Recent advances in bladder cancer chemotherapy

Gender, Bladder Cancer Healthcare and Burden of COVID-19

Bladder cancer as one of the main comorbid diseases might be more susceptible to develop COVID-19 infection with a higher mortality risk during the COVID-19 pandemic. The European Association of Urology (EAU) recommended a comprehensive panel for bladder cancer diagnosis and treatment during this global health problem. The urgent need for treatments of COVID-19 during the pandemic has persuaded researchers to evaluate the different medications, which may lead to drug shortages. Therefore, in this review paper, we have focused on the least recommendations of EAU about bladder cancer during of COVID-19 pandemic to provide a comprehensive panel for high-risk patients.

Role of systemic peri-operative chemotherapy in management of transitional cell carcinoma of bladder

Bladder cancer has variable biological behavior pattern in different individuals and the debate regarding peri-operative use of systemic chemotherapy with the surgical management remains. The optimal treatment strategy, regimen and the timing of peri-operative chemotherapy are not yet known. Here we review the existing literature for the use of systemic peri-operative chemotherapy in management of advanced bladder cancer.

Chemosensitization of gemcitabine-resistant human bladder cancer cell line both in vitro and in vivo using antisense oligonucleotide targeting the anti-apoptotic gene, clusterin

OBJECTIVE

To characterize changes in clusterin (sCLU-2) expression in bladder cancer cells after continuous treatment with gemcitabine and to determine whether knockdown of sCLU-2 can re-introduce sensitivity of gemcitabine-resistant cells to treatment with gemcitabine.

MATERIALS AND METHODS

A human bladder cancer cell line, UM-UC-3, was continuously exposed to increasing doses of gemcitabine in vitro, and a gemcitabine-resistant cell line UM-UC-3R was developed. The role of sCLU-2 in chemoresistant phenotype acquired in both in vitro and in vivo was then analysed using antisense oligonucleotide targeting the sCLU-2 gene (OGX-011).

RESULTS

Treatment of parental UM-UC-3 cells (UM-UC-3P) with gemcitabine induced transient up-regulation of sCLU-2 protein. There was a sustained increase in sCLU-2 expression levels in UM-UC-3R compared with UM-UC-3P cells (6.4-fold). Treatment of UM-UC-3R cells with OGX-011 resulted in a dose-dependent and sequence- specific inhibition in sCLU-2 expression. Furthermore, OGX-011 chemo-sensitized UM-UC-3R cells to gemcitabine in vitro with a reduction in the concentration that reduces the effect by 50% (IC50) from 100 nm to 10 nm. Tumour volume and the incidence of metastasis in nude mice injected with UM-UC-3R cells was significantly greater than those of nude mice injected with UM-UC-3P cells; however, systemic administration of OGX-011 plus a low dose of gemcitabine significantly suppressed tumour volume and the incidence of metastasis in both groups.

CONCLUSION

These findings suggest that sCLU-2 plays a significant role in the acquisition of chemoresistant phenotype in bladder cancer cells and the knockdown of sCLU-2 using OGX-011 combined with a chemotherapeutic agent could be an attractive approach for advanced bladder cancer through the enhancement of chemosensitivity.

Therapeutic efficacy of adenoviral-mediated p53 gene transfer is synergistically enhanced by combined use of antisense oligodeoxynucleotide targeting clusterin gene in a human bladder cancer model

To establish a more effective therapeutic strategy against advanced bladder cancer, we investigated the effects of combined treatment with antisense (AS) oligodeoxynucleotide (ODN) targeting the anti-apoptotic gene clusterin and adenoviral-mediated p53 gene transfer (Ad5CMV-p53) using the human bladder cancer KoTCC-1 model. Clusterin expression in KoTCC-1 cells was highly upregulated by Ad5CMV-p53 treatment; however, AS clusterin ODN treatment further suppressed clusterin expression in KoTCC-1 cells after Ad5CMV-p53 treatment. AS clusterin ODN treatment synergistically enhanced the cytotoxic effect of Ad5CMV-p53, and DNA fragmentation characteristic of apoptosis was observed only after combined treatment with AS clusterin ODN and Ad5CMV-p53, but not after treatment with either agent alone. Administration of AS clusterin ODN and Ad5CMV-p53 into nude mice resulted in a significant inhibition of KoTCC-1 tumor growth as well as lymph node metastases compared to administration of either agent alone. Furthermore, combined treatment with AS clusterin ODN, Ad5CMV-p53, and cisplatin completely eradicated KoTCC-1 tumors and lymph node metastases in 60% and 100% of mice, respectively. These findings suggest that combined treatment with AS clusterin ODN and Ad5CMV-p53 could be a novel strategy to inhibit bladder cancer progression, and that further additional use of a chemotherapeutic agent may substantially enhance the efficacy of this combined regimen.

Quantitative detection of cytokeratin 20 mRNA expression in bladder carcinoma by real-time reverse transcriptase-polymerase chain reaction

OBJECTIVES

To determine cytokeratin 20 (CK 20) expression in tumor tissue, normal urothelial tissue, bladder washings, and urine from patients with urothelial carcinoma by real-time reverse transcriptase-polymerase chain reaction using the LightCycler Instrument.

METHODS

Urine, bladder washings, tumor, and normal urothelial tissue were obtained from 33 patients with bladder carcinoma. RNA was subsequently extracted. Twenty tissue samples from healthy volunteers were used as controls. Real-time reverse transcriptase-polymerase chain reaction with the LightCycler was performed using fluorescence-labeled CK 20 primers as the target gene and the porphobilinogen deaminase housekeeping gene as the internal standard.

RESULTS

CK 20 mRNA expression was detected in all samples investigated. CK 20 expression in the tissue and urine samples from patients with tumor was significantly increased compared with that in normal urothelial tissue (P = 0.028) or urine from the negative control group (P = 0.012). The average CK 20 expression was 70,140 arbitrary units (AU) in tumor tissue (30,533 AU in urine from patients with tumor) and 8460 AU in normal urothelial tissue (2234 AU in normal urine). A stage-related difference in CK 20 mRNA expression was observed in tumor tissue (P = 0.027) and for tumor grade G1-G2 versus G3 (P = 0.03).

CONCLUSIONS

CK 20 mRNA expression levels in tissue and urine were elevated in patients with urothelial carcinoma compared with the levels in healthy individuals. CK 20 expression was also detectable in normal urine or normal urothelial tissue, but at significantly lower levels than in tumor samples. Fluorescence-labeled quantitative polymerase chain reaction using the LightCycler helped to differentiate between low-level CK 20 expression in normal urothelial tissue and the levels in tumor tissue samples. CK 20 might be an excellent and sensitive marker for tumor monitoring and routine follow-up in patients with transitional cell carcinoma.

Enhanced chemosensitivity of bladder cancer cells to cisplatin by suppression of clusterin in vitro

We examined the functional role of clusterin in chemotherapy-induced apoptosis and tested whether anti-sense transfection targeted against clusterin enhances the chemosensitivity in human bladder cancer cells in vitro. Clusterin mRNA and protein expression of 253J cells, a human bladder carcinoma cell line, after treatment with cisplatin were measured by RT-PCR and Western blot analysis. Clusterin expression and cell growth were compared between 253J cells transfected with constructed a clusterin anti-sense plasmid vector (pCR-CLU-AS) and controls. Tumor cell viability was measured with MTT assay after cisplatin treatment. DNA fragmentation and CPP32 assay were performed. Clusterin expression was increased after treatment with cisplatin and highest at 8 h in 253J cells. Clusterin anti-sense transfectants were highly sensitive to apoptotic cell death induced by cisplatin compared with parental 253J cells or control transfectants. Collectively, our results showed that expression of clusterin was increased in the acute phase of cell death caused by cisplatin and that suppressing the expression of clusterin enhanced the susceptibility of apoptosis caused by cisplatin in human bladder cancer cells. These results suggest that lowering the expression of clusterin might increase the sensitivity of bladder cancer cells to chemotherapeutic agents.

Over expression of CD44V8-10 in human bladder cancer cells decreases their interaction with hyaluronic acid and potentiates their malignant progression

PURPOSE

We evaluated the effects of the over expression of CD44v8-10, one of the high molecular form of CD44, on the malignant potential of UM-UC-3 human bladder cancer cells in vitro and in vivo.

MATERIALS AND METHODS

We introduced CD44v8-10 complementary DNA into UM-UC-3 cells, which do not express detectable level of CD44v8-10 protein, and generated the CD44v8-10 over expressing cell line UM-UC-3/v8-10 and the vector only transfected cell line UM-UC-3/C. The effects of the introduction of CD44v8-10 into UM-UC-3 cells on the ability to bind hyaluronic acid (HA) were analyzed by the cell adhesion assay and the cell migration assay. We then evaluated tumor progression of UM-UC-3 sublines after subcutaneous and orthotopic injection into athymic nude mice.

RESULTS

There were no significant differences in in vitro growth rates. UM-UC-3/v8-10 cells showed significantly decreased binding and migration ability to HA but not to other extracellular matrix proteins. Furthermore, UM-UC-3/v8-10 cells demonstrated significantly increased tumor growth after subcutaneous as well as orthotopic injection into athymic nude mice and enhanced lymph node metastasis after orthotopic injection compared with UM-UC-3/C cells.

CONCLUSIONS

These findings suggest that CD44v8-10 over expression in human bladder cancer cells decreases their interaction with HA and potentiates their malignant progression.

Phase II trial of gemcitabine and docetaxel in patients with advanced carcinoma of the urothelium: a trial of the Eastern Cooperative Oncology Group

BACKGROUND

Gemcitabine and docetaxel are active agents in advanced urothelial carcinoma. A Phase II trial of this combination was performed to determine the activity and toxicity of these agents in a multiinstitutional setting in patients previously treated with one prior chemotherapy regimen.

METHODS

Twenty-nine eligible patients with advanced urothelial carcinoma were treated with docetaxel at a dose of 40 mg/m(2) over 1 hour followed by gemcitabine, 800 mg/m(2), over 30 minutes, both intravenously (i.v.) on Days 1 and 8. Cycles were repeated every 21 days until disease progression or a maximum of 6 cycles.

RESULTS

Five patients obtained an objective response for an overall response rate of 17% (90% confidence interval, 7-33%). One patient achieved a complete clinical response. The median overall survival of the group was 7.7 months. Toxicity was moderate with granulocytopenia, anorexia, and fatigue being the most commonly noted side effects.

CONCLUSIONS

Gemcitabine and docetaxel is an active second-line combination in patients with advanced urothelial carcinoma. Responses in visceral, lymph node, and soft tissues sites were observed. Granulocytopenia without fever, fatigue, and anorexia was common. Thromboembolic symptoms were reported and are of concern. The combination of gemcitabine and docetaxel has the potential to palliate a subset of previously treated patients with an adequate performance status.

Locally advanced and metastatic bladder cancer

Metastatic transitional cell carcinoma of the bladder is an aggressive neoplasm characterized by rapid growth and dissemination with a median survival of typically less than 1 year. Despite the availability of a myriad of antineoplastics with moderate-significant anti-tumor activity yielding overall response rates in the 40% to 80% range, randomized trials continue to demonstrate median survival rates in the 13- to14-month range, with very limited long-term survival. Subsets of patients with advanced bladder cancer present additional management problems, including those with renal insufficiency or nontransitional-cell histology. Various observers have noted the similarity in treatment outcomes in advanced bladder cancer and extensive small cell lung cancer where chemotherapy produces relatively high response rates but with limited impact on survival. The optimal chemotherapy combination for patients with advanced bladder cancer remains undefined, however, there is increasing recognition that in order to achieve tangible improvements in complete response rates and survival in this disease will likely require a combination of chemotherapy and targeted molecular therapies and in some settings adjunctive surgery.