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Um PK, Praharaj M, Lombardo KA, Yoshida T, Matoso A, Baras AS, Zhao L, Srikrishna G, Huang J, Prasad P, Kates M, McConkey D, Pardoll DM, Bishai WR, Bivalacqua TJ. Improved bladder cancer antitumor efficacy with a recombinant BCG that releases a STING agonist. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.15.571740. [PMID: 38168333 PMCID: PMC10760079 DOI: 10.1101/2023.12.15.571740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Despite the introduction of several new agents for the treatment of bladder cancer (BC), intravesical BCG remains a first line agent for the management of non-muscle invasive bladder cancer. In this study we evaluated the antitumor efficacy in animal models of BC of a recombinant BCG known as BCG-disA-OE that releases the small molecule STING agonist c-di-AMP. We found that compared to wild-type BCG (BCG-WT), in both the orthotopic, carcinogen-induced rat MNU model and the heterotopic syngeneic mouse MB-49 model BCG-disA-OE afforded improved antitumor efficacy. A mouse safety evaluation further revealed that BCG-disA-OE proliferated to lesser degree than BCG-WT in BALB/c mice and displayed reduced lethality in SCID mice. To probe the mechanisms that may underlie these effects, we found that BCG-disA-OE was more potent than BCG-WT in eliciting IFN-β release by exposed macrophages, in reprogramming myeloid cell subsets towards an M1-like proinflammatory phenotypes, inducing epigenetic activation marks in proinflammatory cytokine promoters, and in shifting monocyte metabolomic profiles towards glycolysis. Many of the parameters elevated in cells exposed to BCG-disA-OE are associated with BCG-mediated trained innate immunity suggesting that STING agonist overexpression may enhance trained immunity. These results indicate that modifying BCG to release high levels of proinflammatory PAMP molecules such as the STING agonist c-di-AMP can enhance antitumor efficacy in bladder cancer.
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Affiliation(s)
- Peter K. Um
- Johns Hopkins University, School of Medicine, Department of Medicine, Center for Tuberculosis Research, Baltimore, USA
| | - Monali Praharaj
- Johns Hopkins University, School of Medicine, Department of Medicine, Center for Tuberculosis Research, Baltimore, USA
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, USA
| | - Kara A. Lombardo
- Johns Hopkins University, School of Medicine, Department of Urology, Baltimore, USA
| | - Takahiro Yoshida
- Department of Urology, Hyogo Prefectural Nishinomiya Hospital, Japan, 6620918
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins University, Baltimore, USA
| | - Alex S. Baras
- Department of Pathology, The Johns Hopkins University, Baltimore, USA
| | - Liang Zhao
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, USA
| | - Geetha Srikrishna
- Johns Hopkins University, School of Medicine, Department of Medicine, Center for Tuberculosis Research, Baltimore, USA
| | - Joy Huang
- Johns Hopkins University, School of Medicine, Department of Medicine, Center for Tuberculosis Research, Baltimore, USA
| | - Pankaj Prasad
- Johns Hopkins University, School of Medicine, Department of Medicine, Center for Tuberculosis Research, Baltimore, USA
| | - Max Kates
- Johns Hopkins University, School of Medicine, Department of Urology, Baltimore, USA
| | - David McConkey
- Johns Hopkins University, School of Medicine, Department of Urology, Baltimore, USA
| | - Drew M. Pardoll
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, USA
| | - William R. Bishai
- Johns Hopkins University, School of Medicine, Department of Medicine, Center for Tuberculosis Research, Baltimore, USA
| | - Trinity J. Bivalacqua
- School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, USA
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Wei Y, Hong H, Huang H. Primary Langerhans cell sarcoma in the urinary bladder: Case report and literature review. Front Oncol 2023; 13:1118222. [PMID: 36968999 PMCID: PMC10033541 DOI: 10.3389/fonc.2023.1118222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
Langerhans cell sarcoma (LCS) is a rare malignancy of dendritic cells and usually results in a poor oncological outcome. Thus, LCS is usually given a positive administration. Herein, we presented the first case of primary LCS in the urinary bladder staged T1N0M0 and treated by TURBT and short-term local chemotherapy. Our experience in this unique case may suggest that LCS in the urinary bladder with a non-muscle-invasive stage may be managed according to the treatment model of non-muscle-invasive urothelial carcinoma of the urinary bladder.
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Affiliation(s)
- Yongbao Wei
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Huaishan Hong
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
- *Correspondence: Huaishan Hong, ; Haijian Huang,
| | - Haijian Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Pathology, Fujian Provincial Hospital, Fuzhou, China
- *Correspondence: Huaishan Hong, ; Haijian Huang,
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Replacement Instead of Discontinuation of Bacillus Calmette-Guérin Instillation in Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2023; 15:cancers15041345. [PMID: 36831686 PMCID: PMC9954124 DOI: 10.3390/cancers15041345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND To evaluate the efficacy of intravesical chemotherapy replacement in patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC), who underwent bacillus Calmette-Guérin (BCG) instillation but discontinued due to global shortages or toxicity of BCG. METHODS This retrospective study included patients with intermediate- and high-risk NMIBC who received BCG intravesical instillation. Those who discontinued the treatment were divided into the pure BCG group and chemotherapy replacement group. Comparisons between these groups were performed. The primary endpoint was bladder recurrence-free survival (RFS). RESULTS A total of 480 patients were included. Baseline characteristics were similar between groups, but the total instillation times were higher in the chemotherapy replacement group than in the pure BCG group (n = 14.9 vs. 10.5). The chemotherapy replacement group had a better three-year RFS (p = 0.022). On multivariate analysis, the pure BCG group had significantly increased all-time and 3-year recurrences (hazard ratio 2.015 and 2.148) compared to the chemotherapy replacement group. CONCLUSIONS Chemotherapy replacement has a better three-year RFS than no instillation in patients with intermediate- and high-risk NMIBC who received BCG instillation but facing treatment stoppage.
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Angulo JC, Álvarez-Ossorio JL, Domínguez-Escrig JL, Moyano JL, Sousa A, Fernández JM, Gómez-Veiga F, Unda M, Carballido J, Carrero V, Fernandez-Aparicio T, García de Jalón Á, Solsona E, Inman B, Palou J. Hyperthermic Mitomycin C in Intermediate-risk Non-muscle-invasive Bladder Cancer: Results of the HIVEC-1 Trial. Eur Urol Oncol 2023; 6:58-66. [PMID: 36435738 DOI: 10.1016/j.euo.2022.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/29/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optimising therapeutic strategies of intermediate-risk non-muscle-invasive bladder cancer (IR-NMIBC) is needed. OBJECTIVE To compare recurrence-free survival (RFS) with adjuvant intravesical mitomycin C (MMC) at normothermia or hyperthermia using the COMBAT bladder recirculation system at 43 °C for 30 and 60 min. DESIGN, SETTING, AND PARTICIPANTS A prospective open-label, phase 3 randomised controlled trial (HIVEC-1) accrued across 13 centres between 2014 and 2020 in Spain. After complete transurethral resection of the bladder and immediate postoperative MMC instillation, patients with IR-NMIBC were randomised (1:1:1) to four weekly followed by three monthly 40-mg MMC instillations at normothermia (control; n = 106), 43 °C for 30 min (n = 107), or 43 °C for 60 min (n = 106) were investigated. Therapeutic compliance was defined as four or more instillations. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was RFS at 24 mo in the intention-to-treat (ITT) and per-protocol (PP) populations. The secondary outcomes included progression-free survival at 24 mo, safety outcome measures, and changes in health-related quality of life. Log-rank, Fisher, χ2, and analysis of variance tests were used. RESULTS AND LIMITATIONS The ITT 24-mo RFS was 77% for control, 82% for 43 °C-30 min, and 80% for 43 °C-60 min (p = 0.6). The PP 24-mo RFS was 77% for control, 83% for 43 °C-30 min, and 80% for 43 °C-60 min (p = 0.59). Six patients progressed to muscle-invasive disease in the ITT population (four in the control, 43 °C-30 min, and 43 °C-60 min groups each) and four in the PP population (all controls). Serious adverse events occurred in 26 patients (8.1%), and we were unable to demonstrate a difference between groups (p = 0.5). Adverse events, mainly dysuria and spasms, occurred in 124 patients (33% in control, 35% in 43 °C-30 min, and 48% in 43 °C-60 min; p = 0.05). The total International Prostate Symptom Score worsened by 1.2 ± 7.3 points, similarly across groups (p = 0.29). The Functional Assessment of Cancer Therapy-Bladder domains and indexes showed no significant change. CONCLUSIONS Four-month adjuvant hyperthermic MMC using the COMBAT system for 30 and 60 min in IR-NMIBC is well tolerated, but we did not find it to be superior to normothermic MMC at 24 mo. PATIENT SUMMARY We were unable to demonstrate the effectiveness of hyperthermia using the COMBAT system in intermediate-risk non-muscle-invasive bladder cancer. Further evaluation of long-term recurrence and progression, and maintenance regimens appears mandatory.
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Affiliation(s)
- Javier C Angulo
- Clinical Department, Faculty of Medical Sciences, Universidad Europea de Madrid, Madrid, Spain; Department of Urology, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
| | | | | | - José L Moyano
- Department of Urology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Alejandro Sousa
- Department of Urology, Hospital Comarcal de Monforte de Lemos, Monforte de Lemos, Lugo, Spain
| | - Jesús M Fernández
- Department of Urology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Francisco Gómez-Veiga
- Department of Urology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Miguel Unda
- Department of Urology, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - Joaquín Carballido
- Department of Urology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Victor Carrero
- Department of Urology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Ángel García de Jalón
- Department of Urology, Hospital General Universitario Miguel Servet, Zaragoza, Spain
| | - Eduardo Solsona
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Brant Inman
- Duke Cancer Center Genitourinary Clinic, Durham, NC, USA
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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5
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Clinical Value Analysis of Xiaozheng Decoction Combined with Bladder Perfusion for Postoperative Treatment of Bladder Cancer and Its Effect on Serum miR-143 and miR-92a. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8177674. [PMID: 35368948 PMCID: PMC8970859 DOI: 10.1155/2022/8177674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 01/16/2023]
Abstract
Objective To study the clinical value of Xiaozheng decoction combined with bladder perfusion treating bladder cancer after the operation and its effect on serum miR-143 and miR-92a. Methods The patients in the control group were treated with gemcitabine bladder instillation, and patients in the study group were treated with the combination of gemcitabine bladder instillation + Xiaozheng decoction. The clinical efficacy, postoperative adverse effects, and recurrence between the two groups were compared. miR-143 and miR-92a levels, immune function levels, and tumor factor levels were compared before and after treatment. The relationship between patient prognosis and miR-143/miR-92a expression was analyzed. Results The overall effective rate of treatment in the study group (86.67%) was significantly increased, and the occurrence of adverse reactions and recurrence were significantly decreased (P < 0.05). After treatment, serum miR-143 and miR-92a levels, CD4+, CD4+/CD8+, and NK levels increased in both groups (P<0.05). CD8+ levels, BTA, NMP, and UBC levels decreased in both groups (P < 0.05). Analysis of survival results indicated that the two-year survival rates of patients with miR-143 and miR-92a high expressions were significantly higher than patients with low expressions (P < 0.05). Conclusion The efficacy of Xiaozheng decoction combined with bladder perfusion in treating postoperative patients with bladder cancer was significant, which could reduce the incidence of adverse reactions and postoperative recurrence rate, improve serum tumor marker levels, and enhance patients' immunity with a good prognosis.
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6
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Teoh JYC, Kamat AM, Black PC, Grivas P, Shariat SF, Babjuk M. Recurrence mechanisms of non-muscle-invasive bladder cancer - a clinical perspective. Nat Rev Urol 2022; 19:280-294. [PMID: 35361927 DOI: 10.1038/s41585-022-00578-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/24/2022]
Abstract
Non-muscle-invasive bladder cancer (NMIBC) is an early-stage cancer without invasion into the detrusor muscle layer. Transurethral resection of bladder tumour (TURBT) is a diagnostic and potentially curative procedure for NMIBC, but has some limitations, including difficulties in ascertaining complete tumour removal upon piecemeal resection and the possibility of tumour re-implantation after the procedure. The oncological control of NMIBC is far from satisfactory, with a 1-year recurrence rate of 15-61%, and a 5-year recurrence rate of 31-78%. Various recurrence mechanisms have been described for NMIBC, such as undetected tumours upon cystoscopy, incomplete resection during TURBT, tumour re-implantation after TURBT, drop metastasis from upper tract urothelial carcinoma and field change cancerization. Understanding the recurrence mechanisms from a clinical perspective has strong implications for the optimization of NMIBC oncological outcomes, as a cure for patients with NMIBC can only be achieved by tackling all possible recurrence mechanisms in a comprehensive manner.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. .,European Association of Urology-Young Academic Urologists (EAU-YAU) Urothelial Cancer Working Group, Amsterdam, Netherlands.
| | - Ashish M Kamat
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.,Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic
| | - Marek Babjuk
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic
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7
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Sasaki N, Ikenaka Y, Aoshima K, Aoyagi T, Kudo N, Nakamura K, Takiguchi M. Safety Assessment of Ultrasound-Assisted Intravesical Chemotherapy in Normal Dogs: A Pilot Study. Front Pharmacol 2022; 13:837754. [PMID: 35370726 PMCID: PMC8974685 DOI: 10.3389/fphar.2022.837754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 12/11/2022] Open
Abstract
Intravesical chemotherapy after transurethral resection is a treatment option in patients with non-muscle invasive bladder cancer. The efficacy of intravesical chemotherapy is determined by the cellular uptake of intravesical drugs. Therefore, drug delivery technologies in the urinary bladder are promising tools for enhancing the efficacy of intravesical chemotherapy. Ultrasound-triggered microbubble cavitation may enhance the permeability of the urothelium, and thus may have potential as a drug delivery technology in the urinary bladder. Meanwhile, the enhanced permeability may increase systemic absorption of intravesical drugs, which may increase the adverse effects of the drug. The aim of this preliminary safety study was to assess the systemic absorption of an intravesical drug that was delivered by ultrasound-triggered microbubble cavitation in the urinary bladder of normal dogs. Pirarubicin, a derivative of doxorubicin, and an ultrasound contrast agent (Sonazoid) microbubbles were administered in the urinary bladder. Ultrasound (transmitting frequency 5 MHz; pulse duration 0.44 μsec; pulse repetition frequency 7.7 kHz; peak negative pressure −1.2 MPa) was exposed to the bladder using a diagnostic ultrasound probe (PLT-704SBT). The combination of ultrasound and microbubbles did not increase the plasma concentration of intravesical pirarubicin. In addition, hematoxylin and eosin staining showed that the combination of ultrasound and microbubble did not cause observable damages to the urothelium. Tissue pirarubicin concentration in the sonicated region was higher than that of the non-sonicated region in two of three dogs. The results of this pilot study demonstrate the safety of the combination of intravesical pirarubicin and ultrasound-triggered microbubble cavitation, that is, ultrasound-assisted intravesical chemotherapy.
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Affiliation(s)
- Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
- *Correspondence: Noboru Sasaki,
| | - Yoshinori Ikenaka
- Translational Research Unit, Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
- Water Research Group, Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - Keisuke Aoshima
- Laboratory of Comparative Pathology, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Teiichiro Aoyagi
- Department of Urology, Tokyo Medical University Ibaraki Medical Center, Ami, Japan
| | - Nobuki Kudo
- Division of Bioengineering and Bioinformatics, Faculty of Information and Technology, Hokkaido University, Sapporo, Japan
| | - Kensuke Nakamura
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
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8
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Wang Y, Zhang Y, Li PC, Guo J, Huo F, Yang J, Jia R, Wang J, Huang Q, Theodorescu D, Yu H, Yan C. Development of novel aptamer-based targeted chemotherapy for bladder cancer. Cancer Res 2022; 82:1128-1139. [DOI: 10.1158/0008-5472.can-21-2691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/08/2021] [Accepted: 01/18/2022] [Indexed: 12/24/2022]
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9
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Steinberg RL, Packiam VT, Thomas LJ, Brooks N, Vitale A, Mott SL, Crump T, Wang J, DeWolf WC, Lamm DL, Kates M, Hyndman ME, Kamat AM, Bivalacqua TJ, Nepple KG, O'Donnell MA. Intravesical sequential gemcitabine and docetaxel versus bacillus calmette-guerin (BCG) plus interferon in patients with recurrent non-muscle invasive bladder cancer following a single induction course of BCG. Urol Oncol 2022; 40:9.e1-9.e7. [PMID: 34092482 DOI: 10.1016/j.urolonc.2021.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Repeat BCG induction remains an option for select non-muscle invasive bladder cancer (NMIBC) patients who fail initial therapy. Alternative salvage intravesical regimens such as Gemcitabine and Docetaxel (Gem/Doce) have been investigated. We aimed to compare the efficacy BCG plus interferon a-2b (BCG/IFN) and Gem/Doce in patients with recurrent NMIBC after a single prior BCG course. METHODS The National Phase II BCG/IFN trial database and multi-institutional Gem/Doce database were queried for patients with recurrent NMIBC after one prior BCG induction course, excluding those with BCG unresponsive disease. Stabilized inverse probability treatment weighted survival curves were estimated using the Kaplan-Meier method and compared. Propensity scores were derived from a logistic regression model. The primary outcome was recurrence free survival (RFS); secondary outcomes were high-grade (HG) RFS and risk factors for treatment failure. RESULTS We identified 197 BCG/IFN and 93 Gem/Doce patients who met study criteria. Patients receiving Gem/Doce were older and more likely to have HG disease, CIS, and persistent disease following induction BCG (all P < 0.01). After propensity score-based weighting, the adjusted 1- and 2-year RFS was 61% and 53% after BCG/IFN versus 68% and 46% after Gem/Doce (P = 0.95). Adjusted 1- and 2-year HG-RFS was 60% and 51% after BCG/IFN versus 63% and 42% after Gem/Doce (P = 0.68). Multivariable Cox regression revealed that Gem/Doce treatment was not associated with an increased risk of failure (HR = 0.97, P = 0.89) as compared to BCG/IFN. CONCLUSION Patients with recurrent NMIBC after a single induction BCG failure and not deemed BCG unresponsive had similar oncologic outcomes with Gem/Doce and BCG/IFN in a post-hoc analysis. Additional prospective studies are needed.
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Affiliation(s)
| | | | - Lewis J Thomas
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Andrew Vitale
- Department of Urology, University of Iowa, Iowa City, IA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
| | - Trafford Crump
- Department of Urology, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Donald L Lamm
- University of Arizona School of Medicine, Phoenix, Az; BCG Oncology, Phoenix, Az
| | - Max Kates
- Department of Urology, Johns Hopkins University, Baltimore, MD
| | - M Eric Hyndman
- Department of Urology, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Kenneth G Nepple
- Department of Urology, University of Iowa, Iowa City, IA; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
| | - Michael A O'Donnell
- Department of Urology, University of Iowa, Iowa City, IA; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA.
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Zhao H, Chan VWS, Castellani D, Chan EOT, Ong WLK, Peng Q, Moschini M, Krajewski W, Pradere B, Ng CF, Enikeev D, Vasdev N, Ekin G, Sousa A, Leon J, Guerrero-Ramos F, Tan WS, Kelly J, Shariat SF, Witjes JA, Teoh JYC. Intravesical Chemohyperthermia vs. Bacillus Calmette-Guerin Instillation for Intermediate- and High-Risk Non-muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:775527. [PMID: 34888347 PMCID: PMC8649716 DOI: 10.3389/fsurg.2021.775527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/27/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The efficacy of intravesical chemotherapy maintenance for patients with non-muscle invasive bladder cancer (NMIBC) is inferior compared to intravesical bacillus Calmette–Guerin (BCG). How intravesical chemohyperthermia (CHT) compares with BCG is under investigation. Objective: To compare the oncological outcomes and safety profile between intravesical CHT and BCG treatment for intermediate- and high-risk NMIBC. Methods: We performed a systematic review and meta-analysis of clinical studies comparing CHT with BCG for intermediate- and high-risk NMIBC patients. A comprehensive literature search on OVID MEDLINE, EMBASE, and Cochrane Library was conducted. Risk of bias was assessed by the Cochrane RoB tool and ROBINS-I. Certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: A total of 2,375 articles were identified and five studies were finally included. Among them, four randomised trials comprising 327 patients (CHT group: 156 patients; BCG group: 171 patients) were included in the meta-analysis. There were no significant differences in the 24–36 months recurrence rates (CHT: 29.5%, BCG: 37.4%; RR: 0.83, 95% CI 0.61–1.13; moderate certainty of evidence) and the 24–36 months progression rates (CHT: 4.4%, BCG: 7.6%, RR = 0.62, 95% CI 0.26–1.49; low certainty of evidence). There were also no significant differences in grade 1–2 adverse events (CHT group: 59.9%, BCG group 54.5%; RR = 1.10, 95% CI 0.93–1.30; moderate certainty of evidence) and grade 3 or above adverse events (CHT group: 23.2%, BCG group 22.5%; RR = 0.99, 95% CI 0.69–1.43; low certainty of evidence). Conclusions: Intravesical CHT had equivalent oncological outcomes and similar safety profile when compared to BCG maintenance therapy for patients with intermediate- and high-risk NMIBC. CHT is a possible alternative treatment in the times of BCG shortage.
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Affiliation(s)
- Hongda Zhao
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Daniele Castellani
- Unit of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
| | - Erica On-Ting Chan
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | | | - Qiang Peng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wrocław, Poland
| | - Benjamin Pradere
- Department of Urology, University Hospital of Tours, Tours, France
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nikhil Vasdev
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital Stevenage, School of Medicine and Life Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Gokhan Ekin
- Department of Urology, Urla State Hospital, Izmir, Turkey
| | | | - Juan Leon
- Department of Urology, Comarcal Hospital, Monforte, Spain
| | | | - Wei-Shen Tan
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom.,Department of Urology, University College London Hospital, London, United Kingdom.,Department of Urology, Royal Free Hospital, London, United Kingdom
| | - John Kelly
- Department of Urology, University College London Hospital, London, United Kingdom.,Department of Urology, Royal Free Hospital, London, United Kingdom
| | - Shahrokh F Shariat
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, NY, United States.,Department of Urology, University of Texas Southwestern, Dallas, TX, United States.,Department of Urology, Charles University, Prague, Czechia.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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11
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Unsworth-White SR, Kitchen MO, Bryan RT. Immunotherapy for non-muscle-invasive bladder cancer: from the origins of BCG to novel therapies. Future Oncol 2021; 18:105-115. [PMID: 34763531 DOI: 10.2217/fon-2021-0781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Supplies of intravesical Bacillus Calmette-Guérin (BCG), the first-line treatment for most intermediate- and high-risk non-muscle-invasive bladder cancers (NMIBC), have proven unreliable over the past decade. This review considers the evolution of BCG immunotherapy for NMIBC: from the discovery of the antitumour side effects of tuberculosis and subsequently the BCG vaccine, to recent advances in novel immunotherapeutic agents. We summarize the evidence for alternative options to standard intravesical BCG therapy regimens and describe the potential for immune response manipulating drugs in the treatment of NMIBC. These new agents, including immune checkpoint inhibitors, toll-like receptor agonists and recombinant viral vectors, may provide better options in the management of NMIBC in the future.
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Affiliation(s)
- Samantha R Unsworth-White
- Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, College of Medical & Dental Sciences, University of Birmingham, UK
| | - Mark O Kitchen
- School of Medicine, Keele, UK.,Urology Department, University Hospitals of North Midlands NHS Trust, UK
| | - Richard T Bryan
- Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, College of Medical & Dental Sciences, University of Birmingham, UK
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12
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Plata A, Guerrero-Ramos F, Garcia C, González-Díaz A, Gonzalez-Valcárcel I, de la Morena JM, Díaz-Goizueta FJ, del Álamo JF, Gonzalo V, Montero J, Sousa-Escandón A, León J, Pontones JL, Delgado F, Adriazola M, Pascual Á, Calleja J, Ruano A, Martínez-Piñeiro L, Angulo JC. Long-Term Experience with Hyperthermic Chemotherapy (HIVEC) Using Mitomycin-C in Patients with Non-Muscle Invasive Bladder Cancer in Spain. J Clin Med 2021; 10:jcm10215105. [PMID: 34768625 PMCID: PMC8584886 DOI: 10.3390/jcm10215105] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Intravesical mitomycin-C (MMC) combined with hyperthermia is increasingly used in non-muscle invasive bladder cancer (NMIBC), especially in the context of a relative BCG shortage. We aim to determine real-world data on the long-term treatment outcomes of adjunct hyperthermic intravesical chemotherapy (HIVEC) with MMC and a COMBAT® bladder recirculation system (BRS); (2) Methods: A prospective observational trial was performed on patients with NMIBC treated with HIVEC using BRS in nine academic institutions in Spain between 2012–2020 (HIVEC-E). Treatment effectiveness (recurrence, progression and overall mortality) was evaluated in patients treated with HIVEC MMC 40mg in the adjuvant setting, with baseline data and a clinical follow-up, that comprise the Full Analysis Set (FAS). Safety, according to the number and severity of adverse effects (AEs), was evaluated in the safety (SAF) population, composed by patients with at least one adjunct HIVEC MMC instillation; (3) Results: The FAS population (n = 502) received a median number of 8.78 ± 3.28 (range 1–20) HIVEC MMC instillations. The median follow-up duration was 24.5 ± 16.5 (range 1–81) months. Its distribution, based on EAU risk stratification, was 297 (59.2%) for intermediate and 205 (40.8%) for high-risk. The figures for five-year recurrence-free and progression-free survival were 50.37% (53.3% for intermediate and 47.14% for high-risk) and 89.83% (94.02% for intermediate and 84.23% for high-risk), respectively. A multivariate analysis identified recurrent tumors (HR 1.83), the duration of adjuvant HIVEC therapy <4 months (HR 1.72) and that high-risk group (HR 1.47) were at an increased risk of recurrence. Independent factors of progression were high-risk (HR 3.89), recurrent tumors (HR 3.32) and the induction of HIVEC therapy without maintenance (HR 2.37). The overall survival was determined by patient age at diagnosis (HR 3.36) and the treatment duration (HR 1.82). The SAF population (n = 592) revealed 406 (68.58%) patients without AEs and 186 (31.42%) with at least one AE: 170 (28.72%) of grade 1–2 and 16 (2.7%) of grade 3–4. The most frequent AEs were dysuria (10%), pain (7.1%), urgency (5.7%), skin rash (4.9%), spasms (3.7%) and hematuria (3.6%); (4) Conclusions: HIVEC using BRS is efficacious and well tolerated. A longer treatment duration, its use in naïve patients and the intermediate-risk disease are independent determinants of success. Furthermore, a monthly maintenance of adjunct MMC HIVEC diminishes the progression rate of NMIBC.
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Affiliation(s)
- Ana Plata
- Urology Department, Hospital Universitario de Canarias, Carretera Ofra s/n, 38320 San Cristóbal de La Laguna, Spain; (A.P.); (C.G.)
| | - Félix Guerrero-Ramos
- Urology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain; (F.G.-R.); (A.G.-D.)
| | - Carlos Garcia
- Urology Department, Hospital Universitario de Canarias, Carretera Ofra s/n, 38320 San Cristóbal de La Laguna, Spain; (A.P.); (C.G.)
| | - Alejandro González-Díaz
- Urology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain; (F.G.-R.); (A.G.-D.)
| | - Ignacio Gonzalez-Valcárcel
- Urology Department, Hospital Universitario Infanta Sofía, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain; (I.G.-V.); (J.M.d.l.M.)
| | - José Manuel de la Morena
- Urology Department, Hospital Universitario Infanta Sofía, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain; (I.G.-V.); (J.M.d.l.M.)
| | | | - Julio Fernández del Álamo
- Urology Department, Hospital Universitario de Torrejón, Mateo Inurria, s/n, Torrejón de Ardoz, 28850 Madrid, Spain;
| | - Victoria Gonzalo
- Urology Department, Hospital Universitario de Burgos, Avenida Islas Baleares 3, 09006 Burgos, Spain; (V.G.); (J.M.)
| | - Javier Montero
- Urology Department, Hospital Universitario de Burgos, Avenida Islas Baleares 3, 09006 Burgos, Spain; (V.G.); (J.M.)
| | - Alejandro Sousa-Escandón
- Urology Department, Hospital Comarcal de Monforte, Rúa Corredoira s/n, 27400 Monforte de Lemos, Spain; (A.S.-E.); (J.L.)
| | - Juan León
- Urology Department, Hospital Comarcal de Monforte, Rúa Corredoira s/n, 27400 Monforte de Lemos, Spain; (A.S.-E.); (J.L.)
| | - Jose Luis Pontones
- Urology Department, Hospital Universitario La Fe, Avinguda de Fernando Abril Martorell 106, 46026 Valencia, Spain; (J.L.P.); (F.D.)
| | - Francisco Delgado
- Urology Department, Hospital Universitario La Fe, Avinguda de Fernando Abril Martorell 106, 46026 Valencia, Spain; (J.L.P.); (F.D.)
| | - Miguel Adriazola
- Urology Department, Hospital General Rio Carrión, Avenida Donantes de Sangre s/n, 34005 Palencia, Spain; (M.A.); (Á.P.)
| | - Ángela Pascual
- Urology Department, Hospital General Rio Carrión, Avenida Donantes de Sangre s/n, 34005 Palencia, Spain; (M.A.); (Á.P.)
| | - Jesús Calleja
- Urology Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003 Valladolid, Spain; (J.C.); (A.R.)
| | - Ana Ruano
- Urology Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003 Valladolid, Spain; (J.C.); (A.R.)
| | - Luis Martínez-Piñeiro
- Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain;
| | - Javier C. Angulo
- Urology Department, Hospital Universitario Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain;
- Clinical Department, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
- Correspondence: ; Tel.: +34-699497569
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13
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Ferro M, Del Giudice F, Carrieri G, Busetto GM, Cormio L, Hurle R, Contieri R, Arcaniolo D, Sciarra A, Maggi M, Porpiglia F, Manfredi M, Fiori C, Antonelli A, Tafuri A, Bove P, Terrone C, Borghesi M, Costantini E, Iliano E, Montanari E, Boeri L, Russo GI, Madonia M, Tedde A, Veccia A, Simeone C, Liguori G, Trombetta C, Brunocilla E, Schiavina R, Dal Moro F, Racioppi M, Vartolomei MD, Longo N, Spirito L, Crocetto F, Cantiello F, Damiano R, Di Stasi SM, Marchioni M, Schips L, Parma P, Carmignani L, Conti A, Soria F, Gontero P, Barone B, Deho F, Zaffuto E, Papalia R, Scarpa RM, Pagliarulo V, Lucarelli G, Ditonno P, Botticelli FMG, Musi G, Catellani M, de Cobelli O. The Impact of SARS-CoV-2 Pandemic on Time to Primary, Secondary Resection and Adjuvant Intravesical Therapy in Patients with High-Risk Non-Muscle Invasive Bladder Cancer: A Retrospective Multi-Institutional Cohort Analysis. Cancers (Basel) 2021; 13:cancers13215276. [PMID: 34771440 PMCID: PMC8582553 DOI: 10.3390/cancers13215276] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary The worldwide COVID-19 emergency has had an important impact on healthcare systems with the need to assist infected patients and also treat non-deferrable oncological conditions. In urology, the main concern has been for patients with bladder cancer, the tenth most common malignancy, where the quality and the alacrity of treatment has a clear well-demonstrated impact on the survivor. The aim of our Italian multi-institutional retrospective study was to assess the impact of the COVID-19 outbreak on diagnosis and treatment of non-muscle invasive bladder cancer. We observed a significant delay between diagnosis and surgical treatment, with a lower adherence to the standard therapeutic scheme such as BCG intravesical instillation and urological guidelines. We also recorded a different attitude in treatment depending on the patients’ location in Italy. Further investigation could show the impact of the pandemic on the survival of these patients. Abstract Background: To investigate the impact of COVID-19 outbreak on the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). Methods: A retrospective analysis was performed using an Italian multi-institutional database of TURBT patients with high-risk urothelial NMIBC between January 2019 and February 2021, followed by Re-TURBT and/or adjuvant intravesical BCG. Results: A total of 2591 patients from 27 institutions with primary TURBT were included. Of these, 1534 (59.2%) and 1056 (40.8%) underwent TURBT before and during the COVID-19 outbreak, respectively. Time between diagnosis and TURBT was significantly longer during the COVID-19 period (65 vs. 52 days, p = 0.002). One thousand and sixty-six patients (41.1%) received Re-TURBT, 604 (56.7%) during the pre-COVID-19. The median time to secondary resection was significantly longer during the COVID-19 period (55 vs. 48 days, p < 0.0001). A total of 977 patients underwent adjuvant intravesical therapy after primary or secondary resection, with a similar distribution across the two groups (n = 453, 86% vs. n = 388, 86.2%). However, the proportion of the patients who underwent maintenance significantly differed (79.5% vs. 60.4%, p < 0.0001). Conclusions: The COVID-19 pandemic represented an unprecedented challenge to our health system. Our study did not show significant differences in TURBT quality. However, a delay in treatment schedule and disease management was observed. Investigation of the oncological impacts of those differences should be advocated.
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Affiliation(s)
- Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence:
| | - Francesco Del Giudice
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Gian Maria Busetto
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Luigi Cormio
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Rodolfo Hurle
- Department of Urology, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy; (R.H.); (R.C.)
| | - Roberto Contieri
- Department of Urology, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy; (R.H.); (R.C.)
| | - Davide Arcaniolo
- Unit of Urology, Luigi Vanvitelli University of Campania, 80138 Naples, Italy;
| | - Alessandro Sciarra
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Martina Maggi
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Alessandro Antonelli
- Department of Urology, Ospedale Civile Maggiore, Polo Chirurgico Confortini, University of Verona, 37126 Verona, Italy; (A.A.); (A.T.)
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, Ospedale Civile Maggiore, Polo Chirurgico Confortini, University of Verona, 37126 Verona, Italy; (A.A.); (A.T.)
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165 Rome, Italy;
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, 16132 Genova, Italy; (C.T.); (M.B.)
| | - Marco Borghesi
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, 16132 Genova, Italy; (C.T.); (M.B.)
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy; (E.C.); (E.I.)
| | - Ester Iliano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy; (E.C.); (E.I.)
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (L.B.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Luca Boeri
- Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (L.B.)
| | | | - Massimo Madonia
- Urologic Clinic, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (M.M.); (A.T.)
| | - Alessandro Tedde
- Urologic Clinic, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (M.M.); (A.T.)
| | - Alessandro Veccia
- Division of Urology, VCU Health System, Richmond, VA 23298, USA;
- Urology Unit, ASST Spedali Civili Hospital, 25133 Brescia, Italy
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Claudio Simeone
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Giovanni Liguori
- Department of Urology, ASUITS, University of Trieste, 34149 Trieste, Italy; (G.L.); (C.T.)
| | - Carlo Trombetta
- Department of Urology, ASUITS, University of Trieste, 34149 Trieste, Italy; (G.L.); (C.T.)
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (E.B.); (R.S.)
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (E.B.); (R.S.)
| | - Fabrizio Dal Moro
- Urology Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35128 Padua, Italy;
| | - Marco Racioppi
- Urology Clinic, A. Gemelli Hospital Foundation, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Mihai Dorin Vartolomei
- Urology Department, Medical University of Vienna, A-1090 Vienna, Austria;
- IOSUD, Universitatea de Medicina Farmacie Stiinte si Tehnologie “George Emil Palade” din Targu Mures, 540142 Mureș, Romania
| | - Nicola Longo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Lorenzo Spirito
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Felice Crocetto
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Francesco Cantiello
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Savino M. Di Stasi
- Department of Surgery and Experimental Medicine, Tor Vergata University, 00133 Rome, Italy;
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Urology Unit, “SS. Annunziata” Hospital, G. d’Annunzio University of Chieti, 66100 Chieti, Italy; (M.M.); (L.S.)
- Department of Urology, ASL Abruzzo 2, 65017 Chieti, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, Urology Unit, “SS. Annunziata” Hospital, G. d’Annunzio University of Chieti, 66100 Chieti, Italy; (M.M.); (L.S.)
- Department of Urology, ASL Abruzzo 2, 65017 Chieti, Italy
| | - Paolo Parma
- Urology Unit, Ospedale San Carlo Poma, 46100 Mantova, Italy;
| | - Luca Carmignani
- Department of Urology, San Donato Policlinic Hospital, 20094 Milan, Italy; (L.C.); (A.C.)
| | - Andrea Conti
- Department of Urology, San Donato Policlinic Hospital, 20094 Milan, Italy; (L.C.); (A.C.)
| | - Francesco Soria
- Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, 10121 Turin, Italy; (F.S.); (P.G.)
| | - Paolo Gontero
- Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, 10121 Turin, Italy; (F.S.); (P.G.)
| | - Biagio Barone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Federico Deho
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy; (F.D.); (E.Z.)
| | - Emanuele Zaffuto
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy; (F.D.); (E.Z.)
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University Hospital, 00198 Rome, Italy; (R.P.); (R.M.S.)
| | - Roberto M. Scarpa
- Department of Urology, Campus Biomedico University Hospital, 00198 Rome, Italy; (R.P.); (R.M.S.)
| | | | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (P.D.)
| | - Pasquale Ditonno
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (P.D.)
| | - Francesco Maria Gerardo Botticelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Michele Catellani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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14
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Pijpers OM, Hendricksen K, Mostafid H, de Jong FC, Rosier M, Mayor N, de Jong JJ, Boormans JL. Long-term efficacy of hyperthermic intravesical chemotherapy for BCG-unresponsive non-muscle invasive bladder cancer. Urol Oncol 2021; 40:62.e13-62.e20. [PMID: 34470725 DOI: 10.1016/j.urolonc.2021.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND The recommended treatment for patients with Bacillus Calmette-Guérin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) is radical cystectomy (RC). However, many patients refuse, or are unfit for RC. Therefore, alternative bladder-sparing treatment modalities are needed for BCG-unresponsive NMIBC. In this study we sought to assess the long-term efficacy of hyperthermic intravesical chemotherapy (HIVEC) as alternative to radical cystectomy in BCG-unresponsive non-muscle invasive bladder cancer patients. METHODS AND MATERIALS Retrospectively collected data from 56 patients with BCG-unresponsive NMIBC who received ≥5 HIVEC instillations between October 2014 and March 2020 was analyzed. All patients met the BCG-unresponsive criteria according to the current EAU guideline on NMIBC 2020. Patients were followed-up with cystoscopy and/or bladder biopsies, urine cytology and annually CT-urography. The Primary outcome was the high grade (HG) recurrence-free survival (RFS), defined as the time from the first HIVEC instillation until histologically confirmed intravesical recurrence or last follow-up. The Kaplan Meier method was used to estimate survival outcomes. Secondary outcomes were: complete response rate (CR), adverse events (AE), assessed by the Common Terminology Criteria for Adverse Events v5.0 (CTCAE) and tumor progression to muscle invasive disease or distant metastases. RESULTS The median follow-up was 32.2 months (IQR 13.7-44.8). The 1- and 2-year HG-RFS was 53% (SE:6.8) and 35% (SE:6.9), respectively. The CR for patients with CIS was 70% (21/30) at 6 months. Overall, 80% of the population developed an AE, only 1 was classified as CTCAE ≥3. Limitation of this study was the small sample size. CONCLUSION HIVEC resulted in a 2-year HG-RFS of 35% for BCG-unresponsive NMIBC patients without severe side-effects and therefore HIVEC seems to be an alternative treatment option for patients who refuse or are unfit for RC.
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Affiliation(s)
- Olga M Pijpers
- Department of Urology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Kees Hendricksen
- Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hugh Mostafid
- Department of Urology, Royal Surrrey County Hospital, Guildford, United Kingdom
| | - Florus C de Jong
- Department of Urology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marloes Rosier
- Department of Urology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nikhil Mayor
- Department of Urology, Royal Surrrey County Hospital, Guildford, United Kingdom
| | - Joep J de Jong
- Department of Urology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands.
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15
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Clinical trial of high dose hyperthermic intravesical mitomycin C for intermediate and high-risk non–muscle invasive bladder cancer during BCG shortage. Urol Oncol 2021; 39:498.e13-498.e20. [DOI: 10.1016/j.urolonc.2020.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/06/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022]
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16
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Real World Outcomes of Patients with Bladder Cancer: Effectiveness Versus Efficacy of Modern Treatment Paradigms. Hematol Oncol Clin North Am 2021; 35:597-612. [PMID: 33958153 DOI: 10.1016/j.hoc.2021.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bladder cancer remains a common and insidious disease in the United States. There have been several advances in the understanding of the biology of bladder cancer, novel diagnostic tools, improvements in multidisciplinary care pathways, and new therapeutics for advanced disease over the past few decades. Clinical trials have demonstrated efficacy for new treatments in each disease state, but additional work is needed to advance the effectiveness of bladder cancer care. Real world data provide critical information regarding patterns of care, adverse events, and outcomes helping to bridge the efficacy versus effectiveness gap.
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17
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Mayor N, Fankhauser C, Sangar V, Mostafid H. Management of
NMIBC
during
BCG
shortage and
COVID
‐19. TRENDS IN UROLOGY & MEN'S HEALTH 2021. [PMCID: PMC8013725 DOI: 10.1002/tre.783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Shortages of Bacille Calmette‐Guérin (BCG) have implications for the management of patients with non‐muscle‐invasive bladder cancers. Further complications come as a result of COVID‐19 for which BCG also shows some promising prospects.
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Affiliation(s)
- Nikhil Mayor
- Stokes Centre for Urology, Royal Surrey NHS Foundation Trust, Guildford
| | | | - Vijay Sangar
- Department of Urology, The Christie NHS Foundation Trust, Manchester
| | - Hugh Mostafid
- Stokes Centre for Urology, Royal Surrey NHS Foundation Trust, Guildford
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18
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Pane K, Mirabelli P, Coppola L, Illiano E, Salvatore M, Franzese M. New Roadmaps for Non-muscle-invasive Bladder Cancer With Unfavorable Prognosis. Front Chem 2020; 8:600. [PMID: 32850635 PMCID: PMC7413024 DOI: 10.3389/fchem.2020.00600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
About 70% of bladder cancers (BCs) are diagnosed as non-muscle-invasive BCs (NMIBCs), while the remaining are muscle-invasive BCs (MIBCs). The European Association of Urology (EAU) guidelines stratify NMIBCs into low, intermediate, and high risk for treatment options. Low-risk NMIBCs undergo only the transurethral resection of the bladder (TURB), whereas for intermediate-risk and high-risk NMIBCs, the transurethral resection of the bladder (TURB) with or without Bacillus Calmette-Guérin (BCG) immune or chemotherapy is the standard treatment. A minority of NMIBCs show unfavorable prognosis. High-risk NMIBCs have a high rate of disease recurrence and/or progression to muscle-invasive tumor and BCG treatment failure. The heterogeneous nature of NMIBCs poses challenges for clinical decision-making. In 2020, the EAU made some changes to NMIBCs BCG failure definitions and treatment options, highlighting the need for reliable molecular markers for improving the predictive accuracy of currently available risk tables. Nowadays, next-generation sequencing (NGS) has revolutionized the study of cancer biology, providing diagnostic, prognostic, and therapy response biomarkers in support of precision medicine. Integration of NGS with other cutting-edge technologies might help to decipher also bladder tumor surrounding aspects such as immune system, stromal component, microbiome, and urobiome; altogether, this might impact the clinical outcomes of NMBICs especially in the BCG responsiveness. This review focuses on NMIBCs with unfavorable prognoses, providing molecular prognostic factors from tumor immune and stromal cells, and the perspective of urobiome and microbiome profiling on therapy response. We provide information on the cornerstone of immunotherapy and new promising bladder-preserving treatments and ongoing clinical trials for BCG–unresponsive NMIBCs.
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Affiliation(s)
| | | | | | - Ester Illiano
- Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
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19
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Low compliance to guidelines in nonmuscle-invasive bladder carcinoma: A systematic review. Urol Oncol 2020; 38:774-782. [PMID: 32654948 DOI: 10.1016/j.urolonc.2020.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/02/2020] [Accepted: 06/13/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE This systematic review assessed compliance to guidelines for the management of nonmuscle-invasive bladder carcinoma (NMIBC). METHODS The PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in November 2019 in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement. RESULTS Fifteen studies incorporating a collective total of 10,575 NMIBC patients were eligible for inclusion in this systematic review. We found that the rates of compliance were 53.0% with a single immediate intravesical instillation in patients with presumed low or intermediate risk, 37.1% with intravesical bacillus Calmette-Guerin or chemotherapy in those with intermediate risk, 43.4% with performance of a second transurethral resection in high-risk patients, 32.5% with administration of adjuvant intravesical bacillus Calmette-Guerin in high-risk patients, 36.1% with radical cystectomy in highest-risk patients, and 82.2% with cystoscopy for follow-up. CONCLUSIONS Compliance with NMIBC guidelines remains low. Better guideline education and understanding holds the key to achieving high compliance. Strategies to improve guideline compliance at the physician level are urgently required.
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