1
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Zhou W, Yang Y, Wang W, Yang C, Cao Z, Lin X, Zhang H, Xiao Y, Zhang X. Pseudogene OCT4-pg5 upregulates OCT4B expression to promote bladder cancer progression by competing with miR-145-5p. Cell Cycle 2024; 23:645-661. [PMID: 38842275 PMCID: PMC11229759 DOI: 10.1080/15384101.2024.2353554] [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: 03/25/2023] [Accepted: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
Bladder cancer (BC) is one of the most common malignant neoplasms worldwide. Competing endogenous RNA (ceRNA) networks may identify potential biomarkers associated with the progression and prognosis of BC. The OCT4-pg5/miR-145-5p/OCT4B ceRNA network was found to be related to the progression and prognosis of BC. OCT4-pg5 expression was significantly higher in BC cell lines than in normal bladder cells, with OCT4-pg5 expression correlating with OCT4B expression and advanced tumor grade. Overexpression of OCT4-pg5 and OCT4B promoted the proliferation and invasion of BC cells, whereas miR-145-5p suppressed these activities. The 3' untranslated region (3'UTR) of OCT4-pg5 competed for miR-145-5p, thereby increasing OCT4B expression. In addition, OCT4-pg5 promoted epithelial-mesenchymal transition (EMT) by activating the Wnt/β-catenin pathway and upregulating the expression of matrix metalloproteinases (MMPs) 2 and 9 as well as the transcription factors zinc finger E-box binding homeobox (ZEB) 1 and 2. Elevated expression of OCT4-pg5 and OCT4B reduced the sensitivity of BC cells to cisplatin by reducing apoptosis and increasing the proportion of cells in G1. The OCT4-pg5/miR-145-5p/OCT4B axis promotes the progression of BC by inducing EMT via the Wnt/β-catenin pathway and enhances cisplatin resistance. This axis may represent a therapeutic target in patients with BC.
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Affiliation(s)
- Wuer Zhou
- The Department of Urology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Yue Yang
- The Department of Urology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wei Wang
- The Department of Urology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Chenglin Yang
- The Department of Urology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Zhi Cao
- The Department of Urology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Xiaoyu Lin
- The Department of Urology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Huifen Zhang
- The Department of Urology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Yuansong Xiao
- The Department of Urology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Xiaoming Zhang
- The Department of Urology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
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2
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Chiang Y, Tsai YC, Wang CC, Hsueh FJ, Huang CY, Chung SD, Chen CH, Pu YS, Cheng JCH. Tumor-derived C-C motif ligand 2 (CCL2) induces the recruitment and polarization of tumor-associated macrophages and increases the metastatic potential of bladder cancer cells in the postirradiated microenvironment. Int J Radiat Oncol Biol Phys 2022; 114:321-333. [PMID: 35691449 DOI: 10.1016/j.ijrobp.2022.06.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/28/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Radiotherapy (RT) is mainly used for bladder preservation in patients with muscle-invasive bladder cancer. The response of urothelial tumors to RT remains unsatisfactory. We investigated the interaction of RT and tumor-associated macrophages (TAMs) in the context of bladder cancer radioresistance. METHODS We evaluated the therapeutic effects of RT and TAM distribution by establishing an ectopic allograft mouse model. A Transwell coculture system was used to simulate the interaction between TAMs and MB49 bladder cancer cells in the tumor microenvironment. Cytokines and chemokines were analyzed in irradiated MB49 cells. Colony formation and Boyden chamber assays were used to assess the cytotoxic effects and the effects of TAMs on MB49 cell invasion, respectively. RESULTS Local RT delayed primary tumor growth but promoted pulmonary metastases in C57BL/6 mice. Increased secretion of C-C motif chemokine ligand (CCL2) by irradiated MB49 cells, especially in the presence of M1-type TAMs, contributed to the infiltration of bone marrow-derived C-C motif chemokine receptor 2 (CCR2)-positive myeloid cells and the polarization of M1-type TAMs toward the M2 type to promote MB49 cell invasion. Blockade of CCL2-CCR2 activation by a CCR2 antagonist reversed the phenotypic TAM transformation and suppressed pulmonary metastases. CONCLUSION Bladder cancer cells responded to RT by producing CCL2, which recruited TAM precursors from bone marrow and polarized M1-type TAMs toward the M2 type. This phenotypic TAM transformation promoted the pulmonary metastasis of bladder cancer cells after RT. Disrupting the CCL2-CCR2 signaling axis in combination with RT holds promise for improving RT efficacy in bladder cancer.
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Affiliation(s)
- Yun Chiang
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital
| | - Yu-Chieh Tsai
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital
| | | | - Fu-Jen Hsueh
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital
| | | | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Nursing, College of Healthcare & Management, Asia Eastern University of Science and Technology
| | | | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital
| | - Jason Chia-Hsien Cheng
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital.
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3
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Immunotherapy in Genitourinary Malignancy: Evolution in Revolution or Revolution in Evolution. Cancer Treat Res 2022; 183:201-223. [PMID: 35551661 DOI: 10.1007/978-3-030-96376-7_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Immunotherapy, the 5th pillar of cancer care after surgery, radiotherapy, cytotoxic chemotherapy, and precision therapy (molecular targeted therapy), is revolutionizing the standard of care in certain patients with genitourinary malignancies. As modest clinical benefits of IL-2 for metastatic renal cell carcinoma and Bacillus Calmette-Guerin therapy for early-stage bladder cancers in the past years, immune checkpoint inhibitors therapies demonstrate meaningful survival benefit and durable clinical response in renal cell carcinoma, urothelial carcinoma, and some prostate cancer. Despite best efforts, the benefits are limited to a minority of unselected patients due to the complexities of biomarker development. Now come the next hurdles: figuring out which patients best respond to immune checkpoint inhibitors and which patients won't respond to immune checkpoint inhibitors? How best to approach immune checkpoint inhibitors therapies to extend/maximize the treatment response as long as possible? How to overcome therapeutic resistance by specific concurrent immunomodulators or targeted therapy or chemotherapy? The role of immune checkpoint inhibitors in combination or sequencing with chemotherapy or other targeted therapies or other immunomodulating therapeutics in the early disease, neoadjuvant, adjuvant, and metastatic setting is actively under exploration. Ideal strategy for cancer care is to provide not just more time, but more quality time: there remain unmet needs for novel therapies that exploit molecular or genetic pathways to extend survival without compromising health-related quality of life for patients with advanced genitourinary malignancies. Further research is needed to discover new therapeutic strategies, and validate efficacy and effectiveness in real-world settings.
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4
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Ni Z, Sun P, Zheng J, Wu M, Yang C, Cheng M, Yin M, Cui C, Wang G, Yuan L, Gao Q, Li Y. JNK Signaling Promotes Bladder Cancer Immune Escape by Regulating METTL3-Mediated m6A Modification of PD-L1 mRNA. Cancer Res 2022; 82:1789-1802. [PMID: 35502544 DOI: 10.1158/0008-5472.can-21-1323] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/15/2021] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
The RNA N6-methyladenosine (m6A) writer methyltransferase-like 3 (METTL3) is upregulated in many types of cancer and promotes cancer progression by increasing expression of several oncogenes. Therefore, a better understanding of the mechanisms regulating METTL3 expression and the key targets of METTL3 in cancer cells could provide new therapeutic targets. In this study, we found that activated JNK signaling is associated with increased METTL3 expression in bladder cancer. Knockdown of JNK1 or administration of a JNK inhibitor impaired the binding of c-Jun with the METTL3 promoter, thereby decreasing the expression of METTL3 and global RNA m6A levels. Moreover, RNA m6A sequencing indicated enrichment of m6A in the 3'-UTR of immune checkpoint PD-L1 mRNA, which could be recognized by the m6A reader IGF2BP1 to mediate RNA stability and expression levels of PD-L1. Inhibition of JNK signaling suppressed m6A abundance in PD-L1 mRNA, leading to decreased PD-L1 expression. Functionally, METTL3 was essential for bladder cancer cells to resist the cytotoxicity of CD8+ T cells by regulating PD-L1 expression. Additionally, JNK signaling contributed to tumor immune escape in a METTL3-dependent manner both in vitro and in vivo. These data reveal the JNK/METTL3 axis as a mechanism of aberrant m6A modification and immune regulation in bladder cancer. SIGNIFICANCE The identification of a novel m6A-dependent mechanism underlying immune system evasion by bladder cancer cells reveals JNK signaling as a potential target for bladder cancer immunotherapy.
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Affiliation(s)
- Zegui Ni
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China
| | - Pengli Sun
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China
| | - Jin Zheng
- Department of Pathology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Hongkou District, Shanghai, China
| | - Mingqing Wu
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China
| | - Congcong Yang
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China
| | - Maosheng Cheng
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China
| | - Mingwei Yin
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China
| | - Chengying Cui
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China
| | - Guangxian Wang
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China
| | - Lin Yuan
- Department of Pathology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Hongkou District, Shanghai, China
| | - Qian Gao
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China.,Department of Anesthesiology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yang Li
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, Anhui, China.,Clinic Pathology Center, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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5
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Gordetsky JB, Montgomery KW, Giannico GA, Rais-Bahrami S, Thapa P, Boorjian S, Frank I, Cheville J. The Significance of Squamous Histology on Clinical Outcomes and PD-L1 Expression in Bladder Cancer. Int J Surg Pathol 2022; 30:6-14. [PMID: 34180731 DOI: 10.1177/10668969211027264] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. To compare the clinicopathologic characteristics of urothelial carcinoma (UC), urothelial carcinoma with squamous differentiation (UCSD), and squamous cell carcinoma (SCC) of the bladder, which have been suggested to differ in terms of risk factors, immunophenotype, and prognosis. Methods. We evaluated the clinicopathologic features of radical cystectomy specimens between 1980 and 2015 with a diagnosis of SCC, UCSD, and UC. PD-L1 immunohistochemistry (clinically available clones 22C3, SP142, and SP263) was performed on SCC and UCSD. Multivariate Cox regression was used to identify prognostic factors. Kaplan-Meier curves were plotted to assess cancer-specific survival (CSS). Results. Of the 1478 cases, there were 1126 UC (76%), 217 UCSD (15%), and 135 SCC (9%). Bladder cancer was more common in men than women (80% vs 20%, P < .0001). However, a higher proportion of SCC and UCSD occurred in women (SCC-36%, UCSD-22%, UC-18%). Women were significantly more likely to be never smokers in all 3 cohorts (UC: 45% vs 16%, UCSD: 44% vs 12%, SCC: 40% vs 18%, P < .0001). Patients with SCC and UCSD were at a higher pathologic stage (>pT2) at the time of cystectomy (UCSD-74%, SCC 71%, UC-44%, P < .0001) and had worse CSS compared to patients with UC (P = 0.006). SCC had higher PD-L1 scores (all clones) than UCSD (P < .0001). PD-L1 22C3 (P = .02, HR: 0.36) and SP142 scores (P = .046, HR: 0.27) predicted CSS on Kaplan-Meier analysis for SCC cases. Conclusions. UC, UCSD, and SCC are associated with different risk factors, gender distributions, and clinical outcomes. PD-L1 is expressed in SCC and UCSD, suggesting some patients may benefit from targeted therapy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- B7-H1 Antigen/metabolism
- Biomarkers, Tumor/metabolism
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/surgery
- Case-Control Studies
- Cystectomy
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Survival Analysis
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/surgery
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6
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Fornarini G, Rebuzzi SE, Banna GL, Calabrò F, Scandurra G, De Giorgi U, Masini C, Baldessari C, Naglieri E, Caserta C, Manacorda S, Maruzzo M, Milella M, Buttigliero C, Tambaro R, Ermacora P, Morelli F, Nolè F, Astolfi C, Sternberg CN. Immune-inflammatory biomarkers as prognostic factors for immunotherapy in pretreated advanced urinary tract cancer patients: an analysis of the Italian SAUL cohort. ESMO Open 2021; 6:100118. [PMID: 33984678 PMCID: PMC8134706 DOI: 10.1016/j.esmoop.2021.100118] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background Reliable and affordable prognostic and predictive biomarkers for urothelial carcinoma treated with immunotherapy may allow patients' outcome stratification and drive therapeutic options. The SAUL trial investigated the safety and efficacy of atezolizumab in a real-world setting on 1004 patients with locally advanced or metastatic urothelial carcinoma who progressed to one to three prior systemic therapies. Patients and methods Using the SAUL Italian cohort of 267 patients, we investigated the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) and the best performing one of these in combination with programmed death-ligand 1 (PD-L1) with or without lactate dehydrogenase (LDH). Previously reported cut-offs (NLR >3 and NLR >5; SII >1375) in addition to study-defined ones derived from receiver operating characteristic (ROC) analysis were used. Results The cut-off values for NLR and SII by the ROC analysis were 3.65 (sensitivity 60.4; specificity 63.0) and 884 (sensitivity 64.4; specificity 67.5), respectively. The median overall survival (OS) was 14.7 months for NLR <3.65 [95% confidence interval (CI) 9.9-not reached (NR)] versus 6.0 months for NLR ≥3.65 (95% CI 3.9-9.4); 14.7 months for SII <884 (95% CI 10.6-NR) versus 6.0 months for SII ≥884 (95% CI 3.7-8.6). The combination of SII, PD-L1, and LDH stratified OS better than SII plus PD-L1 through better identification of patients with intermediate prognosis (77% versus 48%, respectively). Multivariate analyses confirmed significant correlations with OS and progression-free survival for both the SII + PD-L1 + LDH and SII + PD-L1 combinations. Conclusion The combination of immune-inflammatory biomarkers based on SII, PD-L1, with or without LDH is a potentially useful and easy-to-assess prognostic tool deserving validation to identify patients who may benefit from immunotherapy alone or alternative therapies. Reliable biomarkers for immunotherapy may assist in treatment decision making and clinical trial design and interpretation. Immune-inflammatory biomarkers were investigated for their prognostic role within the Italian SAUL study cohort. ROC-based cut-offs were 3.65 for NLR and 884 for SII. Both NLR and SII were prognostic with SII performing slightly better than NLR. The combination of SII, PD-L1, and LDH stratified OS better than SII + PD-L1; both were independent prognostic factors.
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Affiliation(s)
- G Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S E Rebuzzi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - G L Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - F Calabrò
- Medical Oncology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
| | - G Scandurra
- Medical Oncology, Azienda Ospedaliera Cannizzaro di Catania, Catania, Italy
| | - U De Giorgi
- Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola, Italy
| | - C Masini
- Medical Oncology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - C Baldessari
- Oncology, Azienda Ospedaliero - Universitaria di Modena, Modena, Italy
| | - E Naglieri
- Division of Medical Oncology, IRCCS Istituto Tumori Bari Giovanni Paolo II - IRCCS, Bari, Italy
| | - C Caserta
- Medical Oncology Unit, Azienda Ospedaliera S. Maria, Terni, Italy
| | - S Manacorda
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - M Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto, IOV-IRCCS, Padua, Italy
| | - M Milella
- Dipartimento di Oncologia, Policlinico Universitario G.B. Rossi Borgo Roma, Verona, Italy
| | - C Buttigliero
- Medical Oncology, Università degli Studi di Torino, Turin, Italy
| | - R Tambaro
- U.O.C di Oncologia Sperimentale Uroginecologica, I.N.T. IRCCS Fondazione G. Pascale, Naples, Italy
| | - P Ermacora
- Dipartimento di Oncologia, Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | - F Morelli
- Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - F Nolè
- IEO, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - C Astolfi
- Medical Affairs & Clinical Operation, Roche S.p.A., Monza, Italy
| | - C N Sternberg
- Hematology and Oncology, Englander Institute for Precision Medicine Weill Cornell Medicine, New York-Presbyterian, New York, USA.
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7
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Lombardo K, Murati-Amador B, Parimi V, Hoffman-Censits J, Choi W, Hahn NM, Kates M, Bivalacqua TJ, McConkey D, Hoque MO, Matoso A. Urothelial Carcinoma In Situ of the Bladder: Correlation of CK20 Expression With Adaptive Immune Resistance, Response to BCG Therapy, and Clinical Outcome. Appl Immunohistochem Mol Morphol 2021; 29:127-135. [PMID: 32858539 PMCID: PMC7878196 DOI: 10.1097/pai.0000000000000872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Abstract
Immunohistochemical stains have been suggested to aid in diagnostically challenging cases of urothelial carcinoma in-situ (CIS). Although full thickness immunostaining for CK20 is supportive of CIS, a subset of CIS cases is CK20(-), the clinical significance of which was unknown. This study included 43 patients with primary diagnosis of bladder CIS including 32 with only CIS, 5 with CIS and separate noninvasive high-grade papillary urothelial carcinoma, and 6 with CIS and separate high-grade urothelial carcinoma with lamina propria invasion. Digital morphometric image analysis showed that the average nuclear areas of enlarged nuclei were similar in CK20(+) and CK20(-) CIS (26.9 vs. 24.5 µM2; P=0.31). Average Ki67 index for CK20(+) CIS was higher than CK20(-) CIS (31.1% vs. 18.3%; P=0.03). Patients with CK20(+) CIS [28 (65%)] and patients with CK20(-) CIS [15 (35%)] had the same rates of Bacillus Calmete-Guerin (BCG) failure but patients with CK20(-) CIS had higher stage progression [3 CK20(+) (11%) vs. 6 CK20(-) (40%); P=0.02]. Given recent approval of immune checkpoint inhibitors in patients with CIS refractory to BCG, programmed death ligand-1 expression and colocalization with CD8(+) lymphocytes was investigated as signature of adaptive immune response and was seen in 8 patients regardless of CK20 status and exclusively among patients who failed BCG. Our results confirm that negative CK20 IHC does not exclude CIS and that those patients have similar clinical outcomes as patients with CK20(+) CIS. Programmed death ligand-1 and CD8 colocalization seen among patients who failed BCG therapy is an easy assay to perform to identify patients who could potentially benefit from combined BCG therapy and immune checkpoint inhibition.
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Affiliation(s)
- Kara Lombardo
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231
| | - Belkiss Murati-Amador
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
| | - Vamsi Parimi
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
| | - Jean Hoffman-Censits
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231
| | - Woonyoung Choi
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231
| | - Noah M. Hahn
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231
| | - Max Kates
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231
| | - Trinity J. Bivalacqua
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231
| | - David McConkey
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231
| | - Mohammad O. Hoque
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
| | - Andres Matoso
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231
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8
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Daro-Faye M, Kassouf W, Souhami L, Marcq G, Cury F, Niazi T, Sargos P. Combined radiotherapy and immunotherapy in urothelial bladder cancer: harnessing the full potential of the anti-tumor immune response. World J Urol 2020; 39:1331-1343. [PMID: 32915313 PMCID: PMC7484608 DOI: 10.1007/s00345-020-03440-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/03/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Radiotherapy (RT), as part of trimodal therapy, is an attractive alternative treatment in patients with urothelial muscle-invasive bladder cancer (MIBC). There is accumulating evidence suggesting the immunomodulatory effects of RT and its potential synergy when combined with immunotherapy. The aim of this review was to report on the most recent advances on this combination, including the mechanisms of RT immunomodulation, practical approach to combining RT and immunotherapy, and ongoing clinical trials in bladder cancer. METHODS Using the PubMed database, we identified articles published between March 2004 and April 2020 on the combination of RT with immunotherapy in localized or metastatic MIBC. A search of the Clinicaltrials.gov and Clinicaltrialsregister.eu/ retrieved ongoing clinical trials on the topic as well. RESULTS Combination of RT with immunotherapy leads to immunogenic cell death and an increase in immune markers thus leading to improved tumor control. For localized MIBC, there are safety concerns related to the use of concurrent immunotherapy with hypofractionated RT, thus neoadjuvant or adjuvant immunotherapy is preferred. In the metastatic setting, the combination of multi-site RT with SBRT-like doses (≥ 6 Gy per fraction) and concurrent immunotherapy seems most efficacious at harnessing the abscopal effect. At least 25 clinical trials combining immunotherapy and RT in MIBC are currently ongoing and will answer pending questions on safety, efficacy, and practical considerations on RT scheduling, fractionation, and targets volumes. CONCLUSION RT has the potential to synergize with immunotherapy to improve oncological outcomes in patient with localized or metastatic MIBC. Clinical trials results are eagerly awaited.
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Affiliation(s)
- Mame Daro-Faye
- Department of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, QC, Canada
| | - Luis Souhami
- Fellow of the American Society for Radiation Oncology (FASTRO), Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Gautier Marcq
- Department of Urology, McGill University Health Center, Montreal, QC, Canada.,Univ. Lille, Inserm, CHU Lille, U1189-ONCO-THAI-Laser Assisted Therapies and Immunotherapies for Oncology, 59000, Lille, France.,Department of Urology, Claude Huriez Hospital, CHU Lille, 59000, Lille, France
| | - Fabio Cury
- Fellow of the American Society for Radiation Oncology (FASTRO), Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Tamim Niazi
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Paul Sargos
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada. .,Department of Radiation Oncology, Comprehensive Cancer Center, Institut Bergonie, 33076, Bordeaux Cedex, France.
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