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Lu YT, Plets M, Morrison G, Cunha AT, Cen SY, Rhie SK, Siegmund KD, Daneshmand S, Quinn DI, Meeks JJ, Lerner SP, Petrylak DP, McConkey D, Flaig TW, Thompson IM, Goldkorn A. Cell-free DNA Methylation as a Predictive Biomarker of Response to Neoadjuvant Chemotherapy for Patients with Muscle-invasive Bladder Cancer in SWOG S1314. Eur Urol Oncol 2023; 6:516-524. [PMID: 37087309 PMCID: PMC10587361 DOI: 10.1016/j.euo.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is the standard of care in muscle-invasive bladder cancer (MIBC). However, treatment is intense, and the overall benefit is small, necessitating effective biomarkers to identify patients who will benefit most. OBJECTIVE To characterize cell-free DNA (cfDNA) methylation in patients receiving NAC in SWOG S1314, a prospective cooperative group trial, and to correlate the methylation signatures with pathologic response at radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS SWOG S1314 is a prospective cooperative group trial for patients with MIBC (cT2-T4aN0M0, ≥5 mm of viable tumor), with a primary objective of evaluating the coexpression extrapolation (COXEN) gene expression signature as a predictor of NAC response, defined as achieving pT0N0 or ≤pT1N0 at radical cystectomy. For the current exploratory analysis, blood samples were collected prospectively from 72 patients in S1314 before and during NAC, and plasma cfDNA methylation was measured using the Infinium MethylationEPIC BeadChip array. INTERVENTION No additional interventions besides plasma collection. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Differential methylation between pathologic responders (≤pT1N0) and nonresponders was analyzed, and a classifier predictive of treatment response was generated using the Random Forest machine learning algorithm. RESULTS AND LIMITATIONS Using prechemotherapy plasma cfDNA, we developed a methylation-based response score (mR-score) predictive of pathologic response. Plasma samples collected after the first cycle of NAC yielded mR-scores with similar predictive ability. Furthermore, we used cfDNA methylation data to calculate the circulating bladder DNA fraction, which had a modest but independent predictive ability for treatment response. In a model combining mR-score and circulating bladder DNA fraction, we correctly predicted pathologic response in 79% of patients based on their plasma collected at baseline and after one cycle of chemotherapy. Limitations of this study included a limited sample size and relatively low circulating bladder DNA levels. CONCLUSIONS Our study provides the proof of concept that cfDNA methylation can be used to generate classifiers of NAC response in bladder cancer patients. PATIENT SUMMARY In this exploratory analysis of S1314, we demonstrated that cell-free DNA methylation can be profiled to generate biomarker signatures associated with neoadjuvant chemotherapy response. With validation in additional cohorts, this minimally invasive approach may be used to predict chemotherapy response in locally advanced bladder cancer and perhaps also in metastatic disease.
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Affiliation(s)
- Yi-Tsung Lu
- Division of Medical Oncology, Department of Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Melissa Plets
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gareth Morrison
- Division of Medical Oncology, Department of Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander T Cunha
- Division of Medical Oncology, Department of Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Steven Y Cen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Suhn K Rhie
- Department of Biochemistry and Molecular Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kimberly D Siegmund
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David I Quinn
- Division of Medical Oncology, Department of Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joshua J Meeks
- Departments of Urology, Biochemistry, and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Seth P Lerner
- Scott Department of Urology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Thomas W Flaig
- University of Colorado, School of Medicine, Aurora, CO, USA
| | - Ian M Thompson
- CHRISTUS Medical Center Hospital, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Amir Goldkorn
- Division of Medical Oncology, Department of Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Heinzelbecker J, Spieler N, Kuehn M, Fischer C, Volkmer B, von Rundstedt F, Albers P, Becht E, Bannowsky A, Weber HM, Hofmann R, Müller M, Langbein S, Steiner G, Retz M, Kamradt J, Wagenpfeil G, Wellek S, Lehmann J, Stoeckle M. Adjuvant vs. progression-triggered treatment with gemcitabine in platinum-ineligible high-risk bladder cancer patients: Long-term follow-up of a randomized phase 3 trial. Urol Oncol 2023:S1078-1439(23)00134-5. [PMID: 37198025 DOI: 10.1016/j.urolonc.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/27/2023] [Accepted: 04/16/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Cisplatin-based chemotherapy (ChT) is the preferred perioperative treatment in muscle-invasive urothelial carcinoma of the urinary bladder (UCUB). Nevertheless, a certain number of patients are ineligible for platinum-based ChT. This trial compared immediate adjuvant vs. delayed gemcitabine ChT at progression in platinum-ineligible patients with high-risk UCUB. METHODS High-risk platinum-ineligible UCUB patients (n = 115) were randomized 1:1 to adjuvant gemcitabine (n = 59) or gemcitabine at progression (n = 56). Overall survival was analyzed. Additionally, we analyzed progression-free survival (PFS), toxicity and quality of life (QoL). RESULTS After a median follow-up of 3.0 years (inter quartile range [IQR]: 1.3-11.6), adjuvant ChT did not significantly prolong overall survival (OS) (HR: 0.84; 95% CI: 0.57-1.24; P = 0.375), with 5-year OS of 44.1% (95% CI: 31.2-56.2) and 30.4% (95% CI: 19.0-42.5), respectively. We noted no significant difference in PFS (HR: 0.76; 95% CI: 0.49-1.18; P = 0.218), with 5-year PFS of 36.2% (95% CI: 22.8-49.7) in the adjuvant group and 22.2% (95% CI: 11.5%-35.1%) when treated at progression. Patients with adjuvant treatment showed a significantly worse QoL. The trial was prematurely closed after recruitment of 115 of the planned 178 patients. CONCLUSIONS There was no statistically significant difference in terms of OS and PFS for patients with platinum-ineligible high-risk UCUB receiving adjuvant gemcitabine compared to patients treated at progression. These findings underline the importance of implementing and developing new perioperative treatments for platinum-ineligible UCUB patients.
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Affiliation(s)
- Julia Heinzelbecker
- Department of Urology and Pediatric Urology, University Medical Centre Saarland, Saarland University, Homburg/Saar, Germany.
| | - Natalie Spieler
- Department of Urology and Pediatric Urology, University Medical Centre Saarland, Saarland University, Homburg/Saar, Germany
| | - Michael Kuehn
- Department of Urology, Johanniter Krankenhaus Genthin-Stendal, Stendal, Germany
| | - Claus Fischer
- Department of Urology and Pediatric Urology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Björn Volkmer
- Department of Urology, Klinikum Kassel GmbH, Kassel, Germany
| | - Friedrich von Rundstedt
- Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Peter Albers
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Eduard Becht
- Department of Urology and Pediatric Urology, Krankenhaus Nordwest, Frankfurt, Germany
| | | | - H Matthias Weber
- Department of Urology, Helios Krankenhaus Blankenhain, Blankenhain, Germany
| | - Rainer Hofmann
- Department of Urology and Pediatric Urology, University Hospital Marburg, Marburg, Germany
| | - Markus Müller
- Department of Urology, Klinikum Ludwigshafen gGmbH, Ludwigshafen, Germany
| | - Sigrun Langbein
- MVZ-Urology, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gabriel Steiner
- Department of Urology, Helios Klinikum Meiningen, Meiningen, Germany
| | - Margitta Retz
- Department of Urology, Rechts der Isar Medical Center, Technische Universität München, Munich, Germany
| | - Jörn Kamradt
- Department of Urology, Zentrum für Urologie und Nephrologie, Bern, Switzerland
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Campus Homburg, Saar, Germany
| | - Stefan Wellek
- Division of Biostatistics, Center of Mental Health Mannheim, Mannheim, Germany; Department of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, University of Mainz, Mainz, Germany
| | - Jan Lehmann
- Department of Urology and Pediatric Urology, University Medical Centre Saarland, Saarland University, Homburg/Saar, Germany; Städtisches Krankenhaus Kiel, Kiel, Germany; Urologische Gemeinschaftspraxis Pruener Gang, Kiel, Germany
| | - Michael Stoeckle
- Department of Urology and Pediatric Urology, University Medical Centre Saarland, Saarland University, Homburg/Saar, Germany
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Survival Benefits of Adjuvant Chemotherapy for Positive Soft Tissue Surgical Margins Following Radical Cystectomy in Bladder Cancer with Extravesical Extension. Curr Oncol 2023; 30:3223-3231. [PMID: 36975458 PMCID: PMC10046994 DOI: 10.3390/curroncol30030245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction and Objective: Muscle invasive bladder cancer with extravesical extension is an aggressive disease entity that requires multimodal therapy. The benefits of adjuvant chemotherapy (AC) in patients with a positive soft-tissue surgical margin (STSM), however, are relatively unknown due to exclusion of this population in randomized controlled trials of AC. We sought to define survival benefits in this patient population through our institutional bladder cancer database. Methods: Retrospective review of all patients undergoing radical cystectomy for urothelial carcinoma of the bladder from 2004–2020 with ≥pT3b disease irrespective of neoadjuvant chemotherapy (NAC) use was conducted. Progression-free survival (PFS) and overall survival (OS) estimates were obtained using the Kaplan-Meier method with log-rank test, and the Cox-proportional hazards model was used to identify predictors of improved PFS and OS. AC was defined by any chemotherapy use within 90 days of cystectomy, regardless of STSM status. Results: 476 patients with pT3b disease or worse were identified. Median follow-up was 12.3 months. An amount of 21% of patients were treated with AC. An amount of 24% of patients had positive STSM. Median OS for patients with positive STSM was 8.4 months [95% CI 7–11.5] and 18.3 months [95% CI 15.6–20.8] (p < 0.001) for patients with negative STSM. In the overall cohort, positive STSM (HR 1.93, 95% CI 1.45–2.57, p < 0.001), AC use (HR 0.68, 95% CI 0.51–0.90, p = 0.007), and pN1–3 disease (HR 1.47, 95% CI 1.16–1.87, p = 0.002) were independent predictors of OS when adjusted for performance status, pT-stage, and neoadjuvant chemotherapy use. In patients with positive STSM, median survival was seven months [95% CI 5.2–8.4] without AC, compared to 16.2 months [95% CI 11.5–52.5] with AC (p = 0.0038). For patients with negative STSM, median survival was 17.4 months [95% CI 14–20.1] without AC compared to 22.3 months [95% CI 17.2–36.9] with AC (p = 0.23). In patients with positive STSM, AC use was the only factor associated with an OS benefit with a HR of 0.41 (95% CI 0.21–0.78, p = 0.007). In patients with negative STSM, pT4 and pN1–3 disease were the only factors associated with worse overall survival with a HR of 1.32 (95% CI 1.00–1.74, p = 0.050) and 1.97 (95% CI 1.49–2.60, p < 0.001), respectively. Conclusions: Administration of adjuvant chemotherapy is of particular benefit in patients with positive STSM following radical cystectomy for gross extravesical disease. Positive STSM may be a representative of “early metastatic” or micrometastatic disease.
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Melatonin-Assisted Cisplatin Suppresses Urinary Bladder Cancer Cell Proliferation and Growth through Inhibiting PrP C-Regulated Cell Stress and Cell Proliferation Signaling. Int J Mol Sci 2023; 24:ijms24043353. [PMID: 36834767 PMCID: PMC9959909 DOI: 10.3390/ijms24043353] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
This study investigated whether melatonin (Mel) would promote cisplatin to suppress the proliferation and growth of bladder cancer (BC) cells by inhibiting cellular prion protein (PrPC)-mediated cell stress and cell proliferation signaling. An immunohistochemical staining of tissue arrays from BC patients demonstrated that the PrPC expression was significantly upregulated from stage I to III BC (p < 0.0001). The BC cellline of T24 was categorized into G1 (T24), G2 (T24 + Mel/100 μM), G3 (T24+cisplatin/6 μM), G4 (PrPC overexpression in T24 (i.e., PrPC-OE-T24)), G5 (PrPC-OE-T24+Mel), and G6 (PrPC-OE-T24+cisplatin). When compared with a human uroepithelial cell line (SV-HUC-1), the cellular viability/wound healing ability/migration rate were significantly increased in T24 cells (G1) and further significantly increased in PrPC-OE-T24 cells (G4); and they were suppressed in Mel (G2/G5) or cisplatin (G3/G6) treatment (all p < 0.0001). Additionally, the protein expressions of cell proliferation (PI3K/p-Akt/p-m-TOR/MMP-9/PrPC), cell cycle/mitochondrial functional integrity (cyclin-D1/clyclin-E1/ckd2/ckd4/mitochondrial-cytochrome-C/PINK1), and cell stress (RAS/c-RAF/p-MEK1/2, p-ERK1/2) markers showed a similar pattern of cell viability among the groups (all p < 0.001). After the BC cell line of UMUC3 was implanted into nude mouse backs, by day 28 mthe BC weight/volume and the cellular levels of PrPC/MMP-2/MMP-9 were significantly, gradually reduced from groups one to four (all p < 0.0001). The protein expressions of cell proliferation (PI3K/p-Akt/p-m-TOR/MMP-9/PrPC), cell cycle/mitophagy (cyclin-D1/clyclin-E1/ckd2/ckd4/PINK1), and cell stress (RAS/c-RAF/p-MEK1,2/p-ERK1,2) signaling were significantly, progressively reduced from groups one to four, whereas the protein expressions of apoptotic (Mit-Bax/cleaved-caspase-3/cleaved-PARP) and oxidative stress/mitochondrial damaged (NOX-1/NOX-2/cytosolic-cytochrome-C/p-DRP1) markers expressed an opposite pattern of cell proliferation signaling among the groups (all p < 0.0001). Mel-cisplatin suppressed BC cell growth/proliferation via inhibiting the PrPC in upregulating the cell proliferation/cell stress/cell cycle signaling.
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Multidisciplinary Management and Radiotherapy Recommendations for Clinically and Pathologically Node-positive Bladder Cancer. Semin Radiat Oncol 2023; 33:35-50. [PMID: 36517192 DOI: 10.1016/j.semradonc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are limited data regarding the optimal management of patients with pelvic node-positive, but non-metastatic, bladder cancer. Increasing data demonstrate that this is a distinct clinical entity with outcomes bridging between bladder-confined muscle-invasive bladder cancer and metastatic advanced bladder cancer. Guidelines and staging systems have formalized the need to incorporate the unique considerations of management of pelvic node-positive bladder cancer. However, there remains an absence of a definite standard of care. Treatment options include systemic therapy alone, neoadjuvant chemotherapy followed by radical cystectomy, or bladder-preserving trimodality therapy. Furthermore, ongoing studies aim to determine the benefit of incorporating immunotherapy into these treatment paradigms. In this review article, we will discuss the key considerations for management of patients with pelvic node-positive bladder cancer.
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Chemotherapy is superior to checkpoint inhibitors after radical surgery for urothelial carcinoma: a systematic review and network meta-analysis of oncologic and toxicity outcomes. Crit Rev Oncol Hematol 2021; 169:103570. [PMID: 34902554 DOI: 10.1016/j.critrevonc.2021.103570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine the oncologic and toxicity outcomes of adjuvant immunotherapy with immune checkpoint inhibitors (ICIs) compared to adjuvant chemotherapy in patients treated with radical surgery for urothelial carcinoma (UC). METHODS We used the Bayesian approach in the network meta-analysis of different therapy regimens compared to observation or placebo. RESULTS Nine studies comprised of 2,444 patients met the eligibility criteria. In bladder UC, chemotherapy, atezolizumab, and nivolumab did not improve disease progression compared to observation/placebo. In upper tract UC (UTUC), chemotherapy was significantly associated with a lower likelihood of disease progression compared to observation/placebo, while atezolizumab and nivolumab were not. Based on the analysis of the treatment ranking, adjuvant chemotherapy appeared as the best treatment approach in both bladder UC and UTUC. The risk of adverse events with ICIs was comparable to that of observation/placebo. CONCLUSION Our analysis suggests a superior oncologic benefit to adjuvant chemotherapy over ICIs in patients treated with radical surgery for both bladder UC and UTUC.
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Adjuvant Chemotherapy for Muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis of Individual Participant Data from Randomised Controlled Trials. Eur Urol 2021; 81:50-61. [PMID: 34802798 PMCID: PMC8708165 DOI: 10.1016/j.eururo.2021.09.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Context Our prior systematic review and meta-analysis of individual participant data (IPD) suggesting a benefit of adjuvant chemotherapy for muscle-invasive bladder cancer was limited by the number and size of included randomised trials. We have updated results to include additional trials, providing the most up-to-date and reliable evidence of the effects of this treatment. Objective To investigate the role of adjuvant cisplatin-based chemotherapy in the treatment of muscle-invasive bladder cancer. Evidence acquisition Published and unpublished trials were sought via searches of bibliographic databases, trials registers, conference proceedings, and hand searching. Updated IPD were centrally collected, checked, and analysed. Results from individual randomised controlled trials (RCTs) were combined using a two-stage fixed-effect model. Prespecified analyses explored any variation in effect by trial and participant characteristics. Evidence synthesis Analyses of ten RCTs (1183 participants) demonstrated a benefit of cisplatin-based adjuvant chemotherapy on overall survival (hazard ratio [HR] = 0.82, 95% confidence interval [CI] = 0.70–0.96, p = 0.02). This represents an absolute improvement in survival of 6% at 5 yr, from 50% to 56%, and a 9% absolute benefit when adjusted for age, sex, pT stage, and pN category (HR = 0.77, 95% CI = 0.65–0.92, p = 0.004). There was no clear evidence that the effect varied by trial or participant characteristics. Adjuvant chemotherapy was also shown to improve recurrence-free survival (HR = 0.71, 95% CI = 0.60–0.83, p < 0.001), locoregional recurrence-free survival (HR = 0.68, 95% CI = 0.55–0.85, p < 0.001), and metastasis-free survival (HR = 0.79, 95% CI = 0.65–0.95, p = 0.01), with absolute benefits of 11%, 11%, and 8%, respectively. Conclusions This systematic review and meta-analysis demonstrates that cisplatin-based adjuvant chemotherapy is a valid option for improving outcomes for muscle-invasive bladder cancer. Patient summary We looked at the effect of cisplatin-based chemotherapy on outcomes in participants with muscle-invasive bladder cancer. We gathered this information from eligible randomised controlled trials. We demonstrated that cisplatin-based chemotherapy is a valid option for improving outcomes of muscle-invasive bladder cancer.
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Stadler WM, Heiss BL. Adjuvant Chemotherapy in Bladder Cancer. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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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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Del Pozo Jiménez G, Herranz Amo F, Arranz Arija JA, Rodríguez Fernández E, Subirá Ríos D, Lledó García E, Bueno Chomón G, Cancho Gil MJ, Carballido Rodríguez J, Hernández Fernández C. Effect of adjuvant chemotherapy in locally advanced urothelial carcinoma of the bladder treated with cystectomy. Actas Urol Esp 2020; 44:94-102. [PMID: 31866159 DOI: 10.1016/j.acuro.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/09/2019] [Accepted: 08/27/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor remains controversial. OBJECTIVE To evaluate the effect of ADJ on cancer specific survival of muscle invasive bladder tumor after radical cystectomy (RC). MATERIAL AND METHODS Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor pT3-4pN0 / + cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55-80.5). Comparative analysis was performed with Chi-square test and Student's t test /ANOVA. Survival analysis was carried out with the Kaplan-Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM). RESULTS 42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median cancer specific survival was 30 months. No significant differences were observed in cancer specific survival regarding the treatment with ADJ in pT3pN0 (p=.25) or pT4pN0 (p=.29) patients, but it was significant in pT3-4pN+ (p=.001). Multivariate analysis showed pathological stage (p=.0001) and treatment with ADJ (p=.007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95% CI 0.40-0.87, p=.007). CONCLUSIONS pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN+ patients were benefited in the stage analysis.
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Affiliation(s)
- G Del Pozo Jiménez
- Servicio de Urología, Hospital Universitario Puerta de Hierro, Madrid, España.
| | - F Herranz Amo
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J A Arranz Arija
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | - D Subirá Ríos
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - E Lledó García
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - G Bueno Chomón
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - M J Cancho Gil
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
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11
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Propensity-matched analysis of stage-specific efficacy of adjuvant chemotherapy for bladder cancer. Urol Oncol 2019; 37:877-885. [PMID: 31420159 DOI: 10.1016/j.urolonc.2019.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/12/2019] [Accepted: 06/23/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Contemporary randomized controlled trials exploring adjuvant chemotherapy (AC) for bladder cancer (BCa) have yielded inconsistent results due to premature termination and/or poor patient accrual. OBJECTIVE To compare efficacy of AC vs. observation after radical cystectomy stratified by disease stage in a propensity-matched cohort. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective study that included patients who underwent radical cystectomy for any pT, N0-1, M0 BCa from the National Cancer Data Base (2004-2014). Patients who underwent AC were 1:1 propensity matched with patients who received observation only. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Overall survival was assessed with multivariable Cox regression models where adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated. RESULTS AND LIMITATIONS After coarsened exact 1:1 propensity matching, 3,066 patients (AC 1,533; observation 1,533) were included in the analysis. There were no significant differences in patient-, facility-, or tumor-level characteristics among cohorts. Compared with patients who underwent observation, recipients of AC had improved overall survival (aHR 0.67; 95% CI 0.61-0.74). Patients with pT2-4, pN1 disease significantly benefited from AC. Among the pN0 cohort, improved survival from AC was observed only in stages pT3 (aHR 0.67; 95% CI 0.55-0.83) and pT4 (aHR 0.70; 95% CI 0.50-0.98). CONCLUSIONS AC was associated with improved survival in locally advanced (pT3-4, pN0) and regionally advanced (pT2-4, pN1) chemotherapy-naive BCa.
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12
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Pak S, You D, Jeong IG, Song C, Lee JL, Hong B, Hong JH, Kim CS, Ahn H. Adjuvant chemotherapy versus observation after radical cystectomy in patients with node-positive bladder cancer. Sci Rep 2019; 9:8305. [PMID: 31165753 PMCID: PMC6549178 DOI: 10.1038/s41598-019-44504-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/17/2019] [Indexed: 11/15/2022] Open
Abstract
This retrospective study compared adjuvant chemotherapy (AC) versus observation after radical cystectomy (RC) in patients with node-positive bladder cancer (pN+). Outcomes were reviewed in patients with pTanyN1-3M0 bladder cancer who underwent RC with or without AC between 1995 and 2017. Baseline characteristics between the two groups were controlled with inverse probability of treatment weighting (IPTW)-adjusted analyses. Of 281 enrolled patients, the 3-year IPTW-adjusted rates of overall survival was higher in the AC group than the RC group (46.4% vs. 33.7%, p = 0.024). AC was an independent predictor of overall survival (hazard ratio = 0.48; P < 0.0001). When patients were subdivided by lymph node density (LND), the 3-year overall survival rates were similar between the AC and RC groups in patients with LND < 9%, but higher in the AC group in patients with LND 9–25% (53.4% vs. 23.7%) and LND ≥ 25% (27.4% vs. 16.1%). The numbers needed to treat to prevent one death at 3 years were three and nine in patients with LND 9–25% and ≥25%, respectively. In conclusion, AC after RC was associated with improved overall survival in patients with node-positive bladder cancer. Patients with an intermediate nodal burden may benefit most from AC.
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Affiliation(s)
- Sahyun Pak
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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13
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Kim DK, Lee JY, Jung JH, Hah YS, Cho KS. Role of adjuvant cisplatin-based chemotherapy following radical cystectomy in locally advanced muscle-invasive bladder cancer: Systematic review and meta-analysis of randomized trials. Investig Clin Urol 2019; 60:64-74. [PMID: 30838338 PMCID: PMC6397926 DOI: 10.4111/icu.2019.60.2.64] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/03/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose We purposed to assess the effects of adjuvant chemotherapy (ACH) on survival outcomes in patients with locally advanced muscle-invasive bladder cancer (MIBC) who are treated with radical cystectomy (RC). Materials and Methods Literature search was conducted in PubMed, Embase, and Cochrane library databases for all articles that were published until February 2018. Systematic review and meta-analysis were performed by pooling the randomized controlled trials (RCTs) that compared patients with locally advanced MIBC who received ACH after RC to those who underwent cystectomy alone. Endpoints were progression free survival (PFS) and overall survival (OS). Results Four RCTs with a total of 490 patients were selected for the analysis. These four trials included patients with locally advanced MIBC. Pooled HRs for PFS and OS across the studies were 0.48 (95% confidence interval [CI], 0.39–0.60; p<0.00001) and 0.63 (95% CI, 0.48–0.83; p=0.0009), respectively. Absolute increases in PFS and OS for locally advanced MIBC were 17% and 10%, respectively (i.e., equivalent to numbers needed to treat of 5.9 and 10). Conclusions ACH following RC may improve the survival outcomes of locally advanced MIBC patients. Beneficial effect of ACH might be more marked in patients with locally advanced MIBC when comparing the previously reported meta-analysis with all MIBC patients.
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Affiliation(s)
- Do Kyung Kim
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hung Jung
- Department of Urology, Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yoon Soo Hah
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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14
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Peri-operative Chemotherapy for Muscle-Invasive Bladder Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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5 - Trattamento Chirurgico Della Malattia Muscolo-Invasiva E Localmente Avanzata (MIBC). TUMORI JOURNAL 2018; 104:S17-S23. [PMID: 29893170 DOI: 10.1177/0300891618766108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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Goldberg H, Klaassen Z, Chandrasekar T, Sayyid R, Kulkarni GS, Hamilton RJ, Fleshner NE. Does perioperative chemotherapy improve survival in upper tract urothelial carcinoma? A population based analysis. Oncotarget 2018; 9:18797-18810. [PMID: 29721162 PMCID: PMC5922356 DOI: 10.18632/oncotarget.24694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/24/2018] [Indexed: 01/01/2023] Open
Abstract
Objectives To evaluate the utilization and outcomes of perioperative chemotherapy in non-metastatic UTUC patients over the past decade using a large national database. Methods All patients aged 18 and older diagnosed with non-metastatic UTUC between 2004 and 2013 were identified within the Surveillance, Epidemiology and End Results (SEER) database. Relevant clinical data was collected and predictors of cancer specific mortality (CSM) and other cause mortality (OCM) were analyzed. Results The total cohort included 8,762 patients. Of these, 1,402 (16%) patients received chemotherapy, including only 35% of high-risk patients (>pT2 or N1). Treated patients had higher CSM (21.3% vs. 13.1%, p<0.001). Predictors of chemotherapy utilization included residence in Midwest states, tumor located in the ureter, higher stage and grade. Predictors of CSM included older age, residence in southern states, receipt of chemotherapy (HR = 1.151, 95% CI: 1.003-1.32, p=0.044), higher stage and grade. OCM was predicted by male gender, older age, ureteral tumor, and higher stage. A subset analysis of patients younger than 65 showed similar predictors, while an analysis of high risk patients demonstrated that chemotherapy receipt did not predict CSM or OCM. Conclusions In this large contemporary non-metastatic UTUC cohort, chemotherapy utilization was found to be quite infrequent, but increasing steadily. Perioperative chemotherapy had no effect on CSM in high-risk patients, while correlated to higher CSM in the younger patients.
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Affiliation(s)
- Hanan Goldberg
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Zachary Klaassen
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Thenappan Chandrasekar
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Rashid Sayyid
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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18
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Haque W, Lewis GD, Verma V, Darcourt JG, Butler EB, Teh BS. The role of adjuvant chemotherapy in locally advanced bladder cancer. Acta Oncol 2018; 57:509-515. [PMID: 29226744 DOI: 10.1080/0284186x.2017.1415461] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The standard of care for locally advanced bladder cancer (LABC) is neoadjuvant chemotherapy followed by cystectomy. However, the role of adjuvant therapy is unclear. The purpose of this study was to evaluate the outcomes of adjuvant chemotherapy for patients with LABC following neoadjuvant chemotherapy and cystectomy, and to determine whether select patients may benefit from adjuvant chemotherapy. METHODS The National Cancer Data Base (NCDB) was queried (2004-2013) for patients with newly diagnosed pT3-4N0-3M0 bladder cancer that received neoadjuvant chemotherapy and cystectomy. Patients were divided into two groups based on the adjuvant therapy they received: chemotherapy alone or observation. Statistics included multivariable logistic regression to determine factors predictive of receiving adjuvant chemotherapy, Kaplan-Meier analysis to evaluate overall survival (OS) and Cox proportional hazards modeling to determine variables associated with OS. RESULTS Altogether, 2592 patients met inclusion criteria; 901 (34.8%) patients received adjuvant chemotherapy, while 1691 (65.2%) were observed. Patients treated with adjuvant chemotherapy were more likely to have positive margins were younger and more likely to receive treatment at a nonacademic facility. There was no difference in median OS between patients treated with or without adjuvant chemotherapy (22.6 vs. 21.1 months; p = .267). However, a longer median OS was observed with the use of adjuvant chemotherapy was observed among patients with N2-3 disease (17.5 vs. 14.4 months; p = .005) and positive surgical margins (16.7 vs. 12.2 months; p = .025). On multivariate analysis, advancing age, pT4 stage, positive N stage, positive margins and lower socioeconomic status were associated with worse OS. CONCLUSIONS In the largest study to date evaluating efficacy of adjuvant chemotherapy, while no difference in OS was observed for adjuvant chemotherapy in all patients, a longer OS was observed among patients with N2-3 disease or with positive surgical margins. Prospective studies are recommended to further evaluate these findings.
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Affiliation(s)
- Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Gary D. Lewis
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jorge G. Darcourt
- Department of Medical Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - E. Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Bin S. Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
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19
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Oh JJ. Adjuvant Chemotherapy. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Seisen T, Pradère B, Rouprêt M. Peri-operative Chemotherapy for Muscle-Invasive Bladder Cancer. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_25-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Liu D, Abbosh P, Keliher D, Reardon B, Miao D, Mouw K, Weiner-Taylor A, Wankowicz S, Han G, Teo MY, Cipolla C, Kim J, Iyer G, Al-Ahmadie H, Dulaimi E, Chen DYT, Alpaugh RK, Hoffman-Censits J, Garraway LA, Getz G, Carter SL, Bellmunt J, Plimack ER, Rosenberg JE, Van Allen EM. Mutational patterns in chemotherapy resistant muscle-invasive bladder cancer. Nat Commun 2017; 8:2193. [PMID: 29259186 PMCID: PMC5736752 DOI: 10.1038/s41467-017-02320-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022] Open
Abstract
Despite continued widespread use, the genomic effects of cisplatin-based chemotherapy and implications for subsequent treatment are incompletely characterized. Here, we analyze whole exome sequencing of matched pre- and post-neoadjuvant cisplatin-based chemotherapy primary bladder tumor samples from 30 muscle-invasive bladder cancer patients. We observe no overall increase in tumor mutational burden post-chemotherapy, though a significant proportion of subclonal mutations are unique to the matched pre- or post-treatment tumor, suggesting chemotherapy-induced and/or spatial heterogeneity. We subsequently identify and validate a novel mutational signature in post-treatment tumors consistent with known characteristics of cisplatin damage and repair. We find that post-treatment tumor heterogeneity predicts worse overall survival, and further observe alterations in cell-cycle and immune checkpoint regulation genes in post-treatment tumors. These results provide insight into the clinical and genomic dynamics of tumor evolution with cisplatin-based chemotherapy, suggest mechanisms of clinical resistance, and inform development of clinically relevant biomarkers and trials of combination therapies. The impact of cisplatin-based chemotherapy on tumor genomes is complex. Here, the authors study matched pre- and post-chemotherapy primary samples in muscle-invasive bladder cancer, finding a cisplatin-based mutational signature, and highlighting the impact of intratumor heterogeneity on survival.
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Affiliation(s)
- David Liu
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Philip Abbosh
- Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Daniel Keliher
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Brendan Reardon
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Diana Miao
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Kent Mouw
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | | | - Stephanie Wankowicz
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Garam Han
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Min Yuen Teo
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Jaegil Kim
- Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Gopa Iyer
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Essel Dulaimi
- Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | | | | | | | - Levi A Garraway
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Gad Getz
- Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Scott L Carter
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Joaquim Bellmunt
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | | | | | - Eliezer M Van Allen
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA. .,Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA.
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22
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Kim HS, Jeong CW, Kwak C, Kim HH, Ku JH. Adjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and network meta-analysis of randomized clinical trials. Oncotarget 2017; 8:81204-81214. [PMID: 29113380 PMCID: PMC5655275 DOI: 10.18632/oncotarget.20979] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/28/2017] [Indexed: 11/25/2022] Open
Abstract
Although adjuvant chemotherapy (ACH) is widely used in clinical practice for the management of muscle-invasive bladder cancer (MIBC), a consensus has yet to be established on which ACH regimen is the most effective for improving postoperative survival. In this study, we aimed to systematically assess the optimal ACH regimen for improving survival outcomes in patients treated with radical cystectomy (RC) for MIBC. A comprehensive literature search was conducted in the PubMed, Embase, and the Cochrane Library databases for all articles published until December 2016 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The study end-points were progression-free survival (PFS) and overall survival (OS). A direct pairwise meta-analysis was conducted by pooling the studies that compared RC with ACH and RC alone, and the results are presented as a pooled hazard ratio (HR) with a 95% confidence interval (CI). A Bayesian network meta-analysis was adopted for indirect comparisons among various ACH regimens, and the outcomes are presented as HRs with 95% credible intervals (CrI). The eleven randomized controlled trials ultimately selected for the current analysis comprised of 1,546 patients with 49 to 327 subjects per study. Based on the pairwise meta-analysis, the use of ACH showed significantly better PFS (HR, 0.64; 95% CI, 0.49–0.85) and OS (HR, 0.79; 95% CI, 0.68–0.92) than RC alone. In the network meta-analysis, the gemcitabine/cisplatin/paclitaxel (GCP) combination was the only ACH regimen associated with significant improvement in both the PFS (HR, 0.38; 95% CrI, 0.25–0.58) and OS (HR, 0.38; 95% CrI 0.22–0.65). ACH following RC for MIBC may therefore contribute to improved PFS and OS. In particular, the GCP combination may be the optimal ACH regimen for improving postoperative survival outcomes. Additional well-designed, large scale, prospective, randomized trials are still required to establish the optimal ACH regimen in MIBC patients.
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Affiliation(s)
- Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Lobo N, Mount C, Omar K, Nair R, Thurairaja R, Khan MS. Landmarks in the treatment of muscle-invasive bladder cancer. Nat Rev Urol 2017; 14:565-574. [DOI: 10.1038/nrurol.2017.82] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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24
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Luo F, Wang YS, Su YH, Zhang ZH, Sun HH, Li J. Prognostic impact of preoperative anemia on non-muscle-invasive bladder carcinoma treated with GreenLight laser vaporization. Lasers Med Sci 2016; 32:397-403. [DOI: 10.1007/s10103-016-2133-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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Abstract
OPINION STATEMENT In the last 25 years, there has been an improved understanding of the pathogenesis of muscle-invasive bladder cancer (BC). Development of new treatment strategies has followed. We have progressed from the awareness of the efficacy of platinum compounds, especially cisplatin, as single agents to the development of effective drug combinations with greater attention in improving safety profiles while impacting on survival. Peri-operative chemotherapy (CHT) is the standard of care for non-metastatic disease. The most evidence in terms of a survival advantage is derived from neoadjuvant chemotherapy (NC) trials, but adjuvant medical treatment should be strongly considered when NC has not been utilized. Patient selection and a multidisciplinary approach are essential. Platinum-based CHT is still the standard of care for both early and advanced disease. A deeper knowledge of the pathogenesis of BC will derive from gene expression profiling (GEP), and this will give us new prognostic and predictive tools to develop more targeted treatments. A high mutational rate has been observed in BC, which can generate neoantigens that initiate cancer immunity. Immunotherapy will become a pivotal treatment for BC, in the very near future. Emerging data are encouraging, and these treatments may well revolutionize the medical approach to this disease while CHT will play a less important role.
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Affiliation(s)
- Patrizia Trenta
- Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglione Flajani, Circonvallazione Gianicolense 87, Rome, 00152, Italy.
| | - Fabio Calabrò
- Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglione Flajani, Circonvallazione Gianicolense 87, Rome, 00152, Italy.
| | - Linda Cerbone
- Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglione Flajani, Circonvallazione Gianicolense 87, Rome, 00152, Italy.
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglione Flajani, Circonvallazione Gianicolense 87, Rome, 00152, Italy.
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Zargar-Shoshtari K, Kongnyuy M, Sharma P, Fishman MN, Gilbert SM, Poch MA, Pow-Sang JM, Spiess PE, Zhang J, Sexton WJ. Clinical role of additional adjuvant chemotherapy in patients with locally advanced urothelial carcinoma following neoadjuvant chemotherapy and cystectomy. World J Urol 2016; 34:1567-1573. [PMID: 27072536 DOI: 10.1007/s00345-016-1825-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/04/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) can downstage invasive bladder cancers prior to radical cystectomy (RC) and improve overall survival. However, the optimal management in patients with persistent non-organ confined disease (pT3-T4 and/or pN+) following RC has not been completely defined. The aim of this study was to describe outcomes associated with the use of adjuvant chemotherapy (AC) in patients with residual non-organ confined cancer at RC following NAC. MATERIALS AND METHODS Using data from a high-volume referral institution, pT3-T4 and/or pN+ patients who received NAC and then also RC were identified. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were assessed with Kaplan-Meier analysis. RESULTS From 2001 to 2013, 161 patients received NAC and then RC. Eighty-eight pT3-T4 and/or pN+ patients were identified. Twenty-nine (33 %) received AC. Adjuvant chemotherapy in the majority of patients was carboplatin-based (16), followed by cisplatin (8) and other, mainly taxane-containing regimens (5). The median RFS was 17.5 months in the AC and 13.7 months in the non-AC group (p = 0.78). AC remained an insignificant predictor for RFS after adjusting for pT, pN and margin status (HR 0.89, 95 % CI 0.48-1.68]). CSS was 23 and 22 months (p = 0.65) and remained insignificant after adjusting for pathologic confounders. CONCLUSIONS In our current study population, adjuvant conventional cytotoxic chemotherapy was not associated with significant improvements in RFS or CSS. The choice of AC regimens, and incorporation of newer treatments, may be the key for improving outcomes in this high-risk patient group.
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Affiliation(s)
- Kamran Zargar-Shoshtari
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Michael Kongnyuy
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Pranav Sharma
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Mayer N Fishman
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Julio M Pow-Sang
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Jingsong Zhang
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
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Kalogirou C, Svistunov A, Krebs M, Lausenmeyer EM, Vergho D, Riedmiller H, Kocot A. Maintenance monotherapy with Gemcitabine following cisplatin-based primary combination chemotherapy in surgically treated advanced urothelial carcinoma: A matched-pair single institution analysis. Mol Clin Oncol 2016; 4:636-642. [PMID: 27073682 DOI: 10.3892/mco.2016.749] [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: 10/23/2015] [Accepted: 01/13/2016] [Indexed: 11/06/2022] Open
Abstract
The role of maintenance therapy with Gemcitabine (GEM) following cisplatin-based combination chemotherapy (CBCC) in patients with surgically treated advanced urothelial carcinoma (UC) remains to be fully elucidated. In the present case control study, a retrospective analysis was performed to evaluate the role of GEM monotherapy following surgical intervention for advanced UC. Between 1999 and 2013, 38 patients were identified with surgically treated advanced UC after having completed CBCC, who were additionally treated quarterly with two consecutive GEM (1,250 mg/m2) infusions as maintenance therapy. This collective was matched by propensity score matching to a control collective (n=38) that received primary CBCC alone, and the overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS) rates were determined for the two collectives using Kaplan-Meier estimates and the log-rank test. Regression analysis was performed using the Cox proportional hazards model. The median follow-up time was 37 months (interquartile range: 9-148). Interestingly, patients treated with GEM following primary chemotherapy had a significantly improved outcome with respect to the 5-year OS (46.2 vs. 26.4%, P=0.0314) and 5-year CSS (61.3 vs. 33.4%, P=0.0386) rates. Notably, the 5-year PFS rate did not differ between the two groups (10.3 vs. 16.1%, P=0.134). It is proposed that additional GEM maintenance monotherapy is able to improve survival rates following primary CBCC in surgically treated patients with advanced UC, suggesting a possible treatment option for patients with, e.g., unclear disease status, or those who would require an active maintenance therapy in the future. Prospective studies should further determine the impact of GEM monotherapy with respect to PFS rates in groups comprising larger numbers of patients.
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Affiliation(s)
- Charis Kalogirou
- Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany
| | - Andrey Svistunov
- Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany
| | - Markus Krebs
- Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany
| | | | - Daniel Vergho
- Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany
| | - Hubertus Riedmiller
- Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany
| | - Arkadius Kocot
- Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany
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Sonpavde G, Gordetsky JB, Lockhart ME, Nix JW. Chemotherapy for Muscle-Invasive Bladder Cancer: Better Late Than Never? J Clin Oncol 2016; 34:780-5. [PMID: 26786922 DOI: 10.1200/jco.2015.65.4442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 64-year-old man with a history of cigarette smoking but no significant comorbidities presented with hematuria and dysuria. Computed tomography scans demonstrated a mass and thickening of the bladder wall and no evidence of metastasis. His laboratory evaluation showed normal blood cell counts and comprehensive metabolic panel with a calculated creatinine clearance of more than 60 mL per minute. A transurethral resection of the bladder tumor and biopsy identified transitional cell carcinoma or urothelial carcinoma invading the muscularis propria of the bladder. On the basis of the bladder-confined mass on computed tomography scan, the tumor was assigned a clinical stage of cT2N0. The patient was advised to undergo neoadjuvant chemotherapy followed by radical cystectomy (RC). The patient had multiple concerns regarding neoadjuvant chemotherapy, particularly toxicities, especially the possibility of chronic neurologic and renal toxicities, and the potential harm from delay of RC, especially if the bladder cancer was resistant to chemotherapy. After a discussion of approximately 1 hour, he elected to proceed with upfront RC and extended lymph node dissection in conjunction with construction of a neobladder. Pathology revealed pathologic extravesical urothelial carcinoma, with disease in one of 25 lymph nodes removed (ypT3N1). Four weeks after RC, he returned to discuss further management with the medical oncologist. He exhibited an Eastern Cooperative Oncology Group performance status of 0, normal blood cell counts, and a calculated creatinine clearance of more than 60 mL per minute.
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Affiliation(s)
- Guru Sonpavde
- University of Alabama, Birmingham, School of Medicine and Veterans Affairs Medical Center, Birmingham, AL
| | | | - Mark E Lockhart
- University of Alabama, Birmingham, School of Medicine, Birmingham, AL
| | - Jeffrey W Nix
- University of Alabama, Birmingham, School of Medicine, Birmingham, AL
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Galsky MD, Stensland KD, Moshier E, Sfakianos JP, McBride RB, Tsao CK, Casey M, Boffetta P, Oh WK, Mazumdar M, Wisnivesky JP. Effectiveness of Adjuvant Chemotherapy for Locally Advanced Bladder Cancer. J Clin Oncol 2016; 34:825-32. [PMID: 26786930 DOI: 10.1200/jco.2015.64.1076] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Given that randomized trials exploring adjuvant chemotherapy for bladder cancer have been underpowered and/or terminated prematurely, yielding inconsistent results and creating an evidence gap, we sought to compare the effectiveness of cystectomy versus cystectomy plus adjuvant chemotherapy in real-world patients. PATIENTS AND METHODS We conducted an observational study to compare the effectiveness of adjuvant chemotherapy versus observation postcystectomy in patients with pathologic T3-4 and/or pathologic node-positive bladder cancer using the National Cancer Data Base. We compared overall survival using propensity score (-adjusted, -stratified, -weighted, and -matched) analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to examine the impact of performance status. RESULTS A total of 5,653 patients met study inclusion criteria; 23% received adjuvant chemotherapy postcystectomy. Chemotherapy-treated patients were younger and more likely to have private insurance, live in areas with a higher median income and higher percentage of high school-educated residents, and have lymph node involvement and positive surgical margins (P < .05 for all comparisons). Stratified analyses adjusted for propensity score demonstrated an improvement in overall survival with adjuvant chemotherapy (hazard ratio, 0.70; 95% CI, 0.64 to 0.76), and similar results were achieved with propensity score matching and weighting. The association between adjuvant chemotherapy and improved survival was consistent in subset analyses and was robust to the effects of poor performance status. CONCLUSION In this observational study, adjuvant chemotherapy was associated with improved survival in patients with locally advanced bladder cancer. Although neoadjuvant chemotherapy remains the preferred approach based on level I evidence, these data lend further support for the use of adjuvant chemotherapy in patients with locally advanced bladder cancer postcystectomy who did not receive chemotherapy preoperatively.
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Affiliation(s)
- Matthew D Galsky
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA.
| | - Kristian D Stensland
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
| | - Erin Moshier
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
| | - John P Sfakianos
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
| | - Russell B McBride
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
| | - Che-Kai Tsao
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
| | - Martin Casey
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
| | - Paolo Boffetta
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
| | - William K Oh
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
| | - Madhu Mazumdar
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
| | - Juan P Wisnivesky
- Matthew D. Galsky, Erin Moshier, Che-Kai Tsao, Martin Casey, Paolo Boffetta, and William K. Oh, Tisch Cancer Institute at Mount Sinai; Erin Moshier, John P. Sfakianos, Russell B. McBride, Paolo Boffetta, Madhu Mazumdar, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai, New York, NY; and Kristian D. Stensland, Lahey Clinic, Burlington, MA
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Chou R, Selph SS, Buckley DI, Gustafson KS, Griffin JC, Grusing SE, Gore JL. Treatment of muscle-invasive bladder cancer: A systematic review. Cancer 2016; 122:842-51. [PMID: 26773572 DOI: 10.1002/cncr.29843] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 01/22/2023]
Abstract
There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal chemotherapeutic regimens. This study was conducted to systematically review the benefits and harms of bladder-sparing therapies, lymph node dissection, and systemic chemotherapy for patients with clinically localized muscle-invasive bladder cancer. Systematic literature searches of MEDLINE (from 1990 through October 2014), the Cochrane databases, reference lists, and the ClinicalTrials.gov Web site were performed. A total of 41 articles were selected for review. Bladder-sparing therapies were found to be associated with worse survival compared with radical cystectomy, although the studies had serious methodological shortcomings, findings were inconsistent, and only a few studies evaluated currently recommended techniques. More extensive lymph node dissection might be more effective than less extensive dissection at improving survival and decreasing local disease recurrence, but there were methodological shortcomings and some inconsistency. Six randomized trials found cisplatin-based combination neoadjuvant chemotherapy to be associated with a decreased mortality risk versus cystectomy alone. Four randomized trials found adjuvant chemotherapy to be associated with decreased mortality versus cystectomy alone, but none of these trials reported a statistically significant effect. There was insufficient evidence to determine optimal chemotherapeutic regimens.
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Affiliation(s)
- Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Shelley S Selph
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - David I Buckley
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Katie S Gustafson
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Jessica C Griffin
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Sara E Grusing
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - John L Gore
- Department of Urology, Pacific Northwest Evidence-based Practice Center, University of Washington CHASE Alliance, Seattle, Washington
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Knollman H, Godwin JL, Jain R, Wong YN, Plimack ER, Geynisman DM. Muscle-invasive urothelial bladder cancer: an update on systemic therapy. Ther Adv Urol 2015; 7:312-30. [PMID: 26622317 PMCID: PMC4647143 DOI: 10.1177/1756287215607418] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Urothelial carcinoma is a common malignancy that carries a poor prognosis when the disease includes muscle invasion. Metastatic urothelial carcinoma is almost uniformly fatal. The evidence behind treatment options in the neoadjuvant, adjuvant and metastatic settings are discussed in this manuscript, with a focused review of standard and investigational cytotoxic, targeted, and immunotherapy approaches. We have focused especially on neoadjuvant cisplatin-based therapy (supported by level one evidence) and on novel immunotherapy agents such as checkpoint inhibitors, which have shown great promise in early clinical studies.
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Affiliation(s)
- Hayley Knollman
- Department of Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - J. Luke Godwin
- Department of Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Rishi Jain
- Department of Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Yu-Ning Wong
- Department of Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Elizabeth R. Plimack
- Department of Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Daniel M. Geynisman
- Assistant Professor of Medical Oncology, Fox Chase Cancer Center-Temple University Health System, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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Treatment of muscle invasive bladder cancer in the elderly: navigating the trade-offs of risk and benefit. World J Urol 2015; 34:3-11. [PMID: 26497825 DOI: 10.1007/s00345-015-1708-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/06/2015] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Despite the fact that bladder cancer patients have the highest median age of any type of cancer, older patients with muscle invasion are often under-treated. METHODS In this review, we report the most up to date literature on the patterns of care and treatment of older patients with muscle invasive bladder cancer. Data on under-treatment, geriatric principles, cystectomy, perioperative chemotherapy, and bladder preservation for older patients are presented and analyzed. CONCLUSION Chronologic age should not exclude patients from curative-intent therapy. Functional age as determined by geriatric assessments and multidisciplinary evaluation can help clinicians decide on the best course of treatment for individual patients. Cystectomy, perioperative chemotherapy, and curative-intent bladder preservation are reasonable options in healthy older adults. Observation should be limited to patients with extremely poor performance status and very limited life expectancy.
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Braunstein LZ, Shipley WU, James ND, Apolo AB, Efstathiou JA. Integrating chemotherapy and radiotherapy for bladder cancer. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Miyake H, Sakai I, Harada KI, Hara I, Eto H. Long-term Outcome of Adjuvant Chemotherapy with MVP-CAB Regimen (Methotrexate, Vincristine, Cisplatin, Cyclophosphamide, Adriamycin and Bleomycin) for Locally Advanced Bladder Cancer. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15610950400015174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Invasive, clinically non-metastatic bladder cancer has a cure rate of only 50% , when all T stages are considered. The pattern of relapse is dominated by systemic spread, provided that optimal surgery is practiced. Occult metastases are thus most likely to be present at first presentation. For more than 30 years, therapeutic strategies have focused on the use of systemic chemotherapy before, during or after loco-regional therapy to produce cure. More aggressive surgery and more precise radiation techniques in addition to improved chemotherapy have also been tested to improve cure rates. Genetic analysis has focused on prediction and prognostication, without yet having a major impact on outcomes. New agents have been tested in the neoadjuvant and adjuvant setting, but have not yet proven superior to standard algorithms, such as neoadjuvant MVAC chemotherapy. Many studies have tested ineffective metastatic regimens in the neoadjuvant setting without success, giving rise to the maxim that ignoring logical rules of investigation will not advance clinical practice. Leveraging molecular prognostication and immune responsiveness of urothelial cancer may produce the next era of progress. Five simple rules are proposed to guide the development of future studies.
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Affiliation(s)
- Derek Raghavan
- President, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
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Terrisse S, Doucet L, Pouessel D, Gauthier H, le Maignan C, Teixeira L, Pfister C, Culine S. Quelle chimiothérapie périopératoire pour les tumeurs de vessie infiltrant le muscle ? ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2510-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Arcangeli G, Strigari L, Arcangeli S. Radical cystectomy versus organ-sparing trimodality treatment in muscle-invasive bladder cancer: A systematic review of clinical trials. Crit Rev Oncol Hematol 2015; 95:387-96. [PMID: 25934521 DOI: 10.1016/j.critrevonc.2015.04.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/23/2015] [Accepted: 04/07/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Radical cystectomy (RC) represents the mainstay of treatment in patients with muscle-invasive urinary bladder cancer but how it compares with the best organ preservation approach is not known. MATERIALS AND METHODS The objective of our review is to compare the 5-year overall survival (OS) rates from retrospective and prospective studies of RC and trimodality treatment (TMT), i.e. concurrent delivery of chemotherapy and radiotherapy after a transurethral resection of bladder tumor (TURBT), involving a total of 10,265 and 3131 patients, respectively. We used random-effect models to pool outcomes across studies and compared event rates of combined outcomes for TMT and RC using an interaction test. RESULTS The median 5-year OS rate was 57% in the TMT group, when compared with 52% (P=0.04), 51% (P=0.02) and 53% (P=0.38) in the whole group receiving RC or the group treated with RC alone or RC+chemotherapy, respectively. The hazard risk (HR) of mortality of patients treated with TMT or RC was 1.22 (95% CI=1.13-1.32) with an absolute benefit of 5% in favor of the former. The HR of mortality from TMT persisted significantly better not only versus the group treated with RC alone (HR=1.22; 95% CI=1.12-1.32), but also versus the group receiving RC+chemotherapy (HR=1.22; 95% CI=1.09-1.36). Multivariate analysis confirmed TMT as a significant prognostic variable for both RC alone and RC+chemotherapy. CONCLUSION Compared with RC, TMT seems to be associated with a better outcome for patients with muscle-invasive bladder cancer (MIBC). The addition of chemotherapy may improve the RC outcome in some subgroups of patients with a higher probability of micrometastases. Prospective randomized trials are urged to verify these findings and better define the role of organ preservation and radical treatment strategy in the management of patients with MIBC.
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Affiliation(s)
- G Arcangeli
- Medical Physics and Expert Systems Laboratory, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - L Strigari
- Medical Physics and Expert Systems Laboratory, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - S Arcangeli
- Radiotherapy Department, Azienda Ospedaliera S. Camillo-Forlanini , Rome, Italy
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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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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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Raghavan D, Bawtinhimer A, Mahoney J, Eckrich S, Riggs S. Adjuvant chemotherapy for bladder cancer—why does level 1 evidence not support it? Ann Oncol 2014; 25:1930-1934. [DOI: 10.1093/annonc/mdu092] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Booth CM, Siemens DR, Peng Y, Tannock IF, Mackillop WJ. Delivery of perioperative chemotherapy for bladder cancer in routine clinical practice. Ann Oncol 2014; 25:1783-1788. [PMID: 24915872 DOI: 10.1093/annonc/mdu204] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Few articles have documented regimens and timing of perioperative chemotherapy for bladder cancer in routine practice. Here, we describe practice patterns in the general population of Ontario, Canada. METHODS In this retrospective cohort study, treatment and physician billing records were linked to the Ontario Cancer Registry to describe use of neoadjuvant (NACT) and adjuvant (ACT) chemotherapy among all patients with muscle-invasive bladder cancer treated with cystectomy in Ontario 1994-2008. Time to initiation of ACT (TTAC) was measured from cystectomy. Multivariate Cox regression was used to identify factors associated with overall (OS) and cancer-specific survival (CSS). RESULTS Of 2944 patients undergoing cystectomy, 4% (129/2944) and 19% (571/2944) were treated with NACT and ACT, respectively. Five-year OS was 25% [95% confidence interval (CI) 17% to 34%] for NACT, 29% (95% CI 25% to 33%) for ACT cases. Among patients with identifiable drug regimens, cisplatin was used in 82% (253/308) and carboplatin in 14% (43/308). The most common regimens were gemcitabine-cisplatin (54%, 166/308) and methotrexate, vinblastine, doxorubicin, cisplatin (MVAC) (21%, 66/308). Mean TTAC was 10 weeks; 23% of patients had TTAC >12 weeks. TTAC >12 weeks was associated with inferior OS [hazard ratio (HR) 1.28, 95% CI 1.00-1.62] and CSS (HR 1.30, 95% CI 1.00-1.69). In adjusted analyses, OS and CSS were lower among patients treated with carboplatin compared with those treated with cisplatin; OS HR 2.14 (95% CI 1.40-3.29) and CSS HR 2.06 (95% CI 1.26-3.37). CONCLUSIONS Most patients in the general population receive cisplatin, and this may be associated with superior outcomes to carboplatin. Initiation of ACT beyond 12 weeks is associated with inferior survival. Patients should start ACT as soon as they are medically fit to do so.
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Affiliation(s)
- C M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston; Department of Oncology; Department of Public Health Sciences.
| | - D R Siemens
- Department of Oncology; Department of Urology, Queen's University, Kingston
| | - Y Peng
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston; Department of Public Health Sciences
| | - I F Tannock
- Princess Margaret Cancer Centre, Toronto, Canada
| | - W J Mackillop
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston; Department of Oncology; Department of Public Health Sciences
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Van Allen EM, Mouw KW, Kim P, Iyer G, Wagle N, Al-Ahmadie H, Zhu C, Ostrovnaya I, Kryukov GV, O'Connor KW, Sfakianos J, Garcia-Grossman I, Kim J, Guancial EA, Bambury R, Bahl S, Gupta N, Farlow D, Qu A, Signoretti S, Barletta JA, Reuter V, Boehm J, Lawrence M, Getz G, Kantoff P, Bochner BH, Choueiri TK, Bajorin DF, Solit DB, Gabriel S, D'Andrea A, Garraway LA, Rosenberg JE. Somatic ERCC2 mutations correlate with cisplatin sensitivity in muscle-invasive urothelial carcinoma. Cancer Discov 2014; 4:1140-53. [PMID: 25096233 DOI: 10.1158/2159-8290.cd-14-0623] [Citation(s) in RCA: 441] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED Cisplatin-based chemotherapy is the standard of care for patients with muscle-invasive urothelial carcinoma. Pathologic downstaging to pT0/pTis after neoadjuvant cisplatin-based chemotherapy is associated with improved survival, although molecular determinants of cisplatin response are incompletely understood. We performed whole-exome sequencing on pretreatment tumor and germline DNA from 50 patients with muscle-invasive urothelial carcinoma who received neoadjuvant cisplatin-based chemotherapy followed by cystectomy (25 pT0/pTis "responders," 25 pT2+ "nonresponders") to identify somatic mutations that occurred preferentially in responders. ERCC2, a nucleotide excision repair gene, was the only significantly mutated gene enriched in the cisplatin responders compared with nonresponders (q < 0.01). Expression of representative ERCC2 mutants in an ERCC2-deficient cell line failed to rescue cisplatin and UV sensitivity compared with wild-type ERCC2. The lack of normal ERCC2 function may contribute to cisplatin sensitivity in urothelial cancer, and somatic ERCC2 mutation status may inform cisplatin-containing regimen usage in muscle-invasive urothelial carcinoma. SIGNIFICANCE Somatic ERCC2 mutations correlate with complete response to cisplatin-based chemosensitivity in muscle-invasive urothelial carcinoma, and clinically identified mutations lead to cisplatin sensitivity in vitro. Nucleotide excision repair pathway defects may drive exceptional response to conventional chemotherapy.
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Affiliation(s)
- Eliezer M Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Kent W Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Harvard Radiation Oncology Program, Boston, Massachusetts
| | - Philip Kim
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gopa Iyer
- Weill Cornell Medical College, Cornell University, New York, New York. Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nikhil Wagle
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Hikmat Al-Ahmadie
- Weill Cornell Medical College, Cornell University, New York, New York. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cong Zhu
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Kevin W O'Connor
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - John Sfakianos
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ilana Garcia-Grossman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jaegil Kim
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Elizabeth A Guancial
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, New York
| | - Richard Bambury
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samira Bahl
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Namrata Gupta
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Deborah Farlow
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Angela Qu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victor Reuter
- Weill Cornell Medical College, Cornell University, New York, New York. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jesse Boehm
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | | | - Gad Getz
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Massachusetts General Hospital Cancer Center and Department of Pathology, Boston, Massachusetts
| | - Philip Kantoff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, Cornell University, New York, New York
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Dean F Bajorin
- Weill Cornell Medical College, Cornell University, New York, New York. Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David B Solit
- Weill Cornell Medical College, Cornell University, New York, New York. Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stacey Gabriel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Alan D'Andrea
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Harvard Radiation Oncology Program, Boston, Massachusetts
| | - Levi A Garraway
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
| | - Jonathan E Rosenberg
- Weill Cornell Medical College, Cornell University, New York, New York. Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Affiliation(s)
- Jong Chul Park
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Deborah E. Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Piyush K. Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Yelfimov DA, Frank I, Boorjian SA, Thapa P, Cheville JC, Tollefson MK. Adjuvant chemotherapy is associated with decreased mortality after radical cystectomy for locally advanced bladder cancer. World J Urol 2014; 32:1463-8. [PMID: 24420616 DOI: 10.1007/s00345-014-1236-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/03/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We sought to evaluate the association of adjuvant chemotherapy with the risk of subsequent mortality among patients with locally advanced urothelial carcinoma (UC) of the bladder undergoing radical cystectomy (RC). METHODS We identified 675 patients who underwent RC for pT2-4 and/or N+ UC between 1980 and 2005. Adjuvant chemotherapy was defined as treatment within 90 days of RC. Survival was estimated using the Kaplan-Meier method and compared according to receipt of adjuvant chemotherapy with the log-rank test. Multivariate models were used to analyze the impact of adjuvant chemotherapy on disease progression and survival. RESULTS A total of 80 (12 %) patients received adjuvant chemotherapy. Median age was 69 years [interquartile range (IQR) 63, 76]. Median follow-up was 11 years (IQR 8, 16). Patients receiving adjuvant chemotherapy were more likely to have pT3-4 tumors (71 vs. 61 %; p < 0.001) and pN+ (85 vs. 19 %; p < 0.001). The 5-year cancer-specific survival was 46 % in those receiving adjuvant chemotherapy and 51 % in those that did not (p = 0.63). The 5-year overall survival was 39 % in those receiving adjuvant chemotherapy and 38 % in those that did not (p = 0.24). When controlling for age, sex, stage, and performance status, adjuvant chemotherapy was associated with a 29 % decrease in the risk of bladder cancer death (HR 0.71, p = 0.06) and a 39 % decrease in the risk of all-cause mortality (HR 0.61, p = 0.002). CONCLUSIONS After controlling patient and tumor features, adjuvant chemotherapy was associated with a trend toward reduction in cancer-specific mortality and a statistically significant reduction in all-cause mortality.
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Affiliation(s)
- Daniel A Yelfimov
- Department of Urology, Mayo Medical School and Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA,
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Abstract
Carcinoma of the bladder is the second most prevalent genitourinary malignancy and the fifth most common solid malignancy in the USA. Combination chemotherapy is used in most patients with advanced disease. Traditionally, on the basis of favorable response rates and survival data, cisplatin-based regimens have been the preferred chemotherapy for patients with metastatic bladder cancer. However, the toxicity profile of cisplatin precludes its use in a significant subset of patients with advanced bladder cancer. Conversely, noncisplatin-containing regimens have been shown to have a more favorable toxicity profile and to have activity in advanced bladder cancer. Here, various nonplatinum chemotherapy regimens for advanced disease are reviewed.
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Affiliation(s)
- Sandy Srinivas
- Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305, USA.
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48
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Abstract
Radical cystectomy is a standard treatment for patients with muscle-invasive bladder cancer. The presence of occult micrometastatic disease is responsible for both local and distant failure after radical surgery. Postoperative administration of chemotherapy in bladder cancer patients can theoretically give the same survival advantage demonstrated in patients with breast and colon cancer. Studies evaluating adjuvant chemotherapy in patients with pT3-pT4 and/or pN+ M0 disease have major deficiencies in terms of sample sizes, early stopping of patient entry, statistical analyses, reporting of results and drawing conclusions. A recent meta-analysis including all previously published randomized trials concludes that, currently, there is insufficient evidence to reliably recommend adjuvant chemotherapy. The results of appropriately sized randomized trials are needed before any definitive conclusions can be drawn.
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Affiliation(s)
- Cora N Sternberg
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Nuovi Padiglioni IV Floor, Circonvallazione Gianicolense 87, 00152 Rome, Italy.
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Bruins HM, Stein JP. Risk factors and clinical outcomes of patients with node-positive muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2014; 8:1091-101. [DOI: 10.1586/14737140.8.7.1091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Liew MS, Azad A, Tafreshi A, Eapen R, Bolton D, Davis ID, Sengupta S. USANZ: Time-trends in use and impact on outcomes of perioperative chemotherapy in patients treated with radical cystectomy for urothelial bladder cancer. BJU Int 2013; 112 Suppl 2:74-82. [DOI: 10.1111/bju.12384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mun Sem Liew
- Joint Austin-Ludwig Oncology Unit; Austin Health
- Ludwig Institute for Cancer Research; Austin Health
- University of Melbourne
| | - Arun Azad
- Joint Austin-Ludwig Oncology Unit; Austin Health
- Ludwig Institute for Cancer Research; Austin Health
| | - Ali Tafreshi
- Joint Austin-Ludwig Oncology Unit; Austin Health
| | | | - Damien Bolton
- Department of Urology; Austin Health
- University of Melbourne
| | - Ian D. Davis
- Joint Austin-Ludwig Oncology Unit; Austin Health
- Ludwig Institute for Cancer Research; Austin Health
- Department of Oncology; Eastern Health
- University of Melbourne
- Eastern Health Clinical School; Monash University
| | - Shomik Sengupta
- Ludwig Institute for Cancer Research; Austin Health
- Department of Urology; Austin Health
- University of Melbourne
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