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Smith TAD, West CML, Joseph N, Lane B, Irlam-Jones J, More E, Mistry H, Reeves KJ, Song YP, Reardon M, Hoskin PJ, Hussain SA, Denley H, Hall E, Porta N, Huddart RA, James ND, Choudhury A. A hypoxia biomarker does not predict benefit from giving chemotherapy with radiotherapy in the BC2001 randomised controlled trial. EBioMedicine 2024; 101:105032. [PMID: 38387404 PMCID: PMC10897900 DOI: 10.1016/j.ebiom.2024.105032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND BC2001 showed combining chemotherapy (5-FU + mitomycin-C) with radiotherapy improves loco-regional disease-free survival in patients with muscle-invasive bladder cancer (MIBC). We previously showed a 24-gene hypoxia-associated signature predicted benefit from hypoxia-modifying radiosensitisation in BCON and hypothesised that only patients with low hypoxia scores (HSs) would benefit from chemotherapy in BC2001. BC2001 allowed conventional (64Gy/32 fractions) or hypofractionated (55Gy/20 fractions) radiotherapy. An exploratory analysis tested an additional hypothesis that hypofractionation reduces reoxygenation and would be detrimental for patients with hypoxic tumours. METHODS RNA was extracted from pre-treatment biopsies (298 BC2001 patients), transcriptomic data generated (Affymetrix Clariom-S arrays), HSs calculated (median expression of 24-signature genes) and patients stratified as hypoxia-high or -low (cut-off: cohort median). PRIMARY ENDPOINT invasive loco-regional control (ILRC); secondary overall survival. FINDINGS Hypoxia affected overall survival (HR = 1.30; 95% CI 0.99-1.70; p = 0.062): more uncertainty for ILRC (HR = 1.29; 95% CI 0.82-2.03; p = 0.264). Benefit from chemotherapy was similar for patients with high or low HSs, with no interaction between HS and treatment arm. High HS associated with poor ILRC following hypofractionated (n = 90, HR 1.69; 95% CI 0.99-2.89 p = 0.057) but not conventional (n = 207, HR 0.70; 95% CI 0.28-1.80, p = 0.461) radiotherapy. The finding was confirmed in an independent cohort (BCON) where hypoxia associated with a poor prognosis for patients receiving hypofractionated (n = 51; HR 14.2; 95% CI 1.7-119; p = 0.015) but not conventional (n = 24, HR 1.04; 95% CI 0.07-15.5, p = 0.978) radiotherapy. INTERPRETATION Tumour hypoxia status does not affect benefit from BC2001 chemotherapy. Hypoxia appears to affect fractionation sensitivity. Use of HSs to personalise treatment needs testing in a biomarker-stratified trial. FUNDING Cancer Research UK, NIHR, MRC.
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Affiliation(s)
- Tim A D Smith
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK; Nuclear Futures Institute, School of Computer Science and Electronic Engineering, Bangor University, Bangor, UK
| | - Catharine M L West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK.
| | - Nuradh Joseph
- Sri Lanka Cancer Research Group, Maharagama, Sri Lanka
| | - Brian Lane
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Joely Irlam-Jones
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Elisabet More
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Hitesh Mistry
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Kimberley J Reeves
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Yee Pei Song
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Mark Reardon
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Peter J Hoskin
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Cancer Centre, Northwood, London, UK
| | - Syed A Hussain
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Helen Denley
- Pathology Centre, Shrewsbury and Telford NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Emma Hall
- Institute of Cancer Research, Clinical Trials & Statistics Unit, London, UK
| | - Nuria Porta
- Institute of Cancer Research, Clinical Trials & Statistics Unit, London, UK
| | - Robert A Huddart
- Royal Marsden NHS Trust, Department of Oncology, Downs Road, Sutton, Surrey, England, UK
| | - Nick D James
- Royal Marsden NHS Trust, Department of Oncology, Downs Road, Sutton, Surrey, England, UK
| | - Ananya Choudhury
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
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Conci N, Tassinari E, Tateo V, Rosellini M, Marchetti A, Ricci C, Chessa F, Santoni M, Grande E, Mollica V, Massari F. How Do Molecular Classifications Affect the Neoadjuvant Treatment of Muscle-Invasive Urothelial Carcinoma? Mol Diagn Ther 2024; 28:37-51. [PMID: 37874465 DOI: 10.1007/s40291-023-00679-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/25/2023]
Abstract
Despite the significant improvements in the field of oncological treatments in recent decades, and the advent of targeted therapies and immunotherapy, urothelial carcinoma of the bladder remains a highly heterogeneous and difficult-to-treat neoplasm with a poor prognosis. In this context, owing to the new methods of genomic sequencing, numerous studies have analyzed the genetic features of muscle-invasive bladder cancer, providing a consensus set of molecular classes, to identify malignancies that may respond better to specific treatments (standard chemotherapy, immunotherapy, target therapy, local-regional treatment, or combinations) and improve the survival. The aim of the current review is to provide an overview of the current status of the molecular landscape of muscle-invasive bladder cancer, focusing our attention on therapeutic and prognostic implications in order to select the most effective and tailored therapeutic regimen for the individual patient.
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Affiliation(s)
- Nicole Conci
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elisa Tassinari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Valentina Tateo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Matteo Rosellini
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Andrea Marchetti
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Costantino Ricci
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
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Moisoiu T, Dragomir MP, Iancu SD, Schallenberg S, Birolo G, Ferrero G, Burghelea D, Stefancu A, Cozan RG, Licarete E, Allione A, Matullo G, Iacob G, Bálint Z, Badea RI, Naccarati A, Horst D, Pardini B, Leopold N, Elec F. Combined miRNA and SERS urine liquid biopsy for the point-of-care diagnosis and molecular stratification of bladder cancer. Mol Med 2022; 28:39. [PMID: 35365098 PMCID: PMC8973824 DOI: 10.1186/s10020-022-00462-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Bladder cancer (BC) has the highest per-patient cost of all cancer types. Hence, we aim to develop a non-invasive, point-of-care tool for the diagnostic and molecular stratification of patients with BC based on combined microRNAs (miRNAs) and surface-enhanced Raman spectroscopy (SERS) profiling of urine. METHODS Next-generation sequencing of the whole miRNome and SERS profiling were performed on urine samples collected from 15 patients with BC and 16 control subjects (CTRLs). A retrospective cohort (BC = 66 and CTRL = 50) and RT-qPCR were used to confirm the selected differently expressed miRNAs. Diagnostic accuracy was assessed using machine learning algorithms (logistic regression, naïve Bayes, and random forest), which were trained to discriminate between BC and CTRL, using as input either miRNAs, SERS, or both. The molecular stratification of BC based on miRNA and SERS profiling was performed to discriminate between high-grade and low-grade tumors and between luminal and basal types. RESULTS Combining SERS data with three differentially expressed miRNAs (miR-34a-5p, miR-205-3p, miR-210-3p) yielded an Area Under the Curve (AUC) of 0.92 ± 0.06 in discriminating between BC and CTRL, an accuracy which was superior either to miRNAs (AUC = 0.84 ± 0.03) or SERS data (AUC = 0.84 ± 0.05) individually. When evaluating the classification accuracy for luminal and basal BC, the combination of miRNAs and SERS profiling averaged an AUC of 0.95 ± 0.03 across the three machine learning algorithms, again better than miRNA (AUC = 0.89 ± 0.04) or SERS (AUC = 0.92 ± 0.05) individually, although SERS alone performed better in terms of classification accuracy. CONCLUSION miRNA profiling synergizes with SERS profiling for point-of-care diagnostic and molecular stratification of BC. By combining the two liquid biopsy methods, a clinically relevant tool that can aid BC patients is envisaged.
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Affiliation(s)
- Tudor Moisoiu
- Clinical Institute of Urology and Renal Transplantation, 400006, Cluj-Napoca, Romania.,Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania.,Biomed Data Analytics SRL, 400696, Cluj-Napoca, Romania
| | - Mihnea P Dragomir
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, 10117, Berlin, Germany. .,German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Stefania D Iancu
- Faculty of Physics, Babeș-Bolyai University, 400084, Cluj-Napoca, Romania
| | - Simon Schallenberg
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, 10117, Berlin, Germany
| | - Giovanni Birolo
- Department of Medical Sciences, University of Turin, 10126, Turin, Italy
| | - Giulio Ferrero
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole, 10, 10043, Orbassano, Italy
| | - Dan Burghelea
- Clinical Institute of Urology and Renal Transplantation, 400006, Cluj-Napoca, Romania.,Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
| | - Andrei Stefancu
- Faculty of Physics, Babeș-Bolyai University, 400084, Cluj-Napoca, Romania
| | - Ramona G Cozan
- Faculty of Physics, Babeș-Bolyai University, 400084, Cluj-Napoca, Romania
| | - Emilia Licarete
- Faculty of Biology, Babeș-Bolyai University, 400015, Cluj-Napoca, Romania
| | - Alessandra Allione
- Department of Medical Sciences, University of Turin, 10126, Turin, Italy
| | - Giuseppe Matullo
- Department of Medical Sciences, University of Turin, 10126, Turin, Italy
| | - Gheorghita Iacob
- Clinical Institute of Urology and Renal Transplantation, 400006, Cluj-Napoca, Romania
| | - Zoltán Bálint
- Faculty of Physics, Babeș-Bolyai University, 400084, Cluj-Napoca, Romania
| | - Radu I Badea
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania.,Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162, Cluj-Napoca, Romania
| | - Alessio Naccarati
- Candiolo Cancer Institute-FPO IRCCS, 10060, Candiolo, Turin, Italy.,Italian Institute for Genomic Medicine (IIGM), IRCCS Candiolo, 10060, Candiolo, Turin, Italy
| | - David Horst
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, 10117, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Barbara Pardini
- Candiolo Cancer Institute-FPO IRCCS, 10060, Candiolo, Turin, Italy. .,Italian Institute for Genomic Medicine (IIGM), IRCCS Candiolo, 10060, Candiolo, Turin, Italy.
| | - Nicolae Leopold
- Biomed Data Analytics SRL, 400696, Cluj-Napoca, Romania. .,Faculty of Physics, Babeș-Bolyai University, 400084, Cluj-Napoca, Romania.
| | - Florin Elec
- Clinical Institute of Urology and Renal Transplantation, 400006, Cluj-Napoca, Romania. .,Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania.
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Yang T, Liang H, Pei X, Zhang N, Liang X, Zhang M, Shao Q, Wang L, Ma M, Shi X, Fan J. Substratification of patients with highest‐risk non‐muscle invasive bladder cancer helps to identify the candidates for immediate radical cystectomy: A two‐center study. Int J Urol 2022; 29:930-936. [DOI: 10.1111/iju.14808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/13/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Tao Yang
- Departments of Urology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
| | - Hua Liang
- Pathology The First Affiliated Hospital of Xi’an Jiaotong University Xi’anChina
| | - Xinqi Pei
- Department of Urology Shaanxi Provincial People's Hospital Xi’anChina
| | - Nan Zhang
- Departments of Urology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
| | - Xiao Liang
- Departments of Urology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
| | - Mengzhao Zhang
- Departments of Urology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
| | - Qiuya Shao
- Departments of Urology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
| | - Lu Wang
- Departments of Urology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
| | - Minghai Ma
- Departments of Urology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
| | - Xinyu Shi
- Department of Urology The Second Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Jinhai Fan
- Departments of Urology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
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Lopez-Beltran A, Cimadamore A, Montironi R, Cheng L. Molecular pathology of urothelial carcinoma. Hum Pathol 2021; 113:67-83. [PMID: 33887300 DOI: 10.1016/j.humpath.2021.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
The current personalized oncology era has witnessed significant efforts to integrate clinical, pathological, and molecular classifications. The growing need for molecular biomarkers to feed personalized oncology, together with the unprecedented wealth of knowledge on the molecular basis of bladder cancer, has led to a novel approach to this disease, incorporating molecularly generated data in clinical practice for locally advanced or metastatic disease. Translational research allows a better understanding of the early events in the development of urothelial carcinoma in the urinary bladder. Thus, mutations in the KMT2D and KDM6A chromatin-modifying genes confer competitive advantages that drive cells to colonize larger regions of the urothelium. Additional mutations in TP53, PIK3CA, FGFR3, or RB1 genes then trigger the process of malignant transformation in the urothelium. In the current review, we provide an overview of what could be the expected transition from the morphology-based classification to a combined, molecularly enriched reporting of clinically meaningful parameters aiming to promote personalized oncology of urothelial carcinoma.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Morphological Sciences, Cordoba University Medical School, Cordoba, E-14004, Spain.
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, 60126, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, 60126, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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International Society of Urological Pathology Expert Opinion on Grading of Urothelial Carcinoma. Eur Urol Focus 2021; 8:438-446. [PMID: 33771477 DOI: 10.1016/j.euf.2021.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022]
Abstract
CONTEXT Grading is the mainstay for treatment decisions for patients with non-muscle-invasive bladder cancer (NMIBC). OBJECTIVE To determine the requirements for an optimal grading system for NMIBC via expert opinion. EVIDENCE ACQUISITION A multidisciplinary working group established by the International Society of Urological Pathology reviewed available clinical, histopathological, and molecular evidence for an optimal grading system for bladder cancer. EVIDENCE SYNTHESIS Bladder cancer grading is a continuum and five different grading systems based on historical grounds could be envisaged. Splitting of the World Health Organization (WHO) 2004 low-grade class for NMIBC lacks diagnostic reproducibility and molecular-genetic support, while showing little difference in progression rate. Subdividing the clinically heterogeneous WHO 2004 high-grade class for NMIBC into intermediate and high risk categories using the WHO 1973 grading is supported by both clinical and molecular-genetic findings. Grading criteria for the WHO 1973 scheme were detailed on the basis of literature findings and expert opinion. CONCLUSIONS Splitting of the WHO 2004 high-grade category into WHO 1973 grade 2 and 3 subsets is recommended. Provision of more detailed histological criteria for the WHO 1973 grading might facilitate the general acceptance of a hybrid four-tiered grading system or-as a preferred option-a more reproducible three-tiered system distinguishing low-, intermediate (high)-, and high-grade NMIBC. PATIENT SUMMARY Improvement of the current systems for grading bladder cancer may result in better informed treatment decisions for patients with bladder cancer.
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