclinical signals of robust activity guided by predictive biomarkers may provide much needed clinical advances in therapy for advanced UC.
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Affiliation(s)
- Guru Sonpavde
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, 1720 2nd Ave. S., Birmingham, AL 35294, USA
| | - Benjamin S Jones
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, 1720 2nd Ave. S., Birmingham, AL 35294, USA
| | - Joaquim Bellmunt
- Bladder Cancer Institute, Dana Farber Cancer Institute, Dana-Farber/Brigham and Women's Cancer Center, Boston, 450, Brookline Ave, MA 02215, USA
| | - Toni K Choueiri
- Bladder Cancer Institute, Dana Farber Cancer Institute, Dana-Farber/Brigham and Women's Cancer Center, Boston, 450, Brookline Ave, MA 02215, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglioni Flajani, 1st Floor, Circonvallazione Gianicolense 87, Rome 00152, Italy.
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Viúdez A, Ramírez N, Hernández-García I, Carvalho F, Vera R, Hidalgo M. Nab-paclitaxel: A flattering facelift. Crit Rev Oncol Hematol 2014; 92:166-80. [DOI: 10.1016/j.critrevonc.2014.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 06/03/2014] [Accepted: 06/20/2014] [Indexed: 12/21/2022] Open
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Mazzola CR, Siddiqui KM, Billia M, Chin J. Dovitinib: rationale, preclinical and early clinical data in urothelial carcinoma of the bladder. Expert Opin Investig Drugs 2014; 23:1553-62. [PMID: 25284004 DOI: 10.1517/13543784.2014.966900] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Bladder cancer (BC) is the third and fifth cancer in men in terms of incidence and mortality in the US. Overexpression and mutations of fibroblast growth factor receptor 3 (FGFR3) are frequently found in BC and can represent a very interesting therapeutic target. Different FGFR3-targeted strategies have been investigated through in vitro and in vivo settings, including FGFR3 tyrosine kinase inhibitors such as dovitinib . AREAS COVERED The authors review the data that provide a scientific rationale for FGFR3-targeted therapy in BC. They also provide an evaluation of the currently available in vitro and in vivo data on the use of dovitinib in BC patients. EXPERT OPINION The development and progression of BC rely on a very complex signaling network that involves many different receptors aside from FGFR3 and VEGFR2. The involved signaling network can also be very different from one BC to the other, and can also evolve through time in the same patient. Inhibiting only one single target may thus not be sufficient to achieve a complete downstream oncogenic signaling blockage. Additionally, in vitro data on the use of neutralizing monoclonal antibodies targeting FGFR3 show that it can be a more efficient strategy to reach the same goal, with the potential advantage of less toxicity.
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Affiliation(s)
- Clarisse R Mazzola
- Western University, Division of Urology and Division of Surgical Oncology , London, Ontario , Canada +519 685 8451 ; +519 685 8455 ;
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23
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Zargar H, Espiritu PN, Fairey AS, Mertens LS, Dinney CP, Mir MC, Krabbe LM, Cookson MS, Jacobsen NE, Gandhi NM, Griffin J, Montgomery JS, Vasdev N, Yu EY, Youssef D, Xylinas E, Campain NJ, Kassouf W, Dall'Era MA, Seah JA, Ercole CE, Horenblas S, Sridhar SS, McGrath JS, Aning J, Shariat SF, Wright JL, Thorpe AC, Morgan TM, Holzbeierlein JM, Bivalacqua TJ, North S, Barocas DA, Lotan Y, Garcia JA, Stephenson AJ, Shah JB, van Rhijn BW, Daneshmand S, Spiess PE, Black PC. Multicenter assessment of neoadjuvant chemotherapy for muscle-invasive bladder cancer. Eur Urol 2014; 67:241-9. [PMID: 25257030 DOI: 10.1016/j.eururo.2014.09.007] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 09/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The efficacy of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (BCa) was established primarily with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), with complete response rates (pT0) as high as 38%. However, because of the comparable efficacy with better tolerability of gemcitabine and cisplatin (GC) in patients with metastatic disease, GC has become the most commonly used regimen in the neoadjuvant setting. OBJECTIVE We aimed to assess real-world pathologic response rates to NAC with different regimens in a large, multicenter cohort. DESIGN, SETTING, AND PARTICIPANTS Data were collected retrospectively at 19 centers on patients with clinical cT2-4aN0M0 urothelial carcinoma of the bladder who received at least three cycles of NAC, followed by radical cystectomy (RC), between 2000 and 2013. INTERVENTION NAC and RC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was pathologic stage at cystectomy. Univariable and multivariable analyses were used to determine factors predictive of pT0N0 and ≤pT1N0 stages. RESULTS AND LIMITATIONS Data were collected on 935 patients who met inclusion criteria. GC was used in the majority of the patients (n=602; 64.4%), followed by MVAC (n=183; 19.6%) and other regimens (n=144; 15.4%). The rates of pT0N0 and ≤pT1N0 pathologic response were 22.7% and 40.8%, respectively. The rate of pT0N0 disease for patients receiving GC was 23.9%, compared with 24.5% for MVAC (p=0.2). There was no difference between MVAC and GC in pT0N0 on multivariable analysis (odds ratio: 0.89 [95% confidence interval, 0.61-1.34]; p=0.6). CONCLUSIONS Response rates to NAC were lower than those reported in prospective randomized trials, and we did not discern a difference between MVAC and GC. Without any evidence from randomized prospective trials, the best NAC regimen for invasive BCa remains to be determined. PATIENT SUMMARY There was no apparent difference in the response rates to the two most common presurgical chemotherapy regimens for patients with bladder cancer.
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Affiliation(s)
- Homayoun Zargar
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada
| | - Patrick N Espiritu
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Adrian S Fairey
- USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA; University of Alberta, Edmonton, Alberta, Canada
| | - 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, USA
| | - Maria C Mir
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael S Cookson
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | | | - Nilay M Gandhi
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joshua Griffin
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nikhil Vasdev
- 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, USA
| | - David Youssef
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY, USA
| | - 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, Quebec, Canada
| | - Marc A Dall'Era
- Department of Urology, University of California at Davis, Davis Medical Center, Sacramento, CA, USA
| | - Jo-An Seah
- Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Cesar E Ercole
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - 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 Urology, Freeman Hospital, Newcastle Upon Tyne, UK; Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Shahrokh F Shariat
- 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
| | - Jonathan L Wright
- Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - 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
| | - 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, Alberta, 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
| | - Jorge A Garcia
- Glickman Urological and Kidney 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, 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
| | - Siamak Daneshmand
- USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter C Black
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada.
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Teply BA, Kim JJ. Systemic therapy for bladder cancer - a medical oncologist's perspective. ACTA ACUST UNITED AC 2014; 4:25-35. [PMID: 25404954 DOI: 10.5430/jst.v4n2p25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Advanced bladder cancer, both muscle-invasive localized disease and metastatic disease, is managed with systemic chemotherapy. Cisplatin-based multi-agent chemotherapy remains the cornerstone for systemic therapy. MVAC (methotrexate-vinblastine-doxorubicin-cisplatin) has been most rigorously studied, both neoadjuvantly and for palliation of metastatic disease. For metastatic disease, cisplatin-gemcitabine (GC) has compared favorably to MVAC due to improved tolerability with similar efficacy. GC has been adopted as standard therapy. Neoadjuvant chemotherapy for muscle-invasive bladder cancer improves survival among those patients eligible to receive cisplatin. Adjuvant chemotherapy is difficult to administer effectively given morbidity of radical cystectomy, and studies have shown mixed results about its benefit. Non-cisplatin regimens have been investigated but remain experimental and reserved for those not candidates for cisplatin in the metastatic setting. While multiple agents have been studied after metastatic disease progression after cisplatin-based therapy, there remain no FDA-approved therapies for the second line. Future trials with anti-VEGF therapy and immunotherapy are actively being investigated. This review examines the systemic therapy available to oncologists with current evidence and future directions.
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Affiliation(s)
- Benjamin A Teply
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, U.S.A
| | - Jenny J Kim
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, U.S.A
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Booth L, Roberts JL, Cruickshanks N, Conley A, Durrant DE, Das A, Fisher PB, Kukreja RC, Grant S, Poklepovic A, Dent P. Phosphodiesterase 5 inhibitors enhance chemotherapy killing in gastrointestinal/genitourinary cancer cells. Mol Pharmacol 2013; 85:408-19. [PMID: 24353313 DOI: 10.1124/mol.113.090043] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The present studies determined whether clinically relevant phosphodiesterase 5 (PDE5) inhibitors interacted with clinically relevant chemotherapies to kill gastrointestinal/genitourinary cancer cells. In bladder cancer cells, regardless of H-RAS mutational status, at clinically achievable doses, PDE5 inhibitors interacted in a greater than additive fashion with doxorubicin/mitomycin C/gemcitabine/cisplatin/paclitaxel to cause cell death. In pancreatic tumor cells expressing mutant active K-RAS, PDE5 inhibitors interacted in a greater than additive fashion with doxorubicin/gemcitabine/paclitaxel to cause cell death. The most potent PDE5 inhibitor was sildenafil. Knock down of PDE5 expression recapitulated the combination effects of PDE5 inhibitor drugs with chemotherapy drugs. Expression of cellular FLICE-like inhibitory protein-short did not significantly inhibit chemotherapy lethality but did significantly reduce enhanced killing in combination with sildenafil. Overexpression of B-cell lymphoma-extra large suppressed individual and combination drug toxicities. Knock down of CD95 or Fas-associated death domain protein suppressed drug combination toxicity. Combination toxicity was also abolished by necrostatin or receptor interacting protein 1 knock down. Treatment with PDE5 inhibitors and chemotherapy drugs promoted autophagy, which was maximal at ∼24 hour posttreatment, and 3-methyl adenine or knock down of Beclin1 suppressed drug combination lethality by ∼50%. PDE5 inhibitors enhanced and prolonged the induction of DNA damage as judged by Comet assays and γhistone 2AX (γH2AX) and checkpoint kinase 2 (CHK2) phosphorylation. Knock down of ataxia telangiectasia mutated suppressed γH2AX and CHK2 phosphorylation and enhanced drug combination lethality. Collectively our data demonstrate that the combination of PDE5 inhibitors with standard of care chemotherapy agents for gastrointestinal/genitourinary cancers represents a novel modality.
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Affiliation(s)
- Laurence Booth
- Departments of Biochemistry and Molecular Biology (L.B., J.L.R., N.C., A.C., P.D.), Cardiology (D.E.D., A.D., R.C.K.), Medicine (S.G., A.P.), Human and Molecular Genetics (P.B.F.), Virginia Commonwealth University, Richmond, Virginia
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Phase II trial of combination nab-paclitaxel, carboplatin and gemcitabine in first line therapy of advanced urothelial carcinoma. Invest New Drugs 2013; 32:188-94. [PMID: 24318901 DOI: 10.1007/s10637-013-0054-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Paclitaxel has significant single agent activity in urothelial cancer. The 130 nm albumin bound paclitaxel (nab-paclitaxel, ABI-007) delivers more paclitaxel to tumor than conventional paclitaxel without cremophor related toxicities. We assessed the efficacy of nab-paclitaxel in combination with carboplatin and gemcitabine as first line therapy in advanced urothelial cancer. METHODS Eligible patients had histologically confirmed metastatic, locally recurrent or advanced pure or mixed urothelial cancer, ECOG performance status of 0-2, no prior chemotherapy for current disease stage and no taxane for ≥ 1 year. Therapy consisted of nab-paclitaxel at 220 mg/m2 intravenously with optional dose escalation to 260 mg/m2 for subsequent cycles, with carboplatin AUC 5 on day 1 and gemcitabine at 800 mg/m2 on days 1 and 8 in 21-day cycles. Dose modifications in all three drugs to -1 and -2 levels were allowed for toxicity. Primary endpoint was overall response rate by RECIST 1.0. Secondary endpoints were safety, progression free and overall survival. Using a two-stage design, 32 patients were planned to be enrolled. RESULTS Due to poor accrual only 16 patients were enrolled. Thirteen patients had metastatic disease, 3 were women, and median age was 73.9 years (range 51.3-83). ECOG PS was 0 in 4 (25.0 %) and 1 in 11 (68.8 %) patients. Creatinine clearance by Cockroft-Gault formula was less than 60 in 43 % of patients and 50 % of patients had visceral disease at baseline. The regimen was associated with severe toxicity, mainly cytopenias. Adverse events required removal of 11 patients (68.8 %) from study. Seven patients (43.7 %) missed ≥ 1 dose due to toxicity and 7 patients were reduced to -2 dose level. Nine (56.4 %) grade ≥ 3 neutropenia and thrombocytopenia each but only 1 episode of febrile neutropenia (6.3 %) was reported. Grade ≥ 3 anemia was noted in 6 patients (37.5 %). Grade 2 neuropathy was seen in 12.5 % but no grade ≥ 3 neuropathy was observed. One patient had confirmed PR (6.7 %; 95 % CI, 0-32 %) and 2 (13.3 %) had unconfirmed PR. Six other patients (40 %) had SD. Due to censoring at study exit due to adverse events before true progression, median PFS was 11.2 months (95 % CI,2.0-11.2 m). Median overall survival was 13.1 months (95 % CI, 9.8-19.6 m). CONCLUSIONS The combination of nab-paclitaxel, carboplatin and gemcitabine was poorly tolerated in this high risk patient population at these doses and schedule. Other nab-paclitaxel based combinations should be explored in first line therapy of advanced urothelial cancer.
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Abstract
INTRODUCTION Advanced urothelial carcinoma is associated with a poor prognosis. In the metastatic setting, the response rate to first-line, cisplatin-containing chemotherapy is high, but survival is poor. Second-line treatment options are limited. Advanced age at diagnosis and the presence of comorbidities often preclude treatment with cisplatin-containing regimens. AREAS COVERED This review addresses the current therapy of urothelial carcinoma, the unmet needs in treatment and the status of drug development in this disease. The molecular targets identified and efforts to incorporate targeted agents into therapy will be addressed. EXPERT OPINION There have been no major advances in the treatment of urothelial carcinoma in three decades. Despite high response rates in the first-line setting, survival is limited. Major impediments to improved outcomes include poor durability of response to first-line chemotherapy and lack of second-line treatments. Better understanding in tumor biology has identified multiple targets in urothelial carcinoma; however, such discoveries have yet to lead to the incorporation of targeted agents into the routine treatment of urothelial carcinoma. Multiple ongoing clinical trials are investigating the use of targeted agents in urothelial carcinoma. Continued efforts are underway to better understand the molecular drivers of disease and such efforts are likely to identify additional therapeutic targets.
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Affiliation(s)
- Benjamin A Gartrell
- Albert Einstein College of Medicine, Montefiore Medical Center, Department of Medical Oncology , 111 E 210th St, Bronx, NY, 10467 , USA +1 718 920 4826 ; +1 718 798 7474 ;
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