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Shih CH, Lin YH, Luo HL, Sung WW. Antibody-drug conjugates targeting HER2 for the treatment of urothelial carcinoma: potential therapies for HER2-positive urothelial carcinoma. Front Pharmacol 2024; 15:1326296. [PMID: 38572425 PMCID: PMC10987710 DOI: 10.3389/fphar.2024.1326296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/07/2024] [Indexed: 04/05/2024] Open
Abstract
Urothelial carcinoma (UC) is a common cancer characterized by high morbidity and mortality rates. Despite advancements in treatment, challenges such as recurrence and low response rates persist. Antibody-drug conjugates (ADCs) have emerged as a promising therapeutic approach for various cancers, although their application in UC is currently limited. This review focuses on recent research regarding ADCs designed to treat UC by targeting human epidermal growth factor receptor 2 (HER2), a surface antigen expressed on tumor cells. ADCs comprise three main components: an antibody, a linker, and a cytotoxic payload. The antibody selectively binds to tumor cell surface antigens, facilitating targeted delivery of the cytotoxic drug, while linkers play a crucial role in ensuring stability and controlled release of the payload. Cleavable linkers release the drug within tumor cells, while non-cleavable linkers ensure stability during circulation. The cytotoxic payload exerts its antitumor effect by disrupting cellular pathways. HER2 is commonly overexpressed in UCs, making it a potential therapeutic target. Several ADCs targeting HER2 have been approved for cancer treatment, but their use in UC is still being tested. Numerous HER2 ADCs have demonstrated significant growth inhibition and induction of apoptosis in translational models of HER2-overexpressing bladder cancer. Ongoing clinical trials are assessing the efficacy and safety of ADCs targeting HER2 in UC, with the aim of determining tumor response and the potential of ADCs as a treatment option for UC patients. The development of effective therapies with improved response rates and long-term effectiveness is crucial for advanced and metastatic UC. ADCs targeting HER2 show promise in this regard and merit further investigation for UC treatment.
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Affiliation(s)
- Chia-Hsien Shih
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hua Lin
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Chemistry, Fu Jen Catholic University, New Taipei City, Taiwan
- Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hao-Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Wei Sung
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Xie H, Rutz J, Maxeiner S, Grein T, Thomas A, Juengel E, Chun FKH, Cinatl J, Haferkamp A, Tsaur I, Blaheta RA. Plant-Derived Sulforaphane Suppresses Growth and Proliferation of Drug-Sensitive and Drug-Resistant Bladder Cancer Cell Lines In Vitro. Cancers (Basel) 2022; 14:cancers14194682. [PMID: 36230603 PMCID: PMC9564120 DOI: 10.3390/cancers14194682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary The natural compound sulforaphane is highly popular among tumor patients, since it is suggested to prevent oncogenesis and cancer progression. However, knowledge about its precise mode of action, particularly when drug resistance has been established, remains poor. The present study demonstrates the proliferation-blocking effects of SFN on a panel of drug-resistant bladder cancer cell lines. Abstract Combined cisplatin–gemcitabine (GC) application is standard for treating muscle-invasive bladder cancer. However, since rapid resistance to treatment often develops, many patients turn to supplements in the form of plant-based compounds. Sulforaphane (SFN), derived from cruciferous vegetables, is one such compound, and the present study was designed to investigate its influence on growth and proliferation in a panel of drug-sensitive bladder cancer cell lines, as well as their gemcitabine- and cisplatin-resistant counterparts. Chemo-sensitive and -resistant RT4, RT112, T24, and TCCSUP cell lines were exposed to SFN in different concentrations, and tumor growth, proliferation, and clone formation were evaluated, in addition to apoptosis and cell cycle progression. Means of action were investigated by assaying cell-cycle-regulating proteins and the mechanistic target of rapamycin (mTOR)/AKT signaling cascade. SFN significantly inhibited growth, proliferation, and clone formation in all four tumor cell lines. Cells were arrested in the G2/M and/or S phase, and alteration of the CDK–cyclin axis was closely associated with cell growth inhibition. The AKT/mTOR signaling pathway was deactivated in three of the cell lines. Acetylation of histone H3 was up-regulated. SFN, therefore, does exert tumor-suppressive properties in cisplatin- and gemcitabine-resistant bladder cancer cells and could be beneficial in optimizing bladder cancer therapy.
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Affiliation(s)
- Hui Xie
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany
| | - Jochen Rutz
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Sebastian Maxeiner
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Timothy Grein
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Eva Juengel
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Felix K.-H. Chun
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany
| | - Jindrich Cinatl
- Institute of Medical Virology, University Hospital, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Roman A. Blaheta
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
- Correspondence:
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Rodriguez KM, Kates M. Novel intravesical gemcitabine delivery system (TAR-200) for neoadjuvant treatment of MIBC: context is everything. Nat Rev Urol 2022; 19:579-580. [PMID: 35918613 DOI: 10.1038/s41585-022-00634-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Max Kates
- The Greenberg Bladder Cancer Institute & James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA.
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VanderWeele DJ, Hussain M. EDITORIAL COMMENT. Urology 2020; 146:165-166. [PMID: 33272420 DOI: 10.1016/j.urology.2020.06.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- David J VanderWeele
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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5
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Aly A, Johnson C, Doleh Y, Shenolikar R, Botteman MF, Hussain A. Medical oncology referral and systemic therapy of patients with advanced stage urothelial carcinoma. J Comp Eff Res 2020; 9:945-957. [PMID: 32964721 DOI: 10.2217/cer-2020-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To understand physician visit patterns among patients with stage IV (including nonmetastatic [M0] and metastatic [M1] disease) urothelial carcinoma (UC) and understand factors associated with a timely referral to a medical oncologist and systemic treatment. Patients & methods: Retrospective analysis of Surveillance, Epidemiology and End Results-Medicare data. Results: First physician encounter was with a urologist (M0: 69%; M1: 53%) or primary care physician ([PCP]; M0: 19%, M1: 25%) for the majority of patients around UC diagnosis. After the index urologist encounter, most patients had a subsequent medical oncologist visit at a median of 52 days (M0: 69.5 days, M1: 33 days). In an adjusted model, older age, index PCP visit, higher comorbidities and M0 disease were negatively associated with a medical oncologist referral. Among those referred to a medical oncologist, older age, Hispanic or non-Hispanic Black race and not being married were negatively associated with subsequent chemotherapy receipt (p < 0.05). Conclusion: Many patients with advanced UC encounter multiple specialists during their disease course. Older patients or those with a first UC-related encounter with a PCP are less likely to be referred to medical oncology. Once referred to medical oncology, social determinants, including race and marital status, are relevant predictors of receiving chemotherapy.
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Affiliation(s)
- Abdalla Aly
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD 20878, USA
| | - Courtney Johnson
- Pharmerit International, 4350 East-West Hwy, Suite 1110, Bethesda, MD 20814, USA
| | - Yunes Doleh
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD 20878, USA
| | - Rahul Shenolikar
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD 20878, USA
| | - Marc F Botteman
- Pharmerit International, 4350 East-West Hwy, Suite 1110, Bethesda, MD 20814, USA
| | - Arif Hussain
- Marlene & Stewart Greenbaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.,Veterans Affairs Medical Center, Baltimore, MD 21201, USA
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Jiang DM, North SA, Canil C, Kolinsky M, Wood LA, Gray S, Eigl BJ, Basappa NS, Blais N, Winquist E, Mukherjee SD, Booth CM, Alimohamed NS, Czaykowski P, Kulkarni GS, Black PC, Chung PW, Kassouf W, van der Kwast T, Sridhar SS. Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada. Bladder Cancer 2020. [DOI: 10.3233/blc-200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott A. North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kolinsky
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A. Wood
- Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Samantha Gray
- Department of Oncology, Saint John Regional Hospital, Department of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Bernhard J. Eigl
- Department of Medicine, Division of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Naveen S. Basappa
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Normand Blais
- Department of Medicine, Division of Medical Oncology and Hematology, Centre Hospitalier de l’Université de Montréal; Université de Montréal, Montreal, QC, Canada
| | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Som D. Mukherjee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Nimira S. Alimohamed
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Girish S. Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter W. Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Srikala S. Sridhar
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Liu W, Tian J, Zhang S, Yang E, Shen H, Li F, Li K, Zhang T, Wang H, Svatek RS, Rodriguez R, Wang Z. The utilization status of neoadjuvant chemotherapy in muscle-invasive bladder cancer: a systematic review and meta-analysis. Minerva Urol Nephrol 2020; 73:144-153. [PMID: 31920065 DOI: 10.23736/s2724-6051.19.03648-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION To give a comprehensive depiction of the utilization status of neoadjuvant chemotherapy (NAC) in muscle invasive bladder cancer (MIBC) worldwide. EVIDENCE ACQUISITION Potential relevant research papers of Pubmed, Embase, Web of Science, and the Cochrane Library were reviewed to identify eligible studies. Primary outcomes of this meta-analysis were utilization rate of NAC and its utility distribution in different genders, races, ages, countries and temporal trends. The utilization rates of NAC were calculated as 'Proportion (s)' with 95% confidence intervals (CIs) and pooled estimates were calculated by using a random-effect model. EVIDENCE SYNTHESIS A total of thirteen studies and 35,738 patients were included. The total proportion of NAC applied in MIBC populations prior to radical cystectomy (RC) was 17.2% (95% CI: 12.5-21.9%, I2=99.7%). The comparative analyses showed there were no significant differences existing in different genders or races on NAC utilization rates. In terms of age distribution, <60 age group conferred higher utilization rate of NAC than the older (OR=1.919, 95% CI: 1.671-2.202, P=0.0001). As for regional distribution, our meta-analysis showed that Japan (Proportion: 44.0%, 95% CI: 6.5-81.5%, I2=99.6%) and Sweden (37.9%, 95% CI: 34.9-40.8%) were the top two leading countries which contributed to the most frequent application of NAC. In respect of pathologic responses after NAC, complete, partial and down-staged pathologic responses were achieved in 16.6% (95% CI: 7.4-25.9%, I2=89.7%), 14.6% (95% CI: 0.8-28.5%, I2=89.7%) and 45.0% (95% CI: 17.8-72.2%, I2=98.8%) patients, respectively. CONCLUSIONS The present study shows the low utilization rate of NAC in MIBC patients. Standardization of the treatment modality of MIBC and promotion of guidelines might be necessary to expedite the adoption of NAC in near future.
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Affiliation(s)
- Wei Liu
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China
| | - Jinhui Tian
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Evidence-based Medicine Center of Lanzhou University, Lanzhou, China
| | - Su Zhang
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China
| | - Enguang Yang
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China
| | - Haixiang Shen
- Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fudong Li
- Department of Urology, Lanzhou General Hospital of People's Liberation Army, Lanzhou, China
| | - Kailing Li
- Department of Urology, First Hospital of Lanzhou University, Lanzhou, China
| | - Tao Zhang
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China
| | - Hanzhang Wang
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ronald Rodriguez
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zhiping Wang
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China -
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Niu L, Gao Z, Cui Y, Yang X, Li H. Thyroid Receptor-Interacting Protein 13 is Correlated with Progression and Poor Prognosis in Bladder Cancer. Med Sci Monit 2019; 25:6660-6668. [PMID: 31486418 PMCID: PMC6752094 DOI: 10.12659/msm.917112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Bladder cancer is the fourth most common cancer worldwide. Thyroid receptor-interacting protein 13 (TRIP13) is a member of the AAA+ ATPase family. The upregulation of TRIP13 has been shown to be involved in a few diseases, especially in cancers, but the expression and function of TRIP13 in bladder cancer is still elusive. Material/Methods In our study, the expression of TRIP13 was investigated with immunohistochemistry (IHC). The mRNAs of TRIP13 in bladder cancer and adjacent normal tissues were compared using quantitative real-time polymerase chain reaction (qRT-PCR) and IHC scores. The clinical value of TRIP13 was estimated by evaluating its correlation with other clinicopathological factors using the chi-square test. The prognostic significance of TRIP13 was evaluated using univariate and multivariate analyses. The effect of TRIP13 on proliferation and invasion was evaluated using function assays in vitro. Results In the 139 samples of bladder cancer tissues, the patients with low and high expression of TRIP13 accounted for 64.03% and 35.97%, respectively. Moreover, the mRNA expression of TRIP13 in bladder cancer was significantly higher than in normal tissues. High expression of TRIP13 was remarkably correlated with T stage, metastasis, and poor prognosis. In addition, TRIP13 was demonstrated to promote the proliferation, invasion, and epithelial-mesenchymal transition (EMT) of bladder cancer. Conclusions TRIP13 is correlated with poor prognosis of bladder cancer by promoting proliferation, invasion, and EMT, indicating that TRIP13 may be a promising drug target in bladder cancer.
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Affiliation(s)
- Lijuan Niu
- Department of Nephrology, Yidu Central Hospital of Weifang City, Weifang, Shandong, China (mainland).,Department of Nephrology, Weifang Traditional Chinese Hospital, Weifang, Shandong, China (mainland)
| | - Zhiqiang Gao
- Department of Nephrology, Yidu Central Hospital of Weifang City, Weifang, Shandong, China (mainland)
| | - Yubin Cui
- Department of Nephrology, Yidu Central Hospital of Weifang City, Weifang, Shandong, China (mainland)
| | - Xiaoqing Yang
- Department of Pathology, Qianfoshan Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Haiyang Li
- Department of Urology, Gansu Provincial Hospital, Lanzhou, Gansu, China (mainland)
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Meleis L, Moore R, Inman BA, Harrison MR. Retrospective analysis of the efficacy and safety of neoadjuvant gemcitabine and cisplatin in muscle-invasive bladder cancer. J Oncol Pharm Pract 2019; 26:330-337. [DOI: 10.1177/1078155219845434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Neoadjuvant cisplatin-based combination chemotherapy for muscle-invasive bladder cancer (MIBC) improves overall and disease-free survival. However, there is much debate over the optimal neoadjuvant regimen. Gemcitabine plus cisplatin (GC) has been the neoadjuvant regimen of choice for many institutions for patients with MIBC based on data extrapolated from the metastatic setting. Based on recent data, many institutions are transitioning to variations of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) as the neoadjuvant regimen of choice. Objective To assess the effectiveness and safety of neoadjuvant chemotherapy with gemcitabine plus cisplatin in patients with muscle-invasive bladder cancer prior to cystectomy. Methods This is a single-center, retrospective, cohort study at Duke University Hospital (DUH). Patients included had MIBC and received gemcitabine plus cisplatin chemotherapy prior to a cystectomy. The primary endpoint was to assess the pathologic complete response (pCR) rate in MIBC after treatment with gemcitabine and cisplatin. Patients were split into two groups, those who received their chemotherapy at DUH, and those who received their chemotherapy at an outside facility. Results Overall pCR rate for all patients (n = 36) was 14%. The pCR rates for patients in the Duke Chemotherapy Group (n = 17) and in the Community Chemotherapy Group (n = 19) were 24% and 5%, respectively. GC was overall well tolerated in most patients with few adverse events ≥ grade 3. Conclusions This retrospective study demonstrates a consistent pCR rate (24% in Duke Chemotherapy Group) for neoadjuvant GC in MIBC compared with other literature. The overall pCR rate for all patients was 14%.
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Affiliation(s)
- Laura Meleis
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Russell Moore
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Brant A Inman
- Urology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Michael R Harrison
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Okabe K, Shindo T, Maehana T, Nishiyama N, Hashimoto K, Itoh N, Takahashi A, Taguchi K, Tachiki H, Tanaka T, Masumori N. Neoadjuvant chemotherapy with gemcitabine and cisplatin for muscle-invasive bladder cancer: multicenter retrospective study. Jpn J Clin Oncol 2018; 48:934-941. [PMID: 30169681 DOI: 10.1093/jjco/hyy122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/13/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives The aim of this study was to evaluate the efficacy of neoadjuvant gemcitabine and cisplatin (GC) therapy for muscle-invasive bladder cancer (MIBC). Methods We retrospectively evaluated patients who underwent neoadjuvant GC therapy followed by radical cystectomy from April 2009 through December 2015 in the Sapporo Medical University Urologic Consortium. The efficacy of neoadjuvant chemotherapy (NAC) was assessed based on the pathological T0 (pT0) rate in radical cystectomy specimens, and the recurrence-free survival, cause-specific survival and overall survival (OS) rates. To compare the oncological benefit of NC with GC to that of the methotrexate, vinblastine, adriamycin and cisplatin (MVAC) regimen, we also utilized historical clinical data of patients who were treated with MVAC as NAC followed by radical cystectomy in our institute from 1986 through 2010. Results Fifty-eight patients receiving neoadjuvant GC therapy and 74 receiving neoadjuvant MVAC were included. The pT0 achieving rates were comparable between the two groups (20.7% vs. 18.9%, P = 0.83). Neoadjuvant GC was associated with a better 2-year OS rate than neoadjuvant MVAC for clinical T2 disease (95.2% vs. 70.8%, P = 0.036). In contrast, in patients with clinical T3 or more advanced disease, neoadjuvant MVAC provided more pT0 (20.0% vs. 5.6%, P = 0.07) and better 2-year OS than neoadjuvant GC (71.1% vs. 55.0%, P = 0.142), although the difference did not reach statistical significance. Conclusions Neoadjuvant GC had no inferiority in oncological outcomes to MVAC for MIBC.
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Affiliation(s)
- Ko Okabe
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takeshi Maehana
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naotaka Nishiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoki Itoh
- Department of Urology, NTT East Corporation Sapporo Hospital, Sapporo, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Koseiin Hakodate Goryokaku Hospital, Hakodate, Japan
| | - Keisuke Taguchi
- Department of Urology, Oji General Hospital, Tomakomai, Japan
| | - Hitoshi Tachiki
- Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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11
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Duplisea JJ, Mason RJ, Reichard CA, Li R, Shen Y, Boorjian SA, Dinney CP. Trends and disparities in the use of neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma. Can Urol Assoc J 2018; 13:24-28. [PMID: 30138098 DOI: 10.5489/cuaj.5405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) prior to radical or partial cystectomy is considered the standard of care for eligible patients with muscle-invasive urothelial carcinoma. Despite guideline recommendations, adoption of NAC has historically been low, although prior studies have suggested that use is increasing. In this contemporary study, we examine trends in the use of NAC and explore factors associated with its receipt. METHODS We identified patients in the National Cancer Database who underwent radical or partial cystectomy for cT2-cT4N0M0 urothelial carcinoma from 2006-2014. The proportion of patients receiving NAC during each year was examined. Logistic regression models were used to evaluate clinical and socioeconomic factors associated with the receipt of NAC. RESULTS A total of 18 188 patients were identified who underwent radical or partial cystectomy for muscle-invasive bladder cancer. Overall, 3940 (21.7%) received NAC. We noted a significant increase in the use of NAC over time, from 9.7% in 2006 to 32.2% in 2014. Factors associated with lower use of NAC include older age, higher comorbidity score, lower cT stage, lower hospital radical cystectomy volume, treatment at a non-academic facility, lower patient income, and receipt of partial cystectomy (all p<0.001). Interestingly, neither sex nor race were associated with receipt of NAC. CONCLUSIONS Use of NAC has increased significantly over time to a modest rate of 32%. However, disparities still exist in the receipt of NAC, and future efforts aimed at mitigating these disparities are warranted.
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Affiliation(s)
- Jonathan J Duplisea
- University of Texas MD Anderson Cancer Centre and Mayo Clinic, Houston, TX, United States
| | - Ross J Mason
- University of Texas MD Anderson Cancer Centre and Mayo Clinic, Houston, TX, United States
| | - Chad A Reichard
- University of Texas MD Anderson Cancer Centre and Mayo Clinic, Houston, TX, United States
| | - Roger Li
- University of Texas MD Anderson Cancer Centre and Mayo Clinic, Houston, TX, United States
| | - Yu Shen
- University of Texas MD Anderson Cancer Centre and Mayo Clinic, Houston, TX, United States
| | - Stephen A Boorjian
- University of Texas MD Anderson Cancer Centre and Mayo Clinic, Houston, TX, United States
| | - Colin P Dinney
- University of Texas MD Anderson Cancer Centre and Mayo Clinic, Houston, TX, United States
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12
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Anari F, O'Neill J, Choi W, Chen DYT, Haseebuddin M, Kutikov A, Dulaimi E, Alpaugh RK, Devarajan K, Greenberg RE, Bilusic M, Wong YN, Viterbo R, Hoffman-Censits JH, Lallas CD, Trabulsi EJ, Smaldone M, Geynisman DM, Zibelman M, Lin J, Kelly WK, Uzzo R, McConkey D, Plimack ER. Neoadjuvant Dose-dense Gemcitabine and Cisplatin in Muscle-invasive Bladder Cancer: Results of a Phase 2 Trial. Eur Urol Oncol 2018; 1:54-60. [PMID: 30420974 DOI: 10.1016/j.euo.2018.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Accelerated (also termed dose-dense, DD) chemotherapy regimens such as accelerated methotrexate, vinblastine, doxorubicin, and cisplatin have shown better efficacy and tolerability in the metastatic setting, and shortened the time to surgery in the neoadjuvant setting compared to standard-schedule regimens. We hypothesized that a DD schedule of gemcitabine and cisplatin (GC) would shorten the time to surgery and yield similar pathologic complete response rates (pT0) in patients with muscle-invasive bladder cancer (MIBC) compared with historical controls with standard GC. Objective To determine the safety and efficacy of neoadjuvant DDGC in MIBC. Design setting and participants Patients with cT2-4a, N0-1, M0 MIBC were eligible and received three 14-d cycles of DDGC with pegfilgrastim support followed by radical cystectomy with lymph node dissection. The primary end point was the pT0 rate. Molecular subtypes were assigned and correlated with survival. Results and limitations Thirty-one patients were evaluable for toxicity and response, of whom 58% had baseline clinical stage >T2N0M0; the median age was 69 yr. Ten patients (32%, 95% confidence interval [CI] 16-49%) achieved ypT0N0 status at cystectomy. Another four patients (13%, 95% CI 1-25%) were downstaged to non-muscle-invasive (<pT2N0) disease. Most patients (54.8%) experienced only grade 1-2 treatment-related toxicities. However, seven patients (23%) had clinically significant vascular events, leading to early closure of the study. Thirty patients (94%) underwent cystectomy. The median time from the start of chemotherapy to cystectomy was 9.3 wk. There was no correlation between molecular subtypes and survival. Conclusions DDGC yielded a similar pT0 rate to that noted retrospectively with standard GC. Vascular events precluded, delayed, or increased the risk of surgery for 23% of patients, resulting in early closure of the study. Additional prospective studies with embedded biomarker correlatives of GC in the neoadjuvant setting are critical to accurately define both the activity and toxicity of this combination in MIBC. Patient summary Neoadjuvant chemotherapy before cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC). This prospective phase 2 study tested a dose-dense schedule of gemcitabine and cisplatin in MIBC. The study was closed early because of a higher than expected rate of vascular events. These data suggest that caution is required in using this regimen, particularly when there is better prospective evidence for the safety and efficacy of alternative regimens such as dose-dense or accelerated methotrexate, vinblastine, doxorubicin, and cisplatin.
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Affiliation(s)
- Fern Anari
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - John O'Neill
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - Woonyoung Choi
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
| | - David Y T Chen
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | | | | | - Essel Dulaimi
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | | | | | | | - Marijo Bilusic
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - Yu-Ning Wong
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - Rosalia Viterbo
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | | | - Costas D Lallas
- Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, USA
| | | | - Marc Smaldone
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | | | | | - Jianqing Lin
- Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, USA
| | - W Kevin Kelly
- Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, USA
| | - Robert Uzzo
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - David McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
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13
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Harshman LC, Tripathi A, Kaag M, Efstathiou JA, Apolo AB, Hoffman-Censits JH, Stadler WM, Yu EY, Bochner BH, Skinner EC, Downs T, Kiltie AE, Bajorin DF, Guru K, Shipley WU, Steinberg GD, Hahn NM, Sridhar SS. Contemporary Patterns of Multidisciplinary Care in Patients With Muscle-invasive Bladder Cancer. Clin Genitourin Cancer 2018; 16:213-218. [PMID: 29289519 PMCID: PMC6731031 DOI: 10.1016/j.clgc.2017.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multidisciplinary clinics integrate the expertise of several specialties to provide effective treatment to patients. This exposure is especially relevant in the management of muscle-invasive bladder cancer (MIBC), which requires critical input from urology, radiation oncology, and medical oncology, among other supportive specialties. MATERIALS AND METHODS In the present study, we sought to catalog the different styles of multidisciplinary care models used in the management of MIBC and to identify barriers to their implementation. We surveyed providers from academic and community practices regarding their currently implemented multidisciplinary care models, available resources, and perceived barriers using the Bladder Cancer Advocacy Network and the Genitourinary Medical Oncologists of Canada e-mail databases. RESULTS Of the 101 responding providers, most practiced at academic institutions in the United States (61%) or Canada (29%), and only 7% were from community practices. The most frequently used model was sequential visits on different days (57%), followed by sequential same-day (39%) and concurrent (1 visit with all providers; 22%) models. However, most practitioners preferred a multidisciplinary clinic involving sequential same-day (41%) or concurrent (26%) visits. The lack of clinic space (58%), funding (41%), staff (40%), and time (32%) were the most common barriers to implementing a multidisciplinary clinic. CONCLUSION Most surveyed practitioners at academic centers use some form of a multidisciplinary care model for patients with MIBC. The major barriers to more integrated multidisciplinary clinics were limited time and resources rather than a lack of provider enthusiasm. Future studies should incorporate patient preferences, further evaluate practice patterns in community settings, and assess their effects on patient outcomes.
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Affiliation(s)
- Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | - Abhishek Tripathi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Matthew Kaag
- Penn State Milton S. Hershey Medical Center, Hershey, PA
| | | | - Andrea B Apolo
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Evan Y Yu
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | - Anne E Kiltie
- Cancer Research UK/Medical Research Council, Oxford Institute for Radiation Oncology, Oxford, United Kingdom
| | | | | | | | | | - Noah M Hahn
- Johns Hopkins University School of Medicine, Baltimore, MD
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14
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Yip SM, Kaiser J, Li H, North S, Heng DY, Alimohamed NS. Real-world Outcomes in Advanced Urothelial Cancer and the Role of Neutrophil to Lymphocyte Ratio. Clin Genitourin Cancer 2018; 16:e637-e644. [DOI: 10.1016/j.clgc.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/30/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022]
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15
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Mendiratta P, Grivas P. Emerging biomarkers and targeted therapies in urothelial carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:250. [PMID: 30069452 PMCID: PMC6046303 DOI: 10.21037/atm.2018.05.49] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/24/2018] [Indexed: 12/12/2022]
Abstract
The use of immunotherapy has revolutionized the management of patients with locally advanced, unresectable, and metastatic urothelial carcinoma (UC); however, platinum-based chemotherapy remains a therapeutic cornerstone both in localized muscle-invasive and advanced UC. There is still no predictive molecular biomarker with clinical utility to help guide treatment and select patients most likely to derive benefit from a particular therapeutic modality or regimen. However, recent research has further characterized the inherent biology and immunology landscapes of UC leading to the development of potential biomarkers and therapeutic targets that could be used upon further validation. Emerging interrogation of The Cancer Genome Atlas (TCGA) and other molecular profiling datasets has led to the identification of distinct molecular subtypes with diverse clinical behaviors with potential sensitivity to various therapies. It has also led to the discovery of multiple frequently altered genes and proteins that could lead to perturbation of intracellular signaling pathways and of the dynamic interactions between tumor cells, their "microenvironment", and the host "macro-environment". The advent of molecular profiling and deeper next-generation sequencing has the potential to change biomarker and "real time" drug sensitivity assessment, introducing and testing the premise of "precision oncology" and personalized medicine. Within this review, we summarize emerging biomarkers that may predict response to cisplatin-based chemotherapy, immunotherapy, emerging targeted therapies, and promising combination strategies. We also highlight a few examples of 'precision medicine' trials aiming to improve outcomes in UC. Since our review is not exhaustive we strongly recommend the readers to follow the continuously changing literature in the very interesting and dynamic field of UC.
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Affiliation(s)
- Prateek Mendiratta
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA
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16
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Nadal R, Apolo AB. Overview of Current and Future Adjuvant Therapy for Muscle-Invasive Urothelial Carcinoma. Curr Treat Options Oncol 2018; 19:36. [DOI: 10.1007/s11864-018-0551-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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17
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Dogan S, Hennig M, Frank T, Struck J, Cebulla A, Salem J, Borgmann H, Klatte T, Merseburger A, Kramer M, Hofbauer S. Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice. Urol Int 2018; 101:25-30. [DOI: 10.1159/000487405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/02/2018] [Indexed: 11/19/2022]
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18
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Booth CM, Karim S, Brennan K, Siemens DR, Peng Y, Mackillop WJ. Perioperative chemotherapy for bladder cancer in the general population: Are practice patterns finally changing? Urol Oncol 2018; 36:89.e13-89.e20. [DOI: 10.1016/j.urolonc.2017.11.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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19
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Walker M, Doiron RC, French SD, Brennan K, Feldman-Stewart D, Siemens DR, Mackillop WJ, Booth CM. Peri-Operative Chemotherapy for Bladder Cancer: A Survey of Providers to Determine Barriers and Enablers. Bladder Cancer 2018; 4:49-65. [PMID: 29430507 PMCID: PMC5798532 DOI: 10.3233/blc-170148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Utilization of chemotherapy for patients with muscle-invasive bladder cancer (MIBC) is low. In earlier qualitative work we used the Theoretical Domains Framework (TDF) to determine barriers and enablers of chemotherapy use. In this project we aimed to determine the prevalence of these barriers and enablers in Canadian physicians. Methods: Practicing Canadian urologists, medical oncologists (MOs) and radiation oncologists (ROs) participated in a specialty-specific web-based quantitative survey to assess potential barriers and enablers to chemotherapy use. Survey questions were developed that were thematically mapped to TDF domains. Logistic regression was used to identify TDF domains associated with high referral/use of chemotherapy. Results: 110 urologists, 47 MOs and 43 ROs completed the survey; response rates were 20%, 35% and 31% respectively. The mean reported survival gain associated with neoadjuvant chemotherapy (NACT) was 9%, 8%, and 7% for urologists, MOs, and ROs respectively. Among participating urologists, the TDF domains ‘social and professional role’ (OR = 16.5, 95% CI 4.6–59.2), ‘social influences’ (OR = 5.7, 95% CI 2.4–13.4) ‘beliefs about consequences’ (OR = 4.9, 95% CI 1.8–13.3) and ‘memory, attention and decision-making’ (OR = 0.50, 95% CI 0.27–0.91) were associated with MO referral rates. Among MOs, the TDF domains ‘behavioural regulation’, ‘social influences’, and ‘social and professional role’ were associated with greater use of chemotherapy (p < 0.05). No TDF domains were associated with RO referral to MO. Conclusions: We have identified several factors associated with referral/use of chemotherapy for MIBC. Optimization of multidisciplinary patient care needs to be considered when designing future interventions to close the gap between evidence and practice.
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Affiliation(s)
- Melanie Walker
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada.,Department of Public Health Sciences, Queen's University, ON, Canada
| | | | - Simon D French
- Department of Public Health Sciences, Queen's University, ON, Canada.,School of Rehabilitation Therapy, Queen's University, ON, Canada
| | - Kelly Brennan
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada
| | - Deb Feldman-Stewart
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada.,Department of Oncology, Queen's University, ON, Canada
| | - D Robert Siemens
- Department of Oncology, Queen's University, ON, Canada.,Department of Urology, Queen's University, ON, Canada
| | - William J Mackillop
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada.,Department of Oncology, Queen's University, ON, Canada.,Department of Public Health Sciences, Queen's University, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada.,Department of Oncology, Queen's University, ON, Canada.,Department of Public Health Sciences, Queen's University, ON, Canada
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20
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Walker M, Doiron RC, French SD, Feldman-Stewart D, Siemens DR, Mackillop WJ, Booth CM. Perioperative chemotherapy for bladder cancer: A qualitative study of physician knowledge, attitudes, and behaviour. Can Urol Assoc J 2017; 12:E182-E190. [PMID: 29319482 DOI: 10.5489/cuaj.4791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Use of chemotherapy for muscle-invasive bladder cancer (MIBC) is known to be low. To understand factors driving practice we use the Theoretical Domains Framework (TDF) to identify barriers and enablers of chemotherapy use. METHODS A convenience sample of Canadian urologists, medical oncologists (MOs), and radiation oncologists (ROs) participated in individual, semi-structured, one-hour telephone interviews. An interview guide was developed using the TDF to assess potential barriers and enablers of chemotherapy use. Interviews were recorded and transcribed. Two investigators independently identified barriers and enablers and assigned them to specific themes. Participant recruitment continued until saturation. RESULTS A total of 71 physicians were invited to participate and 34 (48%) agreed to be interviewed: 13 urologists, 10 MOs, and 11 ROs. We identified the following barriers to the use of chemotherapy (relevant TDF domains in parentheses): 1) belief that the benefits of chemotherapy are not clinically important (beliefs about consequences); 2) inadequate multidisciplinary collaboration (environmental context and resources); 3) absence of "champions" advocating the use of chemotherapy (social and professional role); and 4) a lack of organizational clarity/policy regarding the referral process (environmental context and resources). The predominant enablers identified included: 1) "champions" who believe in the value of chemotherapy (social and professional role); 2) urologists who refer all patients to MO (behavioural regulation; memory, attention, and decision-making); and 3) system-level factors, including automatic multidisciplinary referral (environmental context and resources). CONCLUSIONS We have identified several system-level factors associated with delivery of chemotherapy. Behaviour change interventions should optimize multidisciplinary care of patients with MIBC. PATIENT SUMMARY Despite the fact that chemotherapy before or after surgery improves survival of patients with bladder cancer, several studies have shown that many patients in routine practice are not treated. In this study, we identify important system-level and physician-level factors that must be considered in efforts to improve patient care.
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Affiliation(s)
- Melanie Walker
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada
| | | | - Simon D French
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Department of School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Deb Feldman-Stewart
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada
| | - D Robert Siemens
- Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Urology, Queen's University, Kingston, ON, Canada
| | - William J Mackillop
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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Galsky MD, Diefenbach M, Mohamed N, Baker C, Pokhriya S, Rogers J, Atreja A, Hu L, Tsao CK, Sfakianos J, Mehrazin R, Waingankar N, Oh WK, Mazumdar M, Ferket BS. Web-Based Tool to Facilitate Shared Decision Making With Regard to Neoadjuvant Chemotherapy Use in Muscle-Invasive Bladder Cancer. JCO Clin Cancer Inform 2017; 1:1-12. [PMID: 30657403 PMCID: PMC6874030 DOI: 10.1200/cci.17.00116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Level 1 evidence supports the use of neoadjuvant chemotherapy (NAC) for the treatment of muscle-invasive bladder cancer (MIBC), but observational data demonstrate that this approach is underused. A barrier to shared decision making is difficulty in predicting and communicating survival estimates after cystectomy with or without NAC. METHODS We included patients with MIBC from the National Cancer Database treated with cystectomy. A state-transition model was constructed for calculating 5-year death risk using baseline patient-, tumor-, and facility-level variables. Internal-external cross-validation by geographic region was performed. The effect of NAC was integrated using a literature-derived hazard ratio. Bladder cancer-specific and other-cause mortality was estimated from all-cause mortality rates from US life tables. From the state-transition model, a Web-based tool was developed and pilot usability testing performed. RESULTS A total of 9,824 patients with MIBC who underwent cystectomy were eligible for inclusion. Median overall survival was 39.6 months (95% CI, 37.4 to 42.4 months). Increasing age, higher clinical T stage, higher comorbidity index, and black race were associated with shorter survival. Private insurance, higher income, and cystectomy at a high-volume facility were associated with longer survival. The prediction model was well calibrated across geographic regions, with observed-to-predicted 5-year death risks ranging from 0.85 to 1.17. Absolute risk reductions with NAC varied from 8.6% to 10.1%. The Web-based tool allowed input of the predictor variables and a user-defined hazard ratio associated with the effect of NAC to generate individualized survival estimates. The tool demonstrated good usability with clinicians. CONCLUSION A Web-based tool was developed to individualize outcome prediction and communication in patients with MIBC treated with cystectomy with or without NAC to facilitate shared decision making.
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Affiliation(s)
- Matthew D. Galsky
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Michael Diefenbach
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Nihal Mohamed
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Charles Baker
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Sumit Pokhriya
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Jason Rogers
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Ashish Atreja
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Liangyuan Hu
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Che-Kai Tsao
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - John Sfakianos
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Reza Mehrazin
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Nikhil Waingankar
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - William K. Oh
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Madhu Mazumdar
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
| | - Bart S. Ferket
- Matthew D. Galsky, Nihal Mohamed, Charles Baker, Sumit Pokhriya, Jason Rogers, Ashish Atreja, Liangyuan Hu, Che-Kai Tsao, John Sfakianos, Reza Mehrazin, Nikhil Waingankar, William K. Oh, Madhu Mazumdar, and Bart S. Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY
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Necchi A, Lo Vullo S, Mariani L, Moschini M, Hendricksen K, Rink M, Sosnowski R, Dobruch J, Raman JD, Wood CG, Margulis V, Roupret M, Briganti A, Montorsi F, Xylinas E, Shariat SF. Adjuvant chemotherapy after radical nephroureterectomy does not improve survival in patients with upper tract urothelial carcinoma: a joint study by the European Association of Urology-Young Academic Urologists and the Upper Tract Urothelial Carcinoma Collaboration. BJU Int 2017; 121:252-259. [PMID: 28940605 DOI: 10.1111/bju.14020] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the outcomes of adjuvant chemotherapy vs observation in a multicentre cohort of patients with upper tract urothelial carcinoma (UTUC) in order to clarify whether such patients benefit from adjuvant chemotherapy after radical nephroureterectomy (RNU). PATIENTS AND METHODS Data from 15 centres were collected for a total of 1544 patients, treated between 2000 and 2015. Criteria for patient selection included pT2-4N0/x stage, or lymph node-positive disease, and prior RNU. The standardized difference approach was used to compare subgroup characteristics. Overall survival (OS) was the primary endpoint. The primary analysis used 1:1 propensity score matching, with inverse probability of treatment weighting in addition to this in the secondary analysis. The latter was also performed with the inclusion of covariates, i.e. with 'doubly robust' estimation. A 6-month landmark analysis was performed to exclude early events. RESULTS A total of 312 patients received adjuvant chemotherapy and 1232 underwent observation. Despite differences between the two groups, the standardized difference was generally <10% after matching. In the matched analysis no difference was observed in OS between adjuvant chemotherapy and observation (hazard ratio [HR] 1.14, 95% confidence inverval [CI] 0.91-1.43; P = 0.268). In the doubly robust estimate-adjusted comparison, adjuvant chemotherapy was significantly associated with shorter OS (HR 1.26, 95% CI 1.02-1.54; P = 0.032). Similar findings were confirmed in subgroup analyses stratified by pathological stage, and after landmark analysis. Results should be interpreted with consideration given to the inherent limitations of retrospective studies. CONCLUSION Adjuvant chemotherapy did not improve OS compared with observation in the present study. These results contribute to the uncertainties regarding postoperative chemotherapy in UTUC, and suggest dedicated prospective trials, new more potent therapies, and the identification of enhanced patient selection criteria are required.
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Affiliation(s)
- Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Luigi Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital, Vita Salute San Raffaele University, Milan, Italy
| | | | - Michael Rink
- Department of Urology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Roman Sosnowski
- Centre of Postgraduate Medical Education, European Health Centre Otwock, Warsaw, Poland
| | - Jakub Dobruch
- M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Jay D Raman
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Morgan Roupret
- Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Pierre et Marie Curie Medical School, University Paris 6, Paris, France
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Hospital, Vita Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, IRCCS San Raffaele Hospital, Vita Salute San Raffaele University, Milan, Italy
| | - Evanguelos Xylinas
- Cochin Hospital, Assistance-Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
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Abstract
Urothelial cancer of the bladder is a smoking-related cancer and the fifth most common cancer in the United States. At presentation, up to 25% of patients will have muscle-invasive disease and, despite cystectomy or bladder-sparing trimodality approaches, will develop metastatic disease. Cisplatin-based combination chemotherapy regimens remain the standard of care in first-line metastatic disease. Although response rates to these regimens are high, they are rarely durable, and median overall survival is only 12 to 15 months. Treatment options following progression on cisplatin-based regimens or for patients unfit for cisplatin due to poor performance status, impaired renal function, or comorbidities have been quite limited. However, there is now a new class of drugs known as immune checkpoint inhibitors, which target the programmed cell death 1/programmed cell death-ligand 1 axis and promote antitumor immunity, that are showing both efficacy and tolerability. These drugs have now been approved for use in both cisplatin-treated and most recently cisplatin-unfit patients. Clinical trials are currently ongoing to determine how best to use these drugs and whether they should be used alone or in combination with other treatments. This review will discuss the current standard of care in the management of urothelial cancer and highlight recent trials of immunotherapy in this disease.
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Affiliation(s)
- Srikala S. Sridhar
- Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
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Zhu C, Liu J, Zhang J, Li Q, Lian Q, Xu J, Ma X. Efficacy and safety of dose-dense chemotherapy in urothelial carcinoma. Oncotarget 2017; 8:71117-71127. [PMID: 29050347 PMCID: PMC5642622 DOI: 10.18632/oncotarget.16759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 03/22/2017] [Indexed: 02/05/2023] Open
Abstract
We conducted a meta-analysis to assess the efficacy and safety of dose-dense chemotherapy in the treatment of patients with urothelial carcinoma. A systematic search was conducted in PubMed, Medline, Embase, Web of Science and Cochrane Collaboration's Central register of controlled trials (CENTRAL) for relevant articles. Data was obtained from 10 trials with a total of 1093 patients. The pooled pathologic complete response (pCR) was 27.8% in the ten studies with a full cohort of 684 patients who received dose-dense methotrexate, vinblastine, adriamycin and cisplatin (dd-MVAC). In the controlled trials, although the difference was not significant, the pCR rate in the dd-MVAC group has a trend of increase (odds ratio (OR) 1.52; 95% confidence interval (CI) 0.78-2.98, P = 0.22) compared with classic MVAC group. A significant improvement of overall survival (OS) (hazard ratio (HR) 0.77, 95% CI 0.61–0.97, p = 0.03) was also observed. Hematologic toxicities were the most frequent grade ≥ 3 toxicities including neutropenia/febrile neutropenia (17.5%), anemia (9.4%) and thrombocytopenia (6.1%). Compared with the classic MVAC group, dd-MVAC was associated with significantly decreased risks of all-grade adverse events (AEs) such as anemia (OR 0.457, 95% CI 0.249–0.840, p = 0.012), febrile neutropenia (OR 0.398 95% CI 0.233–0.681, p = 0.001), and neutropenia (OR 0.373, 95% CI 0.201–0.691, p = 0.002). In conclusion, dose-dense chemotherapy was effective and tolerable in patients with urothelial carcinoma, which could be considered as a reasonable therapeutic option.
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Affiliation(s)
- Chenjing Zhu
- Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaming Liu
- Department of Urology, Institute of Urology, Laboratory of Reconstructive Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingfang Li
- Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qisi Lian
- West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jing Xu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuelei Ma
- Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Buttigliero C, Tucci M, Vignani F, Scagliotti GV, Di Maio M. Molecular biomarkers to predict response to neoadjuvant chemotherapy for bladder cancer. Cancer Treat Rev 2017; 54:1-9. [PMID: 28135623 DOI: 10.1016/j.ctrv.2017.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 12/30/2022]
Abstract
Cystectomy is the gold standard for treatment of localized muscle-invasive bladder cancer. However, about 50% of patients develop metastases within 2years after cystectomy and subsequently die for the disease. Neoadjuvant cisplatin-based chemotherapy before cystectomy improves the overall survival in patients with muscle-invasive bladder cancer, and pathological response to neoadjuvant treatment (downstaging to ⩽pT1 at cystectomy) is a strong predictor of better disease-specific survival. Nevertheless, some patients do not benefit from neoadjuvant therapy. The identification of reliable biomarkers that could enable the clinicians to identify patients who will really benefit from neoadjuvant chemotherapy is a major issue. This approach could lead to individualized therapy, in order to optimize the chance of response, avoiding the impact of neoadjuvant treatment on quality of life and the delay of cystectomy in non-responder patients. However, no molecular predictive biomarkers have shown clinical utility. This paper aims to review currently available data about biomarkers predictive of response to neoadjuvant chemotherapy in muscle-invasive bladder cancer.
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Affiliation(s)
- Consuelo Buttigliero
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Marcello Tucci
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Francesca Vignani
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Giorgio V Scagliotti
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
| | - Massimo Di Maio
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Chandrasekar T, Pugashetti N, Durbin-Johnson B, Dall'Era MA, Evans CP, deVere White RW, Yap SA. Effect of Neoadjuvant Chemotherapy on Renal Function following Radical Cystectomy: Is there a Meaningful Impact? Bladder Cancer 2016; 2:441-448. [PMID: 28035325 PMCID: PMC5181664 DOI: 10.3233/blc-160071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the patterns of impact of neoadjuvant chemotherapy (NAC) on renal function across the initial year following treatment for muscle-invasive bladder cancer (MIBC) with radical cystectomy (RC). Methods: We reviewed the charts of 241 patients who underwent RC for urothelial carcinoma of the bladder between 2003-14 at our institution. Renal function was evaluated at multiple time points (pre-chemotherapy, pre-operatively, post-operatively, 6-12 months follow-up), and then classified by CKD staging. Univariable and multivariable logistic regression analyses were performed to determine relationship between NAC and change in CKD stage. Results: Of the 241 patients who underwent RC for urothelial carcinoma of the bladder, 66 (27%) received NAC and 175 (73%) did not. In multivariable analysis, NAC was significantly associated with a decrease of at least one CKD stage from baseline to post-op (p = 0.009), but not to the 6-12 months follow-up time point (p = 0.050). The loss of GFR in the NAC cohort occurs up-front with chemotherapy, but the peri-operative course is similar to those who underwent cystectomy alone. Of the 15 NAC patients (26.8%) who were Stage 3 CKD prior to chemotherapy, none progressed to a higher stage CKD. Conclusion: NAC is associated with an initial decline in GFR, which then remains stable through the first year following RC. Despite an initial insult, patients receiving NAC are not vulnerable to further deterioration. When appropriately selected, NAC does not appear to result in a clinically significant deterioration of renal function.
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Affiliation(s)
- Thenappan Chandrasekar
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto , Toronto, ON, Canada
| | - Neil Pugashetti
- Department of Urology, University of California , Davis, Sacramento, CA, USA
| | - Blythe Durbin-Johnson
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis , Davis, CA, USA
| | - Marc A Dall'Era
- Department of Urology, University of California, Davis, Sacramento, CA, USA; University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Christopher P Evans
- Department of Urology, University of California, Davis, Sacramento, CA, USA; University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Ralph W deVere White
- Department of Urology, University of California, Davis, Sacramento, CA, USA; University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Stanley A Yap
- Department of Urology, University of California, Davis, Sacramento, CA, USA; University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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Zibelman M, Plimack ER. Systemic therapy for bladder cancer finally comes into a new age. Future Oncol 2016; 12:2227-42. [PMID: 27402371 PMCID: PMC5066115 DOI: 10.2217/fon-2016-0135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/02/2016] [Indexed: 01/16/2023] Open
Abstract
Systemic therapy for bladder cancer, both localized muscle-invasive disease and metastatic disease, has seen minimal progress over the past two decades. Current approaches rely upon cytotoxic chemotherapy combinations aimed at increasing cure rates or achieving palliation and disease control, but these regimens are fraught with short- and long-term toxicities and outcomes remain suboptimal. The emergence of systemic immunotherapies that can provide durable remissions in subsets of patients with other malignancies has the potential to transform the field, and early phase trials have begun to demonstrate activity in some patients with metastatic bladder cancer. In this article, we review the current state of systemic therapy for bladder cancer and discuss the current literature and ongoing trials utilizing various immunotherapies.
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Affiliation(s)
- Matthew Zibelman
- Fox Chase Cancer Center, Temple Health. 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Elizabeth R Plimack
- Fox Chase Cancer Center, Temple Health. 333 Cottman Avenue, Philadelphia, PA 19111, USA
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28
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Iliev R, Kleinova R, Juracek J, Dolezel J, Ozanova Z, Fedorko M, Pacik D, Svoboda M, Stanik M, Slaby O. Overexpression of long non-coding RNA TUG1 predicts poor prognosis and promotes cancer cell proliferation and migration in high-grade muscle-invasive bladder cancer. Tumour Biol 2016; 37:13385-13390. [DOI: 10.1007/s13277-016-5177-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/12/2016] [Indexed: 02/21/2023] Open
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Narayan V, Mamtani R, Keefe S, Guzzo T, Malkowicz SB, Vaughn DJ. Cisplatin, Gemcitabine, and Lapatinib as Neoadjuvant Therapy for Muscle-Invasive Bladder Cancer. Cancer Res Treat 2016; 48:1084-91. [PMID: 26639198 PMCID: PMC4946374 DOI: 10.4143/crt.2015.405] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 11/09/2015] [Indexed: 01/19/2023] Open
Abstract
PURPOSE We sought to investigate the safety and efficacy of gemcitabine, cisplatin, and lapatinib (GCL) as neoadjuvant therapy in patients with muscle-invasive bladder cancer (MIBC) planned for radical cystectomy. MATERIALS AND METHODS Four cycles of GCL were administered as neoadjuvant therapy for patients with MIBC. Although initially designed as a phase II efficacy study with a primary endpoint of pathologic complete response at the time of radical cystectomy, the dose selected for investigation proved excessively toxic. A total of six patients were enrolled. RESULTS The initial four patients received gemcitabine 1,000 mg/m(2) intravenously on days 1 and 8 and cisplatin 70 mg/m(2) intravenously on day 1 of each 21-day treatment cycle. Lapatinib was administered as 1,000 mg orally daily starting one week prior to the initiation of cycle 1 of gemcitabine and cisplatin (GC) and continuing until the completion of cycle 4 of GC. These initial doses were poorly tolerated, and the final two enrolled patients received a reduced lapatinib dose of 750 mg orally daily. However, reduction of the lapatinib dose did not result in improved tolerance or drug-delivery, and the trial was terminated early due to excessive toxicity. Grade 3/4 toxicities included diarrhea (33%), nausea/vomiting (33%), and thrombocytopenia (33%). CONCLUSION The addition of lapatinib to GC as neoadjuvant therapy for MIBC was limited by excessive treatment-related toxicity. These findings highlight the importance of thorough dose-escalation investigation of combination therapies prior to evaluation in the neoadjuvant setting, as well as the limitations of determination of maximum tolerated dose for novel targeted combination regimens.
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Affiliation(s)
- Vivek Narayan
- Division of Medical Oncology, Hospital of the University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Ronac Mamtani
- Division of Medical Oncology, Hospital of the University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Stephen Keefe
- Division of Medical Oncology, Hospital of the University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Thomas Guzzo
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - S. Bruce Malkowicz
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David J. Vaughn
- Division of Medical Oncology, Hospital of the University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
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Managing noninvasive recurrences after definitive treatment for muscle-invasive bladder cancer or high-grade upper tract urothelial carcinoma. Curr Opin Urol 2016; 25:468-75. [PMID: 26125507 DOI: 10.1097/mou.0000000000000201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Approximately 50% of patients with muscle invasive urothelial carcinoma will relapse with distant recurrence. Though rates of local recurrence after definitive therapy have improved, management remains a challenge. In this review, treatment strategies for this cohort are re-examined in an effort to enhance patient outcomes. RECENT FINDINGS Urothelial carcinoma continues to demonstrate high rates of recurrence and low rates of survival. Similarly to the treatment of primary urothelial cancer, treatment of recurrence focuses on cytology, stage, and clinical characteristics. Current areas of interest have focused on identification and causes/predictors of recurrence. SUMMARY Limited progress has been achieved in differentiating management of recurrent urothelial carcinoma from the treatment of primary urothelial carcinoma. However, there may be an increasing role for endoscopic and organ conserving therapies for carefully selected patients with recurrent noninvasive urothelial carcinoma. Identifying those at risk for early recurrence and early diagnosis of recurrence may be the most beneficial future strategies. The treatment regimen for noninvasive bladder recurrence after radical nephroureterectomy for upper tract urothelial carcinoma should include intravesical chemotherapy or Bacillus Calmette-Guerin to prevent further bladder recurrence or tumor progression. We do not advocate diversion sparing techniques for local recurrence after radical cystectomy. Metastasectomy for distant/metastatic urothelial carcinoma recurrence represents a promising area of future study.
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Hughes RT, Lucas JT, Krane LS, Divers JL, Hemal AK, Frizzell BA. Predictors of recurrence and patterns of failure among patients treated with nephroureterectomy for upper tract urothelial carcinoma. CANCER TREATMENT COMMUNICATIONS 2015; 5:39-45. [PMID: 39363914 PMCID: PMC11449456 DOI: 10.1016/j.ctrc.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
Purpose Recurrence rates following nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) remain high. As such, adjuvant therapy directed at high risk sites may improve long term outcomes. We describe patterns and predictors of UTUC recurrence according to patient, disease and treatment-related factors. Methods and materials We reviewed the records of 113 patients treated with NU for UTUC at our institution between 2006 and 2013. Time to locoregional (LR), intravesical (IV), distant recurrence and death were described using the Kaplan-Meier method and compared using the log rank statistic. Cox Proportional Hazards analyses were performed to evaluate the adjusted hazard for LR/IV and LR recurrence. Results Advanced T stage (T3/4) was present in 41 (36%) patients, 10 (9%) were node-positive and 21 (19%) showed evidence of lymphovascular space invasion (LVSI). Median overall survival and time to any recurrence was 54.6 and 20.7 months, respectively. Disease recurrence was observed in 48 (42%) patients. The location of failure was intravesical in 27 (24%), locoregional in 22 (19%) and distant in 20 (18%). Three-year LR/IV and distant failure rates were 38.7% and 22.2%, respectively. Three-year LR failure was 4.6% in pTa-2 vs. 25.8% in T3-T4 disease. Multivariate analysis identified history of prior bladder disease as a significant predictor of LR/IV recurrence. Conclusions In this study we demonstrate LR/IV recurrence as the predominant pattern of failure in UTUC patients treated with nephroureterectomy. This systematic description of recurrence patterns and associated factors will guide further investigation of adjuvant therapy to minimize the treatment failures defined herein.
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Affiliation(s)
- Ryan T. Hughes
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States
| | - John T. Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, United States
| | - Louis Spencer Krane
- Department of Surgical Sciences-Urology, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States
| | - Jude L. Divers
- Department of Anesthesiology, University of Massachusetts Memorial Medical Center, Worchester, MA 01655, United States
| | - Ashok K. Hemal
- Department of Surgical Sciences-Urology, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States
| | - Bart A. Frizzell
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States
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Baras AS, Gandhi N, Munari E, Faraj S, Shultz L, Marchionni L, Schoenberg M, Hahn N, Hoque M, Berman D, Bivalacqua TJ, Netto G. Identification and Validation of Protein Biomarkers of Response to Neoadjuvant Platinum Chemotherapy in Muscle Invasive Urothelial Carcinoma. PLoS One 2015; 10:e0131245. [PMID: 26230923 PMCID: PMC4521868 DOI: 10.1371/journal.pone.0131245] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/08/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The 5-year cancer specific survival (CSS) for patients with muscle invasive urothelial carcinoma of the bladder (MIBC) treated with cystectomy alone is approximately 50%. Platinum based neoadjuvant chemotherapy (NAC) plus cystectomy results in a marginal 5-10% increase in 5-year CSS in MIBC. Interestingly, responders to NAC (<ypT2) have a 5-year CSS of 90% which is in stark contrast to the 30-40% CSS for those whose MIBC is resistance to NAC. While the implementation of NAC for MIBC is increasing, it is still not widely utilized due to concerns related to delay of cystectomy, potential side-effects, and inability to predict effectiveness. Recently suggested molecular signatures of chemoresponsiveness, which could prove useful in this setting, would be of considerable utility but are yet to be translated into clinical practice. METHODS mRNA expression data from a prior report on a NAC-treated MIBC cohort were re-analyzed in conjunction with the antibody database of the Human Protein Atlas (HPA) to identify candidate protein based biomarkers detectable by immunohistochemistry (IHC). These candidate biomarkers were subsequently tested in tissue microarrays derived from an independent cohort of NAC naive MIBC biopsy specimens from whom the patients were treated with neoadjuvant gemcitabine cisplatin NAC and subsequent cystectomy. The clinical parameters that have been previously associated with NAC response were also examined in our cohort. RESULTS Our analyses of the available mRNA gene expression data in a discovery cohort (n = 33) and the HPA resulted in 8 candidate protein biomarkers. The combination of GDPD3 and SPRED1 resulted in a multivariate classification tree that was significantly associated with NAC response status (Goodman-Kruskal γ = 0.85 p<0.0001) in our independent NAC treated MIBC cohort. This model was independent of the clinical factors of age and clinical tumor stage, which have been previously associated with NAC response by our group. The combination of both these protein biomarkers detected by IHC in biopsy specimens along with the relevant clinical parameters resulted in a prediction model able to significantly stratify the likelihood of NAC resistance in our cohort (n = 37) into two well separated halves: low-26% n = 19 and high-89% n = 18, Fisher's exact p = 0.0002). CONCLUSION We illustrate the feasibility of translating a gene expression signature of NAC response from a discovery cohort into immunohistochemical markers readily applicable to MIBC biopsy specimens in our independent cohort. The results from this study are being characterized in additional validation cohorts. Additionally, we anticipate that emerging somatic mutations in MIBC will also be important for NAC response prediction. The relationship of the findings in this study to the current understanding of variant histologic subtypes of MIBC along with the evolving molecular subtypes of MIBC as it relates to NAC response remains to be fully characterized.
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Affiliation(s)
- Alexander S. Baras
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- * E-mail: (AB); (GN)
| | - Nilay Gandhi
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Enrico Munari
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Sheila Faraj
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Luciana Shultz
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Luigi Marchionni
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Mark Schoenberg
- Department of Urology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Noah Hahn
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Mohammad Hoque
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - David Berman
- Department of Pathology, Queen's University, Kingston, Ontario, Canada
| | - Trinity J. Bivalacqua
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - George Netto
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- * E-mail: (AB); (GN)
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Walker M, French SD, Feldman-Stewart D, Siemens DR, Mackillop WJ, Booth CM. A call for theory-informed approaches to knowledge translation studies: an example of chemotherapy for bladder cancer. ACTA ACUST UNITED AC 2015; 22:178-81. [PMID: 26089715 DOI: 10.3747/co.22.2277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a clear evidence-to-practice gap in bladder cancer care. [...]
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Affiliation(s)
- M Walker
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON
| | - S D French
- Department of Public Health Sciences, Queen's University, Kingston, ON; ; School of Rehabilitation Therapy, Queen's University, Kingston, ON
| | - D Feldman-Stewart
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON; ; Department of Oncology, Queen's University, Kingston, ON
| | - D R Siemens
- Department of Urology, Queen's University, Kingston, ON. ; Department of Urology, Queen's University, Kingston, ON
| | - W J Mackillop
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON; ; Department of Urology, Queen's University, Kingston, ON. ; Department of Urology, Queen's University, Kingston, ON
| | - C M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON; ; Department of Public Health Sciences, Queen's University, Kingston, ON; ; Department of Oncology, Queen's University, Kingston, ON
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Galsky MD, Pal SK, Chowdhury S, Harshman LC, Crabb SJ, Wong YN, Yu EY, Powles T, Moshier EL, Ladoire S, Hussain SA, Agarwal N, Vaishampayan UN, Recine F, Berthold D, Necchi A, Theodore C, Milowsky MI, Bellmunt J, Rosenberg JE. Comparative effectiveness of gemcitabine plus cisplatin versus methotrexate, vinblastine, doxorubicin, plus cisplatin as neoadjuvant therapy for muscle-invasive bladder cancer. Cancer 2015; 121:2586-93. [DOI: 10.1002/cncr.29387] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/29/2015] [Accepted: 02/23/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Matthew D. Galsky
- Department of Hematology and Medical Oncology; Mount Sinai Medical Center; New York New York
| | - Sumanta K. Pal
- Department of Medical Oncology and Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte California
| | - Simon Chowdhury
- Department of Urology; Guy's and St. Thomas’ Hospital; London United Kingdom
| | - Lauren C. Harshman
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Simon J. Crabb
- Department of Medical Oncology; Southampton General Hospital; Southampton United Kingdom
| | - Yu-Ning Wong
- Department of Medical Oncology; Fox Chase Cancer Center; Philadelphia Pennsylvania
| | - Evan Y. Yu
- Division of Oncology; Department of Medicine; Fred Hutchinson Cancer Research Center; Seattle Washington
| | - Thomas Powles
- Department of Medical Oncology; Barts Cancer Institute; London United Kingdom
| | - Erin L. Moshier
- Division of Biostatistics; Department of Preventative Medicine; Mount Sinai Medical Center; New York New York
| | - Sylvain Ladoire
- Department of Medical Oncology; Georges François Leclerc Center; Dijon France
| | - Syed A. Hussain
- Department of Molecular and Clinical Cancer Medicine; Institute of Translational Medicine, University of Liverpool; Liverpool United Kingdom
| | - Neeraj Agarwal
- Department of Medical Oncology; Huntsman Cancer Institute, University of Utah; Salt Lake City Utah
| | - Ulka N. Vaishampayan
- Department of Hematology and Oncology; Barbara Ann Karmanos Cancer Center; Detroit Michigan
| | - Federica Recine
- Department of Medical Oncology; Samuel and Barbara Sternberg Cancer Research Foundation; Rome Italy
| | - Dominik Berthold
- Department of Medical Oncology; University Hospital of Lausanne; Lausanne Switzerland
| | - Andrea Necchi
- Department of Medical Oncology; Foundation IRCCS National Cancer Institute; Milan Italy
| | | | - Matthew I. Milowsky
- Division of Hematology and Oncology; Department of Medicine; Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
| | - Joaquim Bellmunt
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Jonathan E. Rosenberg
- Division of Genitourinary Oncology; Department of Medicine; Memorial Sloan Kettering Cancer Center; New York New York
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Leow JJ, Fay AP, Mullane SA, Bellmunt J. Perioperative therapy for muscle invasive bladder cancer. Hematol Oncol Clin North Am 2015; 29:301-18, ix. [PMID: 25836936 DOI: 10.1016/j.hoc.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Muscle invasive bladder cancer (MIBC) is an aggressive disease associated with poor survival rates. High rates of relapse, despite radical cystectomy, suggest that administration of systemic therapy in the perioperative period may improve clinical outcomes. Neoadjuvant treatment with cisplatin-based combination regimens is an established standard of care and has improved long-term survival in MIBC. As the use of neoadjuvant chemotherapy steadily increases, clinicians still need to decide about administering adjuvant chemotherapy to patients with high-risk disease. This review examines in detail the latest evidence available for both neoadjuvant and adjuvant chemotherapy, and highlights pertinent studies.
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Affiliation(s)
- Jeffrey J Leow
- Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Urology, Tan Tock Seng Hospital, Singapore.
| | - André P Fay
- Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Stephanie A Mullane
- Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; University Hospital del Mar-IMIM, Barcelona, Spain
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Hoffman-Censits J, Wong YN. Perioperative and Maintenance Therapy After First-Line Therapy as Paradigms for Drug Discovery in Urothelial Carcinoma. Clin Genitourin Cancer 2015; 13:302-308. [PMID: 25987535 DOI: 10.1016/j.clgc.2015.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 12/25/2022]
Abstract
Perioperative chemotherapy provided to increase the chance of cure for localized disease and maintenance therapy for metastatic disease represent 2 distinct aspects of the urothelial cancer disease treatment spectrum. The ability to access both pre- and postchemotherapy tissue in the neoadjuvant setting provides important opportunities for translational research to test novel therapies and identify predictors of response to therapy. The maintenance setting may be more complex, and study design and endpoints need to be determined on the basis of the candidate drugs' mechanisms of action and toxicity.
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Affiliation(s)
- Jean Hoffman-Censits
- Department of Medical Oncology, Thomas Jefferson University School of Medicine, Philadelphia, PA
| | - Yu-Ning Wong
- Department of Medical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA.
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Gandhi NM, Baras A, Munari E, Faraj S, Reis LO, Liu JJ, Kates M, Hoque MO, Berman D, Hahn NM, Eisenberger M, Netto GJ, Schoenberg MP, Bivalacqua TJ. Gemcitabine and cisplatin neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma: Predicting response and assessing outcomes. Urol Oncol 2015; 33:204.e1-7. [PMID: 25814145 DOI: 10.1016/j.urolonc.2015.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/17/2015] [Accepted: 02/18/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate gemcitabine-cisplatin (GC) neoadjuvant cisplatin-based chemotherapy (NAC) for pathologic response (pR) and cancer-specific outcomes following radical cystectomy (RC) for muscle-invasive bladder cancer and identify clinical parameters associated with pR. MATERIALS AND METHODS We studied 150 consecutive cases of muscle-invasive bladder cancer that received GC NAC followed by open RC (2000-2013). A cohort of 121 patients treated by RC alone was used for comparison. Pathologic response and cancer-specific survival (CSS) were compared. We created the Johns Hopkins Hospital Dose Index to characterize chemotherapeutic dosing regimens and accurately assess sufficient neoadjuvant dosing regarding patient tolerance. RESULTS No significant difference was noted in 5-year CSS between GC NAC (58%) and non-NAC cohorts (61%). The median follow-up was 19.6 months (GC NAC) and 106.5 months (non-NAC). Patients with residual non-muscle-invasive disease after GC NAC exhibit similar 5-year CSS relative to patients with no residual carcinoma (P = 0.99). NAC pR (≤ pT1) demonstrated improved 5-year CSS rates (90.6% vs. 27.1%, P < 0.01) and decreased nodal positivity rates (0% vs. 41.3%, P<0.01) when compared with nonresponders (≥ pT2). Clinicopathologic outcomes were inferior in NAC pathologic nonresponders when compared with the entire RC-only-treated cohort. A lower pathologic nonresponder rate was seen in patients tolerating sufficient dosing of NAC as stratified by the Johns Hopkins Hospital Dose Index (P = 0.049), congruent with the National Comprehensive Cancer Network guidelines. A multivariate classification tree model demonstrated 60 years of age or younger and clinical stage cT2 as significant of NAC response (P< 0.05). CONCLUSIONS Pathologic nonresponders fare worse than patients proceeding directly to RC alone do. Multiple predictive models incorporating clinical, histopathologic, and molecular features are currently being developed to identify patients who are most likely to benefit from GC NAC.
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Affiliation(s)
| | | | | | - Sheila Faraj
- Johns Hopkins Medical Institution, Baltimore, MD
| | | | - Jen-Jane Liu
- Johns Hopkins Medical Institution, Baltimore, MD
| | - Max Kates
- Johns Hopkins Medical Institution, Baltimore, MD
| | | | - David Berman
- Department of Pathology and Molecular Medicine, Queens University, Kingston, Ontario, Canada
| | - Noah M Hahn
- Johns Hopkins Medical Institution, Baltimore, MD
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Narayan V, Vaughn D. Pharmacokinetic and toxicity considerations in the use of neoadjuvant chemotherapy for bladder cancer. Expert Opin Drug Metab Toxicol 2015; 11:731-42. [DOI: 10.1517/17425255.2015.1005600] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sternberg CN, Apolo AB. Reply to D. Pouessel et al, J.B. Aragon-Ching, and B.A. Adesunloye. J Clin Oncol 2014; 32:4172-3. [PMID: 25385726 DOI: 10.1200/jco.2014.58.5299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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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Sternberg CN, Skoneczna I, Kerst JM, Albers P, Fossa SD, Agerbaek M, Dumez H, de Santis M, Théodore C, Leahy MG, Chester JD, Verbaeys A, Daugaard G, Wood L, Witjes JA, de Wit R, Geoffrois L, Sengelov L, Thalmann G, Charpentier D, Rolland F, Mignot L, Sundar S, Symonds P, Graham J, Joly F, Marreaud S, Collette L, Sylvester R. Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (EORTC 30994): an intergroup, open-label, randomised phase 3 trial. Lancet Oncol 2014; 16:76-86. [PMID: 25498218 DOI: 10.1016/s1470-2045(14)71160-x] [Citation(s) in RCA: 265] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with muscle-invasive urothelial carcinoma of the bladder have poor survival after cystectomy. The EORTC 30994 trial aimed to compare immediate versus deferred cisplatin-based combination chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder. METHODS This intergroup, open-label, randomised, phase 3 trial recruited patients from hospitals across Europe and Canada. Eligible patients had histologically proven urothelial carcinoma of the bladder, pT3-pT4 disease or node positive (pN1-3) M0 disease after radical cystectomy and bilateral lymphadenectomy, with no evidence of any microscopic residual disease. Within 90 days of cystectomy, patients were centrally randomly assigned (1:1) by minimisation to either immediate adjuvant chemotherapy (four cycles of gemcitabine plus cisplatin, high-dose methotrexate, vinblastine, doxorubicin, and cisplatin [high-dose MVAC], or MVAC) or six cycles of deferred chemotherapy at relapse, with stratification for institution, pT category, and lymph node status according to the number of nodes dissected. Neither patients nor investigators were masked. Overall survival was the primary endpoint; all analyses were by intention to treat. The trial was closed after recruitment of 284 of the planned 660 patients. This trial is registered with ClinicalTrials.gov, number NCT00028756. FINDINGS From April 29, 2002, to Aug 14, 2008, 284 patients were randomly assigned (141 to immediate treatment and 143 to deferred treatment), and followed up until the data cutoff of Aug 21, 2013. After a median follow-up of 7.0 years (IQR 5.2-8.7), 66 (47%) of 141 patients in the immediate treatment group had died compared with 82 (57%) of 143 in the deferred treatment group. No significant improvement in overall survival was noted with immediate treatment when compared with deferred treatment (adjusted HR 0.78, 95% CI 0.56-1.08; p=0.13). Immediate treatment significantly prolonged progression-free survival compared with deferred treatment (HR 0.54, 95% CI 0.4-0.73, p<0.0001), with 5-year progression-free survival of 47.6% (95% CI 38.8-55.9) in the immediate treatment group and 31.8% (24.2-39.6) in the deferred treatment group. Grade 3-4 myelosuppression was reported in 33 (26%) of 128 patients who received treatment in the immediate chemotherapy group versus 24 (35%) of 68 patients who received treatment in the deferred chemotherapy group, neutropenia occurred in 49 (38%) versus 36 (53%) patients, respectively, and thrombocytopenia in 36 (28%) versus 26 (38%). Two patients died due to toxicity, one in each group. INTERPRETATION Our data did not show a significant improvement in overall survival with immediate versus deferred chemotherapy after radical cystectomy and bilateral lymphadenectomy for patients with muscle-invasive urothelial carcinoma. However, the trial is limited in power, and it is possible that some subgroups of patients might still benefit from immediate chemotherapy. An updated individual patient data meta-analysis and biomarker research are needed to further elucidate the potential for survival benefit in subgroups of patients. FUNDING Lilly, Canadian Cancer Society Research.
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Affiliation(s)
| | - Iwona Skoneczna
- Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | | | - Peter Albers
- Klinikum Kassel, Kassel, Germany; University Clinic Bonn, Bonn, Germany
| | | | | | - Herlinde Dumez
- KU Leuven-University of Leuven, University Hospitals Leuven, Department of General Medical Oncology, Leuven, Belgium
| | - Maria de Santis
- Ludwig Boltzmann Institute for Applied Cancer Research (LBI-ACR VIEnna)-LB Cluster Translational Oncology (LB-CTO), Kaiser Franz Josef-Spital, Vienna, Austria
| | - Christine Théodore
- Hôpital Foch, Suresnes, France; Institut Gustave Roussy, Villejuif, France
| | | | - John D Chester
- St James's University Hospital, Leeds, UK; Cardiff University and Velindre Cancer Center, Cardiff, UK
| | | | - Gedske Daugaard
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lori Wood
- QEII Health Sciences Centre, Dalhousie University Halifax, NS, Canada
| | - J Alfred Witjes
- Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Ronald de Wit
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - Lionel Geoffrois
- Institut de Cancérologie de Lorraine-Alexis Vautrin, Vandoeuvre-Les-Nancy, France
| | - Lisa Sengelov
- Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Danielle Charpentier
- Centre Hospitalier de l'Université de Montreal-Hôpital Notre-Dame, Montreal, QC, Canada
| | - Frédéric Rolland
- Institut de Cancérologie de l'Ouest-Centre Rene Gauducheau, St Herblain, Nantes, France
| | | | - Santhanam Sundar
- Nottingham University Hospitals NHS Trust-City Hospital, Nottingham, UK
| | | | - John Graham
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Apolo AB, Hoffman V, Kaag MG, Latini DM, Lee CT, Rosenberg JE, Knowles M, Theodorescu D, Czerniak BA, Efstathiou JA, Albert ML, Sridhar SS, Margulis V, Matin SF, Galsky MD, Hansel D, Kamat AM, Flaig TW, Smith AB, Messing E, Zipursky Quale D, Lotan Y. Summary of the 8th Annual Bladder Cancer Think Tank: Collaborating to move research forward. Urol Oncol 2014; 33:53-64. [PMID: 25065704 DOI: 10.1016/j.urolonc.2014.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 06/23/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The 8th Annual Bladder Cancer Think Tank (BCAN-TT) brought together a multidisciplinary group of clinicians, researchers, and patient advocates in an effort to advance bladder cancer research. METHODS AND MATERIALS With the theme of "Collaborating to Move Research Forward," the meeting included three panel presentations and seven small working groups. RESULTS The panel presentations and interactive discussions focused on three main areas: gender disparities, sexual dysfunction, and targeting novel pathways in bladder cancer. Small working groups also met to identify projects for the upcoming year, including: (1) improving enrollment and quality of clinical trials; (2) collecting data from multiple institutions for future research; (3) evaluating patterns of care for non-muscle-invasive bladder cancer; (4) improving delivery of care for muscle-invasive disease; (5) improving quality of life for survivors; (6) addressing upper tract disease; and (7) examining the impact of health policy changes on research and treatment of bladder cancer. CONCLUSIONS The goal of the BCAN-TT is to advance the care of patients with bladder cancer and to promote collaborative research throughout the year. The meeting provided ample opportunities for collaboration among clinicians from multiple disciplines, patients and patient advocates, and industry representatives.
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Affiliation(s)
- Andrea B Apolo
- Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD
| | | | - Matthew G Kaag
- Department of Urology, Penn State Hershey Medical Center, Hershey, PA
| | - David M Latini
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Cheryl T Lee
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | | | - Margaret Knowles
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | | | | | | | - Srikala S Sridhar
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | - Matthew D Galsky
- Department of Medical Oncology, Mount Sinai Hospital, New York, NY
| | - Donna Hansel
- Department of Pathology, University of California, La Jolla, San Diego, CA
| | - Ashish M Kamat
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | | | - Angela B Smith
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Edward Messing
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | | | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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