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Ribas A, Bellmunt J, Albanell J, De Torres I, Bermejo B, De Torres JA, Morote J, Gallardo E, Vera R, Carulla J, Sole-Calvo LA. Early Results of the Value of p53 in Predicting Survival in a Homogeneous Cohort of Patients with Invasive Bladder Cancer Treated with a Neoadjuvant Carboplatin-Based Regimen (M-CAVI). TUMORI JOURNAL 2018; 82:554-9. [PMID: 9061063 DOI: 10.1177/030089169608200608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background Several reports on prognostic factors for infiltrating bladder cancer have given controversial results. We assessed the prognostic value of p53 nuclear overexpression together with known prognostic factors for survival in patients with invasive T2-4 NO MO bladder cancer treated with neoadjuvant chemotherapy. Study Design Thirty-five paraffi-nized tumor samples from initial transurethral resection of patients with bladder cancer were analyzed immunohistochemi-cally to detect overexpression of p53 protein. Patients were treated with 3 to 4 cycles of neoadjuvant methotrexate, carboplatin, and vinblastine (M-CAVI) and then underwent radical cystectomy. Prechemotherapy, treatment, and postchemotherapy factors were analyzed for correlation with survival by univariate and multivariate analysis. Fifty-seven percent of tumors were positive for p53 protein, 71.5% had grade III-IV tumors, and 72% had organ-confined disease. The median follow-up was 20 months (range 5-71+). Results By univariate analysis, the significant pretreatment factors were initial tumor (T) stage ( P <0.0001) and the male sex ( P = 0.03). Five postchemotherapy variables were found significant: surgery performed according to protocol ( P = 0.003), overall clinical ( P = 0.004), and overall pathologic ( P = 0.02) response to therapy, postchemotherapy pathologic stage ( P = 0.0002), and tumor status after surgery ( P = 0.0006). By multivariate analysis, the initial prechemotherapy T stage was the only factor that demonstrated independent significance. Conclusions Although the median follow-up of the study is still too short, in this group of patients treated with a neoadjuvant carboplatin-based regimen, a classical variable (prechemotherapy T stage) rather than p53 nuclear overexpression was an independent prognostic factor for survival. Further follow-up will be required to assess the value of p53 overexpression as a prognostic factor in invasive bladder cancer patients treated with neoadjuvant carboplatin-based chemotherapy.
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Affiliation(s)
- A Ribas
- Medical Oncology Section, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
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2
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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 62-year-old man with a 45 pack per year tobacco-smoking history presented with painless gross hematuria in the fall of 2015 and was ultimately diagnosed with muscle-invasive urothelial bladder cancer. He received four cycles of cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy with pelvic lymph node dissection, which disclosed residual high-grade muscle-invasive urothelial cancer extending to the perivesical fat and involving two of 20 pelvic lymph nodes (pT3N2). Six months later, surveillance imaging identified new retroperitoneal lymphadenopathy and a large right pelvic mass with possible rectal wall invasion consistent with locally recurrent and metastatic urothelial cancer. Although feeling generally well, he reported having had progressive constipation, pelvic pressure, and narrow-caliber stools for 2 months. He was seen in consultation for management of recurrent bladder cancer.
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3
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Balar AV, Milowsky MI. Cytotoxic and DNA-targeted therapy in urothelial cancer: have we squeezed the lemon enough? Cancer 2014; 121:179-87. [PMID: 25091501 DOI: 10.1002/cncr.28754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/19/2014] [Accepted: 04/07/2014] [Indexed: 11/08/2022]
Abstract
Urothelial cancer has long been known as a chemotherapy-sensitive disease. However, clinical trial data to date suggest a plateau to the magnitude of benefit from cytotoxic therapy alone. In spite of level 1 evidence supporting cisplatin-based chemotherapy for patients with muscle-invasive and metastatic urothelial cancer, underuse prevails among patients with localized disease and only a modest survival benefit exists in the metastatic setting, although trials have consistently demonstrated that there is a subset of patients who clearly benefit. Recent comprehensive genomic profiling has identified a high prevalence of actionable genomic alterations as well as other potential targets yet to be fully understood. Modern clinical trials must now focus on identifying predictive biomarkers to select those patients who will benefit most from cytotoxic chemotherapy, molecularly targeted therapy, or potentially both.
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Affiliation(s)
- Arjun V Balar
- Genitourinary Cancers Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
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4
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Editorial comment. Int Urol Nephrol 2009; 41:877-9. [PMID: 19449116 DOI: 10.1007/s11255-009-9582-5] [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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5
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Solsona E, Climent MA, Iborra I, Collado A, Rubio J, Ricós JV, Casanova J, Calatrava A, Monrós JL. Bladder preservation in selected patients with muscle-invasive bladder cancer by complete transurethral resection of the bladder plus systemic chemotherapy: long-term follow-up of a phase 2 nonrandomized comparative trial with radical cystectomy. Eur Urol 2008; 55:911-9. [PMID: 18722046 DOI: 10.1016/j.eururo.2008.08.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 08/06/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many phase 2 bladder-sparing programmes using transurethral resection of the bladder (TURB) plus chemotherapy or radio-chemotherapy have been undertaken, but some controversies remain. OBJECTIVE To determine the efficacy of complete TURB plus three cycles of cisplatin-based chemotherapy in selected patients with muscle-invasive bladder cancer (MIBC). DESIGN, SETTING, AND PARTICIPANTS A phase 2 nonrandomized trial was designed that included patients with MIBC who underwent complete TURB with positive biopsies of the tumour bed. Patients with negative biopsies of the tumour bed, with macroscopically residual tumour, with hydronephrosis, or with distant metastasis were excluded from this trial. Patients included in this trial were offered three cycles of systemic chemotherapy or radical cystectomy (RC). Clinical response (cR) was denoted by either no tumour or the presence of Ta1-Tis bladder tumour at 3-mo evaluation; clinical non-response (cNR) was denoted by cases of muscle-invasive tumour or distant metastasis. Of 146 patients who entered this trial, 75 choose the bladder-sparing programme and 71 chose RC. MEASUREMENTS At 5 yr and 10 yr, the cancer-specific survival (CSS) rate was 64.5% and 59.8%, respectively, with no significant difference compared to the RC arm (p=0.544). The progression-free survival with bladder preserved was 52.6% and 34.5%, respectively. In multivariate analysis, cR was the only predictive factor for survival (p=0.001) and bladder preservation (p=0.000). RESULTS AND LIMITATIONS This was not a randomized trial, and patients were included over 16 yr. However, no modifications were made to the therapy schedule except from chemotherapy schemes considered standard at the time. CONCLUSIONS Patients with microscopic residual cancer after complete TURB seem to be good candidates for the bladder-sparing programme using three cycles of systemic chemotherapy, with CSS comparable to RC.
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Affiliation(s)
- Eduardo Solsona
- Urology, Instituto Valenciano de Oncología, Valencia, Spain.
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6
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Re: The Role of Squamous Differentiation in Patients with Transitional Cell Carcinoma of the Bladder Treated with Radical Cystectomy. Eur Urol 2008; 53:209. [DOI: 10.1016/j.eururo.2007.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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7
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Sternberg CN, Pansadoro V. Muscle-invasive transitional cell carcinoma of the bladder: strategies for bladder preservation. Curr Opin Urol 2006; 8:431-5. [PMID: 17039025 DOI: 10.1097/00042307-199809000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For patients with invasive bladder cancer, radical cystectomy remains the gold standard of treatment. However, based upon success with combination chemotherapy, physicians have begun to use this modality in an integrated approach with radiotherapy. This approach is of interest for elderly patients with poor medical conditions and for younger patients who may prefer to retain their bladders. Thorough transurethral resection of the bladder followed by chemotherapy with or without radiotherapy has become the focus of several studies. Bladder-conserving therapy may be offered to selected patients with invasive bladder cancer as a viable alternative to radical cystectomy.
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8
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Abstract
The 30-45% failure rate after radical cystoprostatectomy mandates that we explore and optimize multimodal therapy to achieve better disease control in these patients. Cisplatin-based multi-agent combination chemotherapy has been used with success in metastatic disease and has therefore also been introduced in patients with high-risk but non-metastatic bladder cancer. There is now convincing evidence that chemotherapy given pre-operatively can improve survival in these patients. In this review we establish the need for peri-operative chemotherapy in bladder cancer patients and summarize the evidence for the efficacy of neoadjuvant chemotherapy. The advantages and disadvantages of neoadjuvant versus adjuvant chemotherapy are discussed, and the main shortcomings of both--treatment-related toxicity and the inability to prospectively identify likely responders--are presented. Finally, a risk-adapted approach to neoadjuvant chemotherapy is presented, whereby the highest risk patients are offered treatment while those unlikely to benefit are spared the treatment-related toxicity.
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Affiliation(s)
- Peter C Black
- Department of Urology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1373, Houston, TX 77030, USA
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9
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Abstract
The role of neoadjuvant chemotherapy in muscle-invasive bladder cancer has been clarified by recent randomized studies and meta-analyses, which all showed that cisplatin-based, combination chemotherapy offers a significant survival advantage. Preoperative chemotherapy results in downstaging in a significant percentage of patients, which is an independent factor of favorable prognosis. Nevertheless, the optimal sequence of perioperative chemotherapy remains undefined. The authors examine the results of large Phase II and randomized studies as well as the role of neoadjuvant chemotherapy in the context of bladder preservation strategies. Finally, issues of improving therapeutic efficacy and directing clinical research are discussed.
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Affiliation(s)
- Aristotle Bamias
- Department of Clinical Therapeutics, Medical School, University of Athens, Haidari, 124 62 Athens, Greece.
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10
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Bamias A, Deliveliotis C, Karayiannis A, Varkarakis I, Zervas I, Pantazopoulos D, Gika D, Dimopoulos MA. Neoadjuvant Chemotherapy with Docetaxel and Cisplatin in Patients with High-Risk Resectable Bladder Carcinoma: Long Term Results. Eur Urol 2004; 46:344-50; discussion 350-1. [PMID: 15306106 DOI: 10.1016/j.eururo.2004.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Neoadjuvant chemotherapy has been used to improve outcome after cystectomy or for selection for bladder preservation in patients with bladder cancer. We have shown encouraging results using docetaxel and cisplatin in patients with advanced urothelial cancer. We are reporting the results of a phase II study using this combination as neoadjuvant treatment in patients with muscle invasive bladder cancer. METHODS Fifty patients were treated with docetaxel and cisplatin at 75 mg/m2 every 3 weeks for 3 cycles prior to cystectomy. Median follow-up was 70.2 months. RESULTS Chemotherapy was well tolerated. 5-year survival and progression-free survival (PFS) were 51.92% (95% confidence intervals [CI]: 37.76-66.08) and 52.47% (95%CI: 37.99-66.95). Multivariate analysis showed that clinical stage (cT) < or = 3a was associated with improved 5-year survival (86.42% vs. 40.81%, p = 0.027). Forty one patients underwent cystectomy. No tumor was found in 15 cases (36.6%). 5-year survival was 60.34% (95%CI: 52.2-68.48) and PFS was 57.11% (95%CI: 41.29-72.93). Absence of residual tumor was associated with improved 5-year survival (93.33% vs. 40.72%, p = 0.031). CONCLUSIONS Neoadjuvant chemotherapy with docetaxel and cisplatin is feasible and produced high pathological complete remission rate and excellent outcome in patients with no residual tumor.
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Affiliation(s)
- A Bamias
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Greece.
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11
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Sternberg CN, Pansadoro V, Calabrò F, Schnetzer S, Giannarelli D, Emiliozzi P, De Paula F, Scarpone P, De Carli P, Pizzo M, Platania A, Amini M. Can patient selection for bladder preservation be based on response to chemotherapy? Cancer 2003; 97:1644-52. [PMID: 12655521 DOI: 10.1002/cncr.11232] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy for patients with muscle-invasive bladder carcinoma is given to treat micrometastases and to preserve the bladder. The objective of this study was to evaluate the possibility of bladder preservation in patients with muscle-invasive bladder carcinoma who were treated with neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) chemotherapy. METHODS One hundred four consecutive patients with T2-T4,N0,M0 transitional cell carcinoma of the bladder were treated with 3 cycles of neoadjuvant M-VAC chemotherapy. After clinical restaging, 52 patients underwent transurethral resection of the bladder (TURB) alone, 13 patients underwent partial cystectomy, and 39 patients underwent radical cystectomy. RESULTS The median survival for the entire group was 7.49 years (95% confidence interval, 4.86-10.0 years). Forty-nine patients (49%) were T0 at the time of TURB after receiving M-VAC. Thirty-one of 52 patients (60%) who received chemotherapy and underwent TURB alone were alive at a median follow-up of 56 + months (range, 10-160 + months): Twenty-three patients (44%) in that TURB group maintained an intact bladder. Of 13 responding patients with monofocal lesions who underwent partial cystectomy, only 1 patient required salvage cystectomy, and survival generally was good. The 5-year survival rate for this group was 69%. With a long median follow-up of 88 + months (range, 16-158 months), 4 patients (31%) were alive with a functioning bladder. In the radical cystectomy group, the median follow-up was 45 months (range, 4-172 + months), and 15 of 39 patients (38%) patients remained alive. In 77 patients who had their tumors down-staged to T0 or superficial disease, the median follow-up was 63 months (range, 4-172 + months), and the 5-year rate survival was 69%. This is in contrast to a 5-year survival rate of only 26% in 27 patients who failed to respond and had a status >/= T2 after receiving chemotherapy (median follow-up, 31 months; range, 7-156 + months). The median survival for 27 elderly patients (age >/= 70 years; median age, 73 years; range, 70-82 years) was 90 months (7.5 years). For elderly patients who underwent TURB and partial cystectomy, the 5-year survival rate was 67% with a 109-month (9-year) median survival; 47% of patients preserved their bladders intact. The median follow-up of the living elderly patients was 61 months (range, 20-120 + months). CONCLUSIONS Bladder sparing in selected patients on the basis of response to neoadjuvant chemotherapy is a feasible approach that should be confirmed in prospective, randomized trials. Selected elderly patients are candidates for this approach.
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12
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Sternberg CN. Neo-adjuvant and adjuvant chemotherapy of bladder cancer: Is there a role? Ann Oncol 2003; 13 Suppl 4:273-9. [PMID: 12401701 DOI: 10.1093/annonc/mdf670] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C N Sternberg
- Medical Oncology, Vincenzo Pansadoro Foundation, Clinic Pio XI, Rome, Italy
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13
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Fuwa N, Kodaira T, Kamata M, Matsumoto A, Furutani K, Tachibana H, Ito Y. Phase I study of combination chemotherapy with 5-fluorouracil (5-FU) and nedaplatin (NDP): adverse effects and eecommended dose of NDP administered after 5-FU. Am J Clin Oncol 2002; 25:565-9. [PMID: 12477999 DOI: 10.1097/00000421-200212000-00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
When nedaplatin (NDP) was used as a single agent in the phase I study, the dose-limiting toxicity (DLT) was thrombocytopenia and the recommended dose (RD) was 100 mg/m2. However, the DLT, maximum tolerated dose (MTD) and RD of NDP used in combination with 5-fluorouracil remained unknown. Therefore, we performed this study to assess the DLT and RD of NDP administered after 5-fluorouracil (5-FU). In this study, 5-FU was administered to 38 patients at a fixed dose (700 mg/m2/d on days 1-5) and NDP administered on day 6 at an initial dose of 80 mg/m2, which was subsequently increased to 100, 120, 130, 140, 150, and 160 mg/m2. The DLT of NDP was leukopenia and its MTD and RD were 160 and 150 mg/m2, respectively. Concerning impairment of renal function, only two patients had a grade I increase in serum creatinine. There were 19 responders (50%, 19/38) achieving partial response or complete response in the evaluation of antitumor effect. The result of this study is notable in that administration of 5-FU before NDP allows the dose of NDP to be substantially increased.
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Affiliation(s)
- Nobukazu Fuwa
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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14
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Abstract
Muscle-infiltrating bladder cancer should be dealt with in a multimodality approach with collaboration between the urologist, medical oncologist and radiotherapist. Neo-adjuvant chemotherapy has not been proven to improve survival, but may be useful in programs of bladder preservation. Response to M-VAC neo-adjuvant chemotherapy is an important prognostic factor, but may represent patient selection factors. It is not known whether it is better to administer chemotherapy in the neo-adjuvant or in the adjuvant setting, that may spare some patients unnecessary chemotherapy. The international adjuvant chemotherapy trial coordinated by the EORTC (protocol 30994) will hopefully clarify some of the unanswered questions concerning whether or not adjuvant chemotherapy immediately following cystectomy improves survival.
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Affiliation(s)
- C N Sternberg
- Vincenzo Pansadoro Foundation, Clinic Pio XI, Via Aurelia 559, 00165, Rome, Italy.
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15
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Pavone-Macaluso M, Hall RR, Hirao Y, Kamidono S, Miyanaga N, de Mulder PH, Naito S, Shipley WU, Tsushima T. The role of neoadjuvant or adjuvant chemotherapy for invasive bladder cancer Is there a benefit for survival or preserving the bladder? Urol Oncol 1998; 4:154-67. [PMID: 21227221 DOI: 10.1016/s1078-1439(99)00010-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/1999] [Indexed: 10/18/2022]
Affiliation(s)
- M Pavone-Macaluso
- Universita di Palermo, Department of Urology, via Villa Trabia 9, 90141, Palermo, Italy
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16
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SERRETTA VINCENZO, LO GRECO GIOVANNI, PAVONE CARLO, PAVONE-MACALUSO MICHELE. THE FATE OF PATIENTS WITH LOCALLY ADVANCED BLADDER CANCER TREATED CONSERVATIVELY WITH NEOADJUVANT CHEMOTHERAPY, EXTENSIVE TRANSURETHRAL RESECTION AND RADIOTHERAPY: 10-YEAR EXPERIENCE. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63549-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- VINCENZO SERRETTA
- Department of Urology, Civic Hospital Benfratelli, Department of Radiotherapy, Oncology Hospital M. Ascoli and Institute of Urology, University of Palermo, Palermo, Italy
| | - GIOVANNI LO GRECO
- Department of Urology, Civic Hospital Benfratelli, Department of Radiotherapy, Oncology Hospital M. Ascoli and Institute of Urology, University of Palermo, Palermo, Italy
| | - CARLO PAVONE
- Department of Urology, Civic Hospital Benfratelli, Department of Radiotherapy, Oncology Hospital M. Ascoli and Institute of Urology, University of Palermo, Palermo, Italy
| | - MICHELE PAVONE-MACALUSO
- Department of Urology, Civic Hospital Benfratelli, Department of Radiotherapy, Oncology Hospital M. Ascoli and Institute of Urology, University of Palermo, Palermo, Italy
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17
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THE FATE OF PATIENTS WITH LOCALLY ADVANCED BLADDER CANCER TREATED CONSERVATIVELY WITH NEOADJUVANT CHEMOTHERAPY, EXTENSIVE TRANSURETHRAL RESECTION AND RADIOTHERAPY. J Urol 1998. [DOI: 10.1097/00005392-199804000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Serretta V, Corselli G, Piazza F, Ingargiola G, Greco GL, Pavone C, Pavone-Macaluso M. Neoadjuvant chemotherapy, TUR and radiotherapy in T2-T4 NO MO bladder carcinoma. Urologia 1997. [DOI: 10.1177/039156039706400409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
– Forty patients affected by locally advanced carcinoma of the bladder were submitted to up-front chemotherapy followed by TUR and radiotherapy. A complete response was obtained in 27 patients (67.5%). A residual mass was present in 13 (32.5%) patients. At a mean follow-up of 38 months (range: 18–112 months), 7 patients showed a recurrence that was superficial in 3 cases and infiltrating the muscular layer in 4. Fifteen patients (37.5%), 12 of whom disease-free, are alive with a mean survival of 65 months. Five more patients died of non-related disease.
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Affiliation(s)
- V. Serretta
- Divisione Urologica - Ospedale Civico - Palermo
| | - G. Corselli
- Istituto di Materie Urologiche - Università di Palermo
| | - F. Piazza
- Istituto di Materie Urologiche - Università di Palermo
| | | | - G. Lo Greco
- Divisione di Radioterapia - Centro Tumori - Palermo
| | - C. Pavone
- Istituto di Materie Urologiche - Università di Palermo
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19
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Primary Cisplatin, Methotrexate and Vinblastine Aiming at Bladder Preservation in Invasive Bladder Cancer. J Urol 1996. [DOI: 10.1097/00005392-199606000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Angulo JC, Sanchez-Chapado M, Lopez JI, Flores N. Primary Cisplatin, Methotrexate and Vinblastine Aiming at Bladder Preservation in Invasive Bladder Cancer: Multivariate Analysis on Prognostic Factors. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66041-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Javier C. Angulo
- From the Departments of Urology and Pathology, Hospital de Basurto, Bilbao, Universidad del Pais Vasco and Universidad de Alcala de Henares, Madrid, Spain
| | - Manuel Sanchez-Chapado
- From the Departments of Urology and Pathology, Hospital de Basurto, Bilbao, Universidad del Pais Vasco and Universidad de Alcala de Henares, Madrid, Spain
| | - Jose I. Lopez
- From the Departments of Urology and Pathology, Hospital de Basurto, Bilbao, Universidad del Pais Vasco and Universidad de Alcala de Henares, Madrid, Spain
| | - Nicolas Flores
- From the Departments of Urology and Pathology, Hospital de Basurto, Bilbao, Universidad del Pais Vasco and Universidad de Alcala de Henares, Madrid, Spain
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21
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Splinter TA, Pavone-Macaluso M, Jacqmin D, Roberts JT, Carpentier P, de Pauw M, Sahmoud T. Genitourinary group phase II study of chemotherapy in stage T3-4 N0-X M0 transitional cell cancer of the bladder: prognostic factor analysis. Eur J Cancer 1996; 32A:1129-34. [PMID: 8758242 DOI: 10.1016/0959-8049(96)00012-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to examine prognostic factors for survival of patients with invasive bladder cancer who had received neoadjuvant chemotherapy followed by further treatment. From 1986 to 1990, 149 eligible patients with T3-4 N0-X M0 bladder cancer were entered into a phase II trial of neoadjuvant chemotherapy, consisting of cisplatin and methotrexate. Patients received two or four courses of chemotherapy, depending on the absence or presence, respectively, of a major clinical response after two courses. 136 patients were evaluable for clinical response after two courses of chemotherapy, and 75 patients were evaluable for pathological response after two or four courses. A multivariate analysis, based on pretreatment variables and the post-treatment variables, clinical response and pathological response, showed that performance status, tumour size and clinical response after two courses of chemotherapy were the only independent prognostic factors for all eligible patients. A second multivariate analysis in the selected subgroup of patients, who underwent a cystectomy, showed that the G-cagetory and pathological response were the only independent prognostic factors. In conclusion, in this group of patients, the response to chemotherapy was a strong and independent prognostic factor in addition to other independent variables. However, it was not accurate or strong enough to allow an impact on the choice of locoregional therapy.
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Affiliation(s)
- T A Splinter
- Department of Medical Oncology, University Hospital Dijkzigt, Rotterdam, Netherlands
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22
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Sternberg CN, Raghaven D, Ohi Y, Bajorin D, Herr H, Kato T, Kuroda M, Logothetis CH, Scher H, Splinter TA. Neoadjuvant and adjuvant chemotherapy in advanced disease--what are the effects on survival and prognosis? Int J Urol 1995; 2 Suppl 2:76-88. [PMID: 7553308 DOI: 10.1111/j.1442-2042.1995.tb00482.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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23
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Sternberg CN, Pansadoro V, Lauretti S, Platania A, Giannarelli D, Rossetti A, De Carli P, Arena MG, Cancrini A. Neoadjuvant M-VAC (methotrexate, vinblastine, adriamycin, and cisplatin) chemotherapy and bladder preservation for muscle-infiltrating transitional cell carcinoma of the bladder. Urol Oncol 1995; 1:127-33. [DOI: 10.1016/1078-1439(95)00025-d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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Sternberg CN. Bladder preservation--a prospect for patients with urinary bladder cancer. Acta Oncol 1995; 34:589-97; discusion 588. [PMID: 7546823 DOI: 10.3109/02841869509094033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C N Sternberg
- San Raffaele Hospital, Department of Medical Oncology, Rome, Italy
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Bosl GJ, Fair WR, Herr HW, Bajorin DF, Dalbagni G, Sarkis AS, Reuter VE, Cordon-Cardo C, Sheinfeld J, Scher HI. Bladder cancer: advances in biology and treatment. Crit Rev Oncol Hematol 1994; 16:33-70. [PMID: 8074800 DOI: 10.1016/1040-8428(94)90041-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Integrating systemic chemotherapy in the treatment of patients with invasive bladder cancer is essential to improve survival because the majority of deaths are from systemic relapse. However, as experience with invasive tumors evolves, it is clear that treatment recommendations need to be tailored to an individual patient based on metastatic risk and, ideally, sensitivity to treatment. For those with tumors that do not extend through the bladder wall, standard therapy remains radical surgery. Nevertheless, encouraging results are being reported with increasing frequency using strategies designed to preserve bladder function through a variety of means. Crucial to the recommendation of a specific approach for an individual is improving our ability to define prognosis prior to initiating treatment. Patients with a high risk of systemic recurrence generally require chemotherapy, although the optimal route of integration, pre vs. post-operatively, remains controversial. In those patients who require it, chemotherapy can be administered more safely with the concomitant administration of hematopoietic growth factors. These factors alone, however, are unlikely to improve overall survival. Crucial to the latter effort will be the identification of more active agents, improving our understanding of intrinsic and acquired resistance to chemotherapy, and better delivery of the chemotherapeutic agents currently available. Of equal importance, is the enrollment of patients in clinical trials. These can include large scale randomized comparisons with using a survival end-point, as well as new therapies in high risk populations. The latter would include patients with advanced T3b, T4 and N+ disease, with a high risk of metastatic failure, and low complete response proportions to presently available regimens.
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Affiliation(s)
- G J Bosl
- Division of Solid Tumor Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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