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Asakawa K, Waratani M, Massey O, Holbrook T, Kondo M, Saito A, Nishiyama H. Real-world epidemiology and treatment patterns of patients with locally advanced or metastatic urothelial carcinoma: Retrospective analysis of Diagnosis Procedure Combination claims data in Japan. Int J Urol 2024; 31:730-738. [PMID: 38468564 DOI: 10.1111/iju.15450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Evaluate real-world epidemiologic trends and treatment patterns in newly diagnosed patients with locally advanced or metastatic urothelial carcinoma (la/mUC) in Japan. METHODS This retrospective analysis included adults with newly diagnosed la/mUC in Japan (January 2015-December 2019) from a nationwide-linked electronic medical record Diagnostic Procedure Combination claims dataset. Outcomes included epidemiologic trends (incidence and prevalence), baseline demographics, clinical characteristics, and treatment patterns in newly diagnosed patients with la/mUC before (2015-2017) and after (2018-2019) approval of pembrolizumab in Japan. RESULTS Of 975 patients included, 76.4% were men; 71.6% were aged 70 years or older. Most cases (70.5%) were of the bladder. Between 2015 and 2019, the annual age-adjusted incidence increased from 6.8 to 12.4 per 100 000; the annual age-adjusted period prevalence increased from 13.0 to 25.2 per 100 000; and 307 (31.5%) and 668 (68.5%) patients were diagnosed from 2015 to 2017 and 2018 to 2019, respectively. Overall, 731 (75%) patients received systemic anticancer therapy; all received 1 line and 50.2% received 2 lines of therapy; 78.3% of patients received gemcitabine plus platinum-based therapy and 2.2% received pembrolizumab as first-line treatment. First-line treatment rates increased from 69.4% to 77.5% after pembrolizumab approval. Of 367 patients who received second-line treatment, 22.3% received gemcitabine plus platinum-based therapy; 14.7% received pembrolizumab. CONCLUSIONS In the Japanese regions considered, incidence and prevalence of newly diagnosed la/mUC increased over time and first-line treatment with pembrolizumab increased after approval.
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Affiliation(s)
- Keiko Asakawa
- Department of Global Medical Affairs Japan, Astellas Pharma, Inc., Tokyo, Japan
| | - Miina Waratani
- Department of Global Medical Affairs Japan, Astellas Pharma, Inc., Tokyo, Japan
| | - Olivia Massey
- Secondary Data Evidence Generation, Adelphi Real World, Bollington, UK
| | - Tim Holbrook
- Secondary Data Evidence Generation, Adelphi Real World, Bollington, UK
| | - Makoto Kondo
- Department of Global Medical Affairs Japan, Astellas Pharma, Inc., Tokyo, Japan
| | - Atsushi Saito
- Department of Global Medical Affairs Japan, Astellas Pharma, Inc., Tokyo, Japan
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Mizukami T, Kawamura H, Kubo N, Sato H, Kawahara M, Adachi A, Matsui H, Suzuki K, Saitoh JI, Nakano T, Ohno T. Carbon-ion radiotherapy for inoperable upper tract ureteral cancer. Asia Pac J Clin Oncol 2024; 20:365-371. [PMID: 37088970 DOI: 10.1111/ajco.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/13/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023]
Abstract
AIM This study aimed to report initial results of hypofractionated carbon-ion radiotherapy (C-ion RT) for inoperable upper tract ureteral cancer. METHODS Retrospective chart review was performed for five consecutive patients with medically inoperable ureter cancer that was treated with radical C-ion RT between December 2013 and December 2014. The median age of the patients was 80 years (range, 68-84 years). The reasons for inoperability were advanced age, post-contralateral nephrectomy, alcoholic cirrhosis, both advanced age and contralateral renal function degeneracy, and pneumonia. The median size of tumor was 2.8 cm (range, 2.2-4.0 cm). Diagnostic imaging did not identify lymph node metastases or distant metastases in any case. All patients underwent C-ion RT (52.8 Gy relative biological effectiveness; 12 fractions in 3 weeks). The clinical target volume encompassed the growth tumor volume with a 5-mm margin bilaterally; there was a 40-mm margin craniocaudally but the clinical target volume did not encompass the whole ureter. RESULTS Within a median follow-up time of 32.9 months (range, 24-36 months), two patients died and three remained alive. Neither local recurrence nor regional lymph node metastases were observed. Secondary bladder tumor was observed in four patients, and one patient had a liver metastasis. Grade 1 hematuria was observed in two patients, and Grade 3 pyelonephritis was observed in one patient as acute toxicity. Ureteral obstruction was observed in two patients. CONCLUSION C-ion RT might be a useful treatment option for inoperable ureter cancer.
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Affiliation(s)
- Tatsuji Mizukami
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
- Gunma University Heavy Ion Medical Center, Gunma, Japan
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
- Gunma University Heavy Ion Medical Center, Gunma, Japan
| | - Hiro Sato
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
- Gunma University Heavy Ion Medical Center, Gunma, Japan
| | - Masahiro Kawahara
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Akiko Adachi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
- Gunma University Heavy Ion Medical Center, Gunma, Japan
| | - Hiroshi Matsui
- Gunma University Heavy Ion Medical Center, Gunma, Japan
- Department of Urology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kazuhiro Suzuki
- Gunma University Heavy Ion Medical Center, Gunma, Japan
- Department of Urology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Jun-Ichi Saitoh
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
- Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
- Gunma University Heavy Ion Medical Center, Gunma, Japan
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Nishihara K, Ueda K, Kurose H, Ogasawara N, Hiroshige T, Chikui K, Ejima K, Uemura K, Nakiri M, Suekane S, Igawa T. Survival outcomes of non‑definitive therapy for muscle‑invasive bladder cancer. Oncol Lett 2022; 23:126. [DOI: 10.3892/ol.2022.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/20/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kiyoaki Nishihara
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Hirofumi Kurose
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Naoyuki Ogasawara
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Tasuku Hiroshige
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Katsuaki Chikui
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Kazuhisa Ejima
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Keiichiro Uemura
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Makoto Nakiri
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Shigetaka Suekane
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Tsukasa Igawa
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
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Miyata H, Osawa T, Abe T, Kikuchi H, Matsumoto R, Maruyama S, Nishioka K, Shimizu S, Hashimoto T, Shirato H, Shinohara N. The updated outcomes of bladder-preserving trimodal therapy using a real-time tumor-tracking radiotherapy system for patients with muscle-invasive bladder cancer. Jpn J Clin Oncol 2020; 50:609-616. [PMID: 31955206 PMCID: PMC7202139 DOI: 10.1093/jjco/hyz211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 10/13/2019] [Accepted: 12/20/2019] [Indexed: 11/14/2022] Open
Abstract
Objective Bladder-preserving trimodal therapy is recognized as a promising alternative treatment for muscle-invasive bladder cancer. We report the updated outcomes of muscle-invasive bladder cancer patients that were treated using our treatment protocol, which involves radiotherapy delivered with a real-time tumor-tracking radiotherapy system. Methods Thirty-eight patients who were diagnosed with T2-T4N0M0 bladder cancer between 1998 and 2016 and had clinically inoperable disease or refused to undergo surgery were enrolled. The treatment protocol included maximal transurethral resection followed by whole-bladder radiotherapy (40 Gy). Concurrent nedaplatin-based chemotherapy was administered to patients with adequate renal function. At the time of the first evaluation (via transurethral resection of the tumor bed), fiducial markers were endoscopically inserted into the bladder wall around the tumor. A boost of 25 Gy was administered using the real-time tumor-tracking radiotherapy system. The second evaluation (via transurethral resection of the tumor bed) was performed 6 months after the start of treatment. The Kaplan–Meier method and Cox hazards analysis were used to analyze overall survival and cancer-specific survival. Results The median duration of the follow-up period was 28 months (range: 3–161 months). The 5- and 10-year overall survival rates were 54.9 and 41.2%, respectively. Twenty-five (65.8%) and twenty (74.1%) patients had achieved complete responses to chemoradiation at the first and second evaluations, respectively. In univariate and multivariate analyses, performance status was found to be significantly associated with overall survival [P = 0.03, hazard ratio: 3.48, 95% confidence interval: 1.15–10.6] and cancer-specific survival [P = 0.02, hazard ratio: 4.57, 95% confidence interval: 1.32–16.9], and sex was shown to be significantly associated with cancer-specific survival [P = 0.03, hazard ratio: 3.07, 95% confidence interval: 1.09–8.30]. Conclusions Our bladder-preserving trimodal therapy protocol, which involves the use of a real-time tumor-tracking radiotherapy system, produced an acceptable overall survival rate. This therapy is a reasonable alternative for patients that are medically unfit for or do not want to undergo cystectomy.
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Affiliation(s)
- Haruka Miyata
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Satoru Maruyama
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Hokkaido University, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Radiation Medical Science and Engineering, Hokkaido University, Sapporo, Japan.,Global Station for Quantum Biomedical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | | | - Hiroki Shirato
- Global Station for Quantum Biomedical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
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