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Uchimoto T, Matsuda T, Komura K, Fukuokaya W, Adachi T, Hirasawa Y, Hashimoto T, Yoshizawa A, Saruta M, Hashimoto M, Higashio T, Tsuchida S, Nishimura K, Tsujino T, Nakamura K, Fukushima T, Nishio K, Yamamoto S, Iwatani K, Urabe F, Mori K, Yanagisawa T, Tsuduki S, Takahara K, Inamoto T, Miki J, Fujita K, Kimura T, Ohno Y, Shiroki R, Uemura H, Azuma H. C-Reactive Protein-Albumin Ratio Predicts Objective Response to Enfortumab Vedotin in Metastatic Urothelial Carcinoma. Target Oncol 2024:10.1007/s11523-024-01068-7. [PMID: 38807017 DOI: 10.1007/s11523-024-01068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Enfortumab vedotin (EV), an antibody-drug conjugate that targets Nectin-4, is used for patients with metastatic urothelial carcinoma who have experienced progression on platinum-based chemotherapy and checkpoint inhibitors. Despite the widespread use of the drug, evidence remains scarce regarding clinical indicators that can predict the response to EV treatment. OBJECTIVE We aimed to explore the predictive value of clinical indicators derived from peripheral blood tests for treatment responses to EV. METHODS We utilized records of 109 patients with metastatic urothelial carcinoma treated by EV from our multi-institutional dataset. Receiver operating characteristic curve analyses for predicting objective responses including several indicators from blood examinations, such as C-reactive protein-albumin ratio (CAR), hemoglobin, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lactate dehydrogenase, were performed. The optimal cutoff points were determined by the Youden index. Logistic regression analyses for achieving objective responses to EV treatment were performed among these indicators. RESULTS The median age of the cohort was 74 years, and the median follow-up duration was 10 months for the entire group. Median overall survival and progression-free survival from the initiation of EV were 12 and 6 months, respectively. The objective response rate and disease control rate were 48% and 70%, respectively. The receiver operating characteristic curve analysis aimed at predicting the achievement of an objective response to EV showed that the concordant index for the CAR was 0.774, significantly surpassing other indicators such as hemoglobin level, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and serum lactate dehydrogenase. The Youden index identified an optimal cutoff value of 1 for CAR (mg/L for C-reactive protein and g/dL for serum albumin level) in predicting the objective response to EV treatment. Using the cutoff value for the CAR, the cohort was divided into 32 patients (29%) with lower CAR and 77 patients (71%) with higher CAR. The objective response rate was observed to be 84% in the lower CAR group and 32% in the higher CAR group (p < 0.0001). A logistic regression analysis revealed that an Eastern Cooperative Oncology Group Performance Status ≥1 (p = 0.04) and a CAR ≥1 (p < 0.001) were identified as independent predictors for the objective response to EV. CONCLUSIONS The evaluation of the CAR from a concise blood examination at the initiation of EV could effectively predict the treatment response to EV in patients with metastatic urothelial carcinoma after the progression of platinum-based chemotherapy and checkpoint inhibitors.
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Affiliation(s)
- Taizo Uchimoto
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Takuya Matsuda
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kazumasa Komura
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
- Division of Translational Research, Department of Urology, Osaka Medical and Pharmaceutical University, Daigaku-machi 2-7, Takatsuki, Japan.
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takahiro Adachi
- Department of Urology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yosuke Hirasawa
- Department of Urology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Hashimoto
- Department of Urology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Atsuhiko Yoshizawa
- Department of Urology, Fujita-Health University School of Medicine, Kutsukake, Toyoake, Aichi Nagoya, Japan
| | - Masanobu Saruta
- Department of Urology, Fujita-Health University School of Medicine, Kutsukake, Toyoake, Aichi Nagoya, Japan
| | - Mamoru Hashimoto
- Department of Urology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Takuya Higashio
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shuya Tsuchida
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kazuki Nishimura
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Takuya Tsujino
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Ko Nakamura
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Tatsuo Fukushima
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kyosuke Nishio
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shutaro Yamamoto
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shunsuke Tsuduki
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita-Health University School of Medicine, Kutsukake, Toyoake, Aichi Nagoya, Japan
| | - Teruo Inamoto
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazutoshi Fujita
- Department of Urology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yoshio Ohno
- Department of Urology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita-Health University School of Medicine, Kutsukake, Toyoake, Aichi Nagoya, Japan
| | - Hirotsugu Uemura
- Department of Urology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
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Xu X, Zhao Y, Ying Y, Zhu H, Luo J, Mou T, Zhang Z. m7G-related genes-NCBP2 and EIF4E3 determine immune contexture in head and neck squamous cell carcinoma by regulating CCL4/CCL5 expression. Mol Carcinog 2023; 62:1091-1106. [PMID: 37067401 DOI: 10.1002/mc.23548] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/15/2023] [Accepted: 04/09/2023] [Indexed: 04/18/2023]
Abstract
Aberrant N7 -methylguanosine (m7G) levels closely correlate with tumor genesis and progression. NCBP2 and EIF4E3 are two important m7G-related cap-binding genes. This study aimed to identify the relationship between the EIF4E3/NCBP2 function and immunological characteristics of head and neck squamous cell carcinoma (HNSCC). Hierarchical clustering was employed in classifying HNSCC patients into two groups based on the expressions of NCBP2 and EIF4E3. The differentially expressed genes were identified between the two groups, and GO functional enrichment was subsequently performed. Weighted gene co-expression network analysis was conducted to identify the hub genes related to EIF4E3/NCBP2 expression and immunity. The differential infiltration of immune cells and the response to immunotherapy were compared between the two groups. Single-cell sequence and trajectory analyses were performed to predict cell differentiation and display the expression of EIF4E3/NCBP2 in each state. In addition, quantitative real-time PCR, spatial transcriptome analysis, transwell assay, and western blotting were conducted to verify the biological function of EIF4E3/NCBP2. Here, group A showed a higher EIF4E3 expression and a lower NCBP2 expression, which had higher immune scores, proportion of most immune cells, immune activities, expression of immunomodulatory targets, and a better response to cancer immunotherapy. Besides, 56 hub molecules with notable immune regulation significance were identified. A risk model containing 17 hub genes and a prognostic nomogram was successfully established. Moreover, HNSCC tissues had a lower EIF4E3 expression and a higher NCBP2 expression than normal tissues. NCBP2 and EIF4E3 played a vital role in the differentiation of monocytes. Furthermore, the expression of CCL4/CCL5 can be regulated via EIF4E3 overexpression and NCBP2 knockdown. Collectively, NCBP2 and EIF4E3 can affect downstream gene expression, as well as immune contexture and response to immunotherapy, which could induce "cold-to-hot" tumor transformation in HNSCC patients.
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Affiliation(s)
- Xuhui Xu
- Department of Stomatology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Yue Zhao
- Department of Stomatology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Yukang Ying
- Department of Stomatology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Haoran Zhu
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jun Luo
- Department of Stomatology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Tingchen Mou
- Department of Stomatology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Zhenxing Zhang
- Department of Stomatology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
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Politis D, Konstantakou P, Bramis K, Alexandraki KI, Spyroglou A, Mastorakos G, Anastasiou I, Papaconstantinou I, Dimopoulos MA. Surgical Treatment of Solitary Metachronous Adrenal Metastasis from Urothelial Carcinoma of the Urinary Bladder. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:94-97. [PMID: 37313235 PMCID: PMC10258614 DOI: 10.17925/ee.2023.19.1.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/19/2022] [Indexed: 06/15/2023]
Abstract
Urothelial cancer is a common neoplasm and metastatic disease correlates with a poor prognosis. Isolated adrenal gland metastases of urothelial carcinoma are quite rare, and management options can decide a patient's prognosis. Herein we report the case of a 76-year-old man with a metachronous solitary adrenal metastasis from a bladder carcinoma, who underwent adrenalectomy as part of his treatment. Furthermore, we discuss the cases of solitary adrenal metastases of urothelial carcinoma available in the literature, to identify key features to direct appropriate treatment of this rare metastatic site of urothelial cancer and improve prognosis and survival. Still, further prospective studies are needed to design effective therapeutic strategies.
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Affiliation(s)
- Dimitrios Politis
- Second Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Panagiota Konstantakou
- Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Bramis
- Second Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Krystallenia I Alexandraki
- Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ariadni Spyroglou
- Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - George Mastorakos
- Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis Anastasiou
- First Department of Urology, National and Kapodistrian University of Athens, Laikon University Hospital, Athens, Greece
| | - Ioannis Papaconstantinou
- Second Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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Zhu Y, Chen J, Zhou L, Zhang L, Liu Y, Zhuang Y, Peng L, Huang YT. A Platinum Resistance-Related lncRNA Signature for Risk Classification and Prognosis Prediction in Patients with Serous Ovarian Cancer. JOURNAL OF ONCOLOGY 2022; 2022:7625138. [PMID: 37223641 PMCID: PMC10202609 DOI: 10.1155/2022/7625138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/11/2022]
Abstract
Accurate risk stratification for patients with serous ovarian cancer (SOC) is pivotal for treatment decisions. In this study, we identified a lncRNA-based signature for predicting platinum resistance and prognosis stratification for SOC patients. We analyzed the RNA-sequencing data and the relevant clinical information of 295 SOC samples obtained from The Cancer Genome Atlas (TCGA) database and 180 normal ovarian tissues from the Genotype-Tissue Expression (GTEx) database. A total of 284 differentially expressed lncRNAs were screened out between platinum-sensitive and platinum-resistant groups by univariate Cox regression analysis. Then, a signature consisting of eight prognostic lncRNAs was used to construct a lncRNA score model by least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression analysis. The ROC analysis showed that this signature had a good predictive performance for chemotherapy response in the training set (AUC = 0.8524) and the testing and whole sets with 0.8142 and 0.8393 of AUC, respectively. Dichotomized by the risk score of lncRNAs (lncScore), the high-risk patients showed significantly shorter progression-free survival (PFS) and overall survival (OS). Based on the final Cox model, a nomogram comprising the 8-lncRNA signature and 3 clinicopathological risk factors was then established for clinical application to predict the 1, 2, and 3-year PFS of SOC patients. The gene set enrichment analysis (GSEA) revealed that genes in the high-risk group were active in ATP synthesis, coupled electron transport, and mitochondrial respiratory chain complex assembly. Overall, our findings demonstrated the potential clinical significance of the 8-lncRNA-based classifier as a novel biomarker for outcome prediction and therapy decisions in SOC patients with platinum treatment.
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Affiliation(s)
- Yan Zhu
- Health Care Center, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
- Medical Laboratory, Shenzhen Luohu People's Hospital, Shenzhen 518001, Guangdong, China
| | - Jiongyu Chen
- Central Laboratory, Cancer Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Li Zhou
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Lina Zhang
- Health Care Center, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Yuxin Liu
- Health Care Center, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Yixuan Zhuang
- Department of Pathology, Cancer Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Lin Peng
- Central Laboratory, Cancer Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Yi-Teng Huang
- Health Care Center, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
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5
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Lin CT, Su PJ, Huang SY, Wu CC, Wang HJ, Cheng YT, Luo HL, Chen CH, Liu TT, Huang CC, Su YL. First-line Immune Checkpoint Inhibitor Versus Immune Checkpoint Inhibitor With Chemotherapy for Cisplatin-ineligible Metastatic Urothelial Carcinoma: Evidence From a Real-world, Multicenter Analysis. J Immunother 2022; 45:407-414. [PMID: 36121316 PMCID: PMC9528941 DOI: 10.1097/cji.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022]
Abstract
Immune checkpoint inhibitors (ICIs) are widely used for first-line cisplatin-ineligible patients with metastatic urothelial carcinoma (mUC). However, whether to use ICIs as monotherapy or in combination with chemotherapy is still uncertain. We retrospectively analyzed cisplatin-ineligible patients with mUC who underwent first-line ICI monotherapy or ICI plus chemotherapy at 2 medical centers in Taiwan from 2016 to 2021. We calculated the objective response rate, progression-free survival, and overall survival (OS) using the Kaplan-Meier method and Cox regression model for multivariable analysis. In total, 130 patients were enrolled and categorized into 2 groups: an ICI monotherapy group [immunotherapy (IO), n=101] and an ICI plus noncisplatin chemotherapy group [immunotherapy and chemotherapy (IC), n=29]. The median OS of patients in the IO and IC groups was 19.5 and 9.7 months ( P =0.33). Among patients with high programmed cell death ligand-1-expressing tumors, the median OS was significantly prolonged in the IO group compared with the IC group (not reached vs. 6.3 mo, P =0.02). First-line ICI monotherapy demonstrated robust antitumor activity in cisplatin-ineligible patients with mUC. Combining noncisplatin chemotherapy with ICI did not improve clinical outcomes.
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Affiliation(s)
- Chang-Ting Lin
- Division of Hematology Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung
| | - Po-Jung Su
- Division of Hematology Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, College of Medicine, Taoyuan
| | - Shih-Yu Huang
- Division of Hematology Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung
| | - Chia-Che Wu
- Division of Hematology Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung
| | | | | | | | | | | | - Chun-Chieh Huang
- Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine
| | - Yu-Li Su
- Division of Hematology Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung
- Clinical Trial Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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6
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Wang J, Zhang W, Hou W, Zhao E, Li X. Molecular Characterization, Tumor Microenvironment Association, and Drug Susceptibility of DNA Methylation-Driven Genes in Renal Cell Carcinoma. Front Cell Dev Biol 2022; 10:837919. [PMID: 35386197 PMCID: PMC8978676 DOI: 10.3389/fcell.2022.837919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Accumulating evidence suggests that DNA methylation has essential roles in the development of renal cell carcinoma (RCC). Aberrant DNA methylation acts as a vital role in RCC progression through regulating the gene expression, yet little is known about the role of methylation and its association with prognosis in RCC. The purpose of this study is to explore the DNA methylation-driven genes for establishing prognostic-related molecular clusters and providing a basis for survival prediction. In this study, 5,198 differentially expressed genes (DEGs) and 270 DNA methylation-driven genes were selected to obtain 146 differentially expressed DNA methylation-driven genes (DEMDGs). Two clusters were distinguished by consensus clustering using 146 DEMDGs. We further evaluated the immune status of two clusters and selected 106 DEGs in cluster 1. Cluster-based immune status analysis and functional enrichment analysis of 106 DEGs provide new insights for the development of RCC. To predict the prognosis of patients with RCC, a prognostic model based on eight DEMDGs was constructed. The patients were divided into high-risk groups and low-risk groups based on their risk scores. The predictive nomogram and the web-based survival rate calculator (http://127.0.0.1:3496) were built to validate the predictive accuracy of the prognostic model. Gene set enrichment analysis was performed to annotate the signaling pathways in which the genes are enriched. The correlation of the risk score with clinical features, immune status, and drug susceptibility was also evaluated. These results suggested that the prognostic model might be a promising prognostic tool for RCC and might facilitate the management of patients with RCC.
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Affiliation(s)
- Jinpeng Wang
- Department of Urology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Zhang
- Department of Urology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenbin Hou
- Department of Urology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Enyang Zhao
- Department of Urology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuedong Li
- Department of Urology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Park JH, Park I, Kim IH, Hur JY, Hwang I, Kim C, Kim HJ, Maeng CH, Park K, Lee MY, Lee HJ, Jung JY, Keam B, Park SH, Lee JL. Prognostic model in patients with metastatic urothelial carcinoma receiving immune checkpoint inhibitors after platinum failure. Curr Probl Cancer 2022; 46:100848. [PMID: 35344842 DOI: 10.1016/j.currproblcancer.2022.100848] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
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8
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Lau HC, Shen Y, Huang Q, Huang HY, Zhou L. Glycolysis related gene expression signature in predicting prognosis of laryngeal squamous cell carcinoma. Bioengineered 2021; 12:8738-8752. [PMID: 34565301 PMCID: PMC8806568 DOI: 10.1080/21655979.2021.1980177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Researches have suggested that aerobic glycolysis can reflect the development and progression of most carcinomas. We aimed to investigate whether glycolysis-related genes (GRGs) are associated with overall survival in laryngeal squamous cell carcinoma (LSCC). Here, we identified differentially expressed GRGs in TCGA dataset and microarray sample of GSE27020 from GEO database. A set of two glycolytic gene signatures, including DDIT4 and PLOD2 was screened through Cox and Lasso regression. The risk score was calculated using the gene expression of the two GRGs. The high-risk group presented a poor prognosis through Kaplan–Meier method. The ROC curve indicated good prediction performance in survival based on the validation of four cohorts. Univariate and multivariate Cox regression analyses suggested that two-gene signature could be an independent risk factor in LSCC. A total of 17 LSCC patients were enrolled to clarify the genetic expression through using reverse transcription-polymerase chain reaction (RT-PCR). A visualized nomogram was then constructed to predict 1-, 3-, and 5-year overall survival. Taken together, two novel glycolytic gene signatures were discovered and validated, providing a potential therapeutic and overall survival (OS)-prediction biomarker for LSCC.
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Affiliation(s)
- Hui-Ching Lau
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, PR China
| | - Yujie Shen
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, PR China
| | - Qiang Huang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, PR China
| | - Hui-Ying Huang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, PR China
| | - Liang Zhou
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, PR China
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9
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Khaki AR, Li A, Diamantopoulos LN, Miller NJ, Carril-Ajuria L, Castellano D, De Kouchkovsky I, Koshkin V, Park J, Alva A, Bilen MA, Stewart T, Santos V, Agarwal N, Jain J, Zakharia Y, Morales-Barrera R, Devitt M, Nelson A, Hoimes CJ, Shreck E, Gartrell BA, Sankin A, Tripathi A, Zakopoulou R, Bamias A, Rodriguez-Vida A, Drakaki A, Liu S, Kumar V, Lythgoe MP, Pinato DJ, Murgic J, Fröbe A, Joshi M, Isaacsson Velho P, Hahn N, Alonso Buznego L, Duran I, Moses M, Barata P, Galsky MD, Sonpavde G, Yu EY, Shankaran V, Lyman GH, Grivas P. A New Prognostic Model in Patients with Advanced Urothelial Carcinoma Treated with First-line Immune Checkpoint Inhibitors. Eur Urol Oncol 2021; 4:464-472. [PMID: 33423945 PMCID: PMC8169524 DOI: 10.1016/j.euo.2020.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND While immune checkpoint inhibitors (ICIs) are approved in the first-line (1L) setting for cisplatin-unfit patients with programmed death-ligand 1 (PD-L1)-high tumors or for platinum (cisplatin/carboplatin)-unfit patients, response rates remain modest and outcomes vary with no clinically useful biomarkers (except for PD-L1). OBJECTIVE We aimed to develop a prognostic model for overall survival (OS) in patients receiving 1L ICIs for advanced urothelial cancer (aUC) in a multicenter cohort study. DESIGN, SETTING, AND PARTICIPANTS Patients treated with 1L ICIs for aUC across 24 institutions and five countries (in the USA and Europe) outside clinical trials were included in this study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used a stepwise, hypothesis-driven approach using clinician-selected covariates to develop a new risk score for patients receiving ICIs in the 1L setting. Demographics, clinicopathologic data, treatment patterns, and OS were collected uniformly. Univariate Cox regression was performed on 18 covariates hypothesized to be associated with OS based on published data. Variables were retained for multivariate analysis (MVA) if they correlated with OS (p < 0.2) and were included in the final model if p < 0.05 on MVA. Retained covariates were assigned points based on the beta coefficient to create a risk score. Stratified median OS and C-statistic were calculated. RESULTS AND LIMITATIONS Among 984 patients, 357 with a mean age of 71 yr were included in the analysis, 27% were female, 68% had pure UC, and 13% had upper tract UC. Eastern Cooperative Oncology Group performance status ≥2, albumin <3.5 g/dl, neutrophil:lymphocyte ratio >5, and liver metastases were significant prognostic factors on MVA and were included in the risk score. C index for new 1L risk score was 0.68 (95% confidence interval 0.65-0.71). Limitations include retrospective nature and lack of external validation. CONCLUSIONS We developed a new 1L ICI risk score for OS based on data from patients with aUC treated with ICIs in the USA and Europe outside of clinical trials. The score components highlight readily available factors related to tumor biology and treatment response. External validation is being pursued. PATIENT SUMMARY With multiple new treatments under development and approved for advanced urothelial carcinoma, it can be difficult to identify the best treatment sequence for each patient. The risk score may help inform treatment discussions and estimate outcomes in patients treated with first-line immune checkpoint inhibitors, while it can also impact clinical trial design and endpoints. TAKE HOME MESSAGE: A new risk score was developed for advanced urothelial carcinoma treated with first-line immune checkpoint inhibitors. The score assigned Eastern Cooperative Oncology Group performance status ≥2, albumin <3.5 g/dl, neutrophil:lymphocyte ratio >5, and liver metastases each one point, with a higher score being associated with worse overall survival.
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Affiliation(s)
- Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Ang Li
- Section of Hematology/Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Natalie J Miller
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Ivan De Kouchkovsky
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vadim Koshkin
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph Park
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ajjai Alva
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Tyler Stewart
- Division of Oncology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Victor Santos
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Neeraj Agarwal
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jayanshu Jain
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Michael Devitt
- Division of Hematology/Oncology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ariel Nelson
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA; Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher J Hoimes
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA; Division of Medical Oncology, Duke University, Durham, NC, USA
| | - Evan Shreck
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Benjamin A Gartrell
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Alex Sankin
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Abhishek Tripathi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar Research Institute, Barcelona, Spain
| | - Alexandra Drakaki
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sandy Liu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vivek Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark P Lythgoe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, School of Dental Medicine, Zagreb, Croatia
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, School of Dental Medicine, Zagreb, Croatia
| | - Monika Joshi
- Division of Hematology/Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA, USA
| | - Pedro Isaacsson Velho
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Noah Hahn
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Marcus Moses
- Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA, USA
| | - Pedro Barata
- Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA, USA
| | - Matthew D Galsky
- Division of Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guru Sonpavde
- Genitourinary Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Veena Shankaran
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Gary H Lyman
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA.
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10
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Bamias A, Merseburger AS, Loriot Y, James N, Choy E, Castellano D, Lopez-Rios F, Calabrò F, Kramer M, de Velasco G, Zakopoulou R, Tzannis K, Sternberg CN. SAUL, a single-arm study of atezolizumab for chemotherapy-pretreated locally advanced or metastatic carcinoma of the urinary tract: outcomes by key baseline factors, PD-L1 expression and prior platinum therapy. ESMO Open 2021; 6:100152. [PMID: 33984672 PMCID: PMC8134736 DOI: 10.1016/j.esmoop.2021.100152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/06/2021] [Accepted: 04/17/2021] [Indexed: 11/19/2022] Open
Abstract
Background The impact of pretreatment factors on immune checkpoint inhibition in platinum-refractory advanced urothelial cancer (aUC) deserves further evaluation. The aim was to study the association of Bellmunt risk factors, time from last chemotherapy (TFLC), previous therapy and PD-L1 expression with atezolizumab efficacy in platinum-refractory aUC. Patients and methods This was a post-hoc analysis of patients who had received prior cisplatin or carboplatin in the prospective, single-arm, phase IIIb SAUL study (NCT02928406). Patients were treated with 3-weekly atezolizumab 1200 mg intravenously. The primary outcome was overall survival (OS). Relationships were analysed using Cox regression and long-rank test. Results Of 997 patients in SAUL, 969 were eligible for this analysis. The number of Bellmunt risk factors was associated with OS (P < 0.001); median OS (mOS) for 0, 1 and 2-3 risk factors was 17.9, 8.9 and 3.3 months, respectively. Significant associations were also observed between OS and TFLC (P < 0.001), programmed death-ligand 1 (PD-L1) expression (P = 0.002), and prior perioperative chemotherapy (P = 0.013); mOS was 6.97 versus 11.63 months for TFLC ≤6 versus >6 months, 7.75 versus 11.6 months for PD-L1 expression on <1% of tumour-infiltrating immune cells (ICs) (IC0)/expression on 1% to <5% of tumour-infiltrating ICs (IC1) versus expression on ≥5% of tumour-infiltrating ICs (IC2/3) and 10.2 versus 7.8 months for prior versus no prior perioperative chemotherapy, respectively. The type of platinum compound and number of previous treatment lines were not associated with outcomes. Conclusions Post-platinum atezolizumab is active in aUC, irrespective of previous platinum compound and lines of therapy. Bellmunt risk stratification, PD-L1 expression, TFLC and perioperative chemotherapy were identified as prognostic factors for OS with second-line atezolizumab, indicating the need for novel prognostic signatures for immunotherapy-treated patients with aUC. Bellmunt stratification is an accepted risk algorithm in second-line chemotherapy for aUC. The impact of pretreatment factors on immune checkpoint inhibition in aUC requires further evaluation. We studied the prognostic significance of pretreatment factors in post-platinum immunotherapy of aUC in real-world setting. Bellmunt factors, TFLC, prior therapy and PD-L1 expression were identified as prognostic factors. Our results suggest a need for novel prognostic signatures for immunotherapy in aUC.
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Affiliation(s)
- A Bamias
- Second Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National & Kapodistrian University of Athens, Athens, Greece.
| | - A S Merseburger
- Department of Urology, University Clinic Schleswig-Holstein-Lu¨beck, Lu¨beck, Germany
| | - Y Loriot
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - N James
- Institute of Cancer Research, The Royal Marsden Hospital NHS Foundation Trust, London
| | - E Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - D Castellano
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Lopez-Rios
- Pathology Laboratory of Therapeutic Targets, HM Sanchinarro University Hospital, Madrid, Spain
| | - F Calabrò
- GU Oncology Unit, San Camillo and Forlanini Hospital, Rome, Italy
| | - M Kramer
- Department of Urology, University Clinic Schleswig-Holstein-Lu¨beck, Lu¨beck, Germany
| | - G de Velasco
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Zakopoulou
- Clinical Therapeutics, University of Athens, Athens, Greece
| | - K Tzannis
- Second Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - C N Sternberg
- Englander Institute for Precision Medicine, Department of Medical Oncology, Weill Cornell Medicine, Meyer Cancer Center, New York, USA
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11
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Ito K, Kobayashi T, Kojima T, Hikami K, Yamada T, Ogawa K, Nakamura K, Sassa N, Yokomizo A, Abe T, Tsuchihashi K, Tatarano S, Inokuchi J, Tomida R, Fujiwara M, Takahashi A, Matsumoto K, Shimizu K, Araki H, Kurahashi R, Osaki Y, Tashiro Y, Uegaki M, Ogawa O, Kitamura H, Nishiyama H. Pembrolizumab for treating advanced urothelial carcinoma in patients with impaired performance status: Analysis of a Japanese nationwide cohort. Cancer Med 2021; 10:3188-3196. [PMID: 33931987 PMCID: PMC8124127 DOI: 10.1002/cam4.3863] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background The benefits of pembrolizumab in patients with advanced urothelial carcinoma (UC) and impaired performance status (PS) remain unknown. This study assessed the safety and efficacy of pembrolizumab in patients with platinum‐refractory UC and Eastern Cooperative Oncology Group PS ≥2 to identify which subgroups may benefit from this drug. Methods This retrospective nationwide cohort study collected clinicopathological information for 755 patients from 59 institutions. The overall response rate (ORR) and overall survival (OS) were compared among the patients with PS 0–1, 2, and 3–4. Multivariate analysis was conducted to identify factors predicting OS in patients with PS ≥2. Results The numbers of patients with PS 0–1, 2, and 3–4 were 602, 98, and 55, respectively; the ORRs in these groups were 29.5, 15.3, and 9.1%, respectively, and the median OS times were 14.3, 3.1, and 2.4 months, respectively. In multivariate Cox regression analysis, a neutrophil–lymphocyte ratio (NLR) ≥3.5 (hazard ratio [HR] = 1.897) and liver metastasis (HR = 2.072) were associated with OS in the PS ≥2 subgroup. The median OS of patients with PS ≥2 without either risk factor was 6.8 months, compared with 3.1 months for patients with one risk factor and 2.3 months for patients with both risk factors. Conclusions PS ≥2 portended worse ORR and OS than PS ≤1 despite a comparable safety profile. Among the patients with impaired PS, patients with NLR <3.5 and no liver metastasis may most greatly benefit from pembrolizumab therapy.
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Affiliation(s)
- Katsuhiro Ito
- Department of Urology, Kyoto University Hospital, Kyoto, Japan.,Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.,Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Hospital, Kyoto, Japan.,Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba, Ibaraki, Japan
| | - Kensuke Hikami
- Department of Urology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takeshi Yamada
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kosuke Ogawa
- Department of Urology, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
| | - Kenji Nakamura
- Department of Urology, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Naoto Sassa
- Department of Urology, Nagoya University, Aichi, Japan
| | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | | | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryotaro Tomida
- Department of Urology, Shikoku Cancer Center, Ehime, Japan
| | | | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hokkaido, Japan
| | | | - Kosuke Shimizu
- Department of Urology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hiromasa Araki
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Yu Osaki
- Department of Urology, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Yu Tashiro
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | | | - Osamu Ogawa
- Department of Urology, Kyoto University Hospital, Kyoto, Japan.,Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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12
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Kobayashi T, Ito K, Kojima T, Kato M, Kanda S, Hatakeyama S, Matsui Y, Matsushita Y, Naito S, Shiga M, Miyake M, Muro Y, Nakanishi S, Kato Y, Shibuya T, Hayashi T, Yasumoto H, Yoshida T, Uemura M, Taoka R, Kamiyama M, Ogawa O, Kitamura H, Nishiyama H. Risk stratification for the prognosis of patients with chemoresistant urothelial cancer treated with pembrolizumab. Cancer Sci 2020; 112:760-773. [PMID: 33283385 PMCID: PMC7893997 DOI: 10.1111/cas.14762] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
The use of immune checkpoint inhibitors to treat urothelial carcinoma (UC) is increasing rapidly without clear guidance for validated risk stratification. This multicenter retrospective study collected clinicopathological information on 463 patients, and 11 predefined variables were analyzed to develop a multivariate model predicting overall survival (OS). The model was validated using an independent dataset of 292 patients. Patient characteristics and outcomes were well balanced between the discovery and validation cohorts, which had median OS times of 10.2 and 12.5 mo, respectively. The final validated multivariate model was defined by risk scores based on the hazard ratios (HRs) of independent prognostic factors including performance status, site of metastasis, hemoglobin levels, and the neutrophil‐to‐lymphocyte ratio. The median OS times (95% confidence intervals [CIs]) for the low‐, intermediate‐, and high‐risk groups (discovery cohort) were not yet reached (NYR) (NYR–19.1), 6.8 mo (5.8‐8.9), and 2.3 mo (1.2‐2.6), respectively. The HRs (95% CI) for OS in the low‐ and intermediate‐risk groups vs the high‐risk group were 0.07 (0.04‐0.11) and 0.23 (0.15‐0.37), respectively. The objective response rates for in the low‐, intermediate‐, and high‐risk groups were 48.3%, 28.8%, and 10.5%, respectively. These differential outcomes were well reproduced in the validation cohort and in patients who received pembrolizumab after perioperative or first‐line chemotherapy (N = 584). In conclusion, the present study developed and validated a simple prognostic model predicting the oncological outcomes of pembrolizumab‐treated patients with chemoresistant UC. The model provides useful information for external validation, patient counseling, and clinical trial design.
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Affiliation(s)
- Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Minoru Kato
- Department of Urology, Osaka City University, Osaka, Japan
| | - Souhei Kanda
- Department of Urology, Akita University, Akita, Japan
| | | | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sei Naito
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masanobu Shiga
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Yusuke Muro
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Yoichiro Kato
- Department of Urology, Iwate Medical University, Morioka, Japan
| | | | | | | | - Takashi Yoshida
- Department of Urology, Kansai Medical University, Hirakata, Japan
| | | | - Rikiya Taoka
- Department of Urology, Kagawa University, Kita, Japan
| | | | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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13
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Molecular and histopathology directed therapy for advanced bladder cancer. Nat Rev Urol 2019; 16:465-483. [PMID: 31289379 DOI: 10.1038/s41585-019-0208-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 12/29/2022]
Abstract
Bladder cancer is a heterogeneous group of tumours with at least 40 histological subgroups. Patients with localized disease can be cured with surgical resection or radiotherapy, but such curative options are limited in the setting of recurrent disease or distant spread, in which case systemic therapy is used to control disease and palliate symptoms. Cytotoxic chemotherapy has been the mainstay of treatment for advanced bladder cancer, but high-quality evidence is lacking to inform the management of rare subgroups that are often excluded from studies. Advances in molecular pathology, the development of targeted therapies and the resurgence of immunotherapy have led to the reclassification of bladder cancer subgroups and rigorous efforts to define predictive biomarkers for cancer therapies. In this Review, we present the current evidence for the management of conventional, variant and divergent urothelial cancer subtypes, as well as non-urothelial bladder cancers, and discuss how the integration of genomic, transcriptomic and proteomic characterization of bladder cancer could guide future therapies.
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14
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Chrom P, Kawecki M, Stec R, Bodnar L, Szczylik C, Czarnecka AM. Biomarkers defining probability of receiving second-line targeted therapy in metastatic renal cell carcinoma. Med Oncol 2018; 35:91. [PMID: 29737510 PMCID: PMC5940724 DOI: 10.1007/s12032-018-1148-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022]
Abstract
In order to facilitate long-term treatment decisions, we aimed to define biomarkers defining the probability of receiving second-line (SL) targeted therapy (TT) in patients with metastatic renal cell carcinoma (mRCC) based on their characteristics present at first-line TT initiation. We analysed 152 consecutive mRCC patients treated and used multivariable binominal logistic regression to identify factors contributing to the probability of receiving SL TT. Final model was assessed with bias-corrected indices (Nagelkerke’s R2 and area under receiver operating characteristic curve [AUC]) and two bootstrap procedures were used for internal validation. Factors associated with the probability of SL TT eligibility were the presence of brain metastases (odds ratio [OR] 0.084, 95% confidence interval [CI] 0.010–0.707), number of metastatic sites (OR 0.740, 95% CI 0.575–0.953 per each site), platelet count (OR 0.971, 95% CI 0.947–0.997, per 104/ml), lactate dehydrogenase level (OR 0.952, 95% CI 0.910–0.997 per 10 units/l), and albumin concentration (OR 1.924, 95% CI 1.057–3.503 per 1 g/dl). We developed on-line calculator that enables practicing clinicians to estimate SL treatment probability (http://www.r-calc.com).
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Affiliation(s)
- Pawel Chrom
- Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141, Warsaw, Poland
| | - Maciej Kawecki
- Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141, Warsaw, Poland.,Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Wawelska 15, 00-001, Warsaw, Poland
| | - Rafal Stec
- Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141, Warsaw, Poland
| | - Lubomir Bodnar
- Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141, Warsaw, Poland
| | - Cezary Szczylik
- Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141, Warsaw, Poland.,Medical University of Warsaw, Zwirki i Wigury 61, 02-091, Warsaw, Poland
| | - Anna M Czarnecka
- Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141, Warsaw, Poland.
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15
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Nomogram to Assess the Survival Benefit of New Salvage Agents for Metastatic Urothelial Carcinoma in the Era of Immunotherapy. Clin Genitourin Cancer 2018; 16:e961-e967. [PMID: 29706503 DOI: 10.1016/j.clgc.2018.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/31/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Optimal end points in phase 2 trials evaluating salvage therapy for metastatic urothelial carcinoma are necessary to identify promising drugs, particularly immunotherapeutics, where response and progression-free survival may be unreliable. We developed a nomogram using data from phase 2 trials of historical agents to estimate the 12-month overall survival (OS) for patients to which observed survival of nonrandomized data sets receiving immunotherapies could be compared. PATIENTS AND METHODS Survival and data for major prognostic factors were obtained from phase 2 trials: hemoglobin, performance status, liver metastasis, treatment-free interval, and albumin. A nomogram was developed to estimate 12-month OS. Patients were randomly allotted to discovery:validation data sets in a 2:1 ratio. Calibration plots were constructed in the validation data set and data bootstrapped to assess performance. The nomogram was tested on external nonrandomized cohorts of patients receiving pemetrexed and atezolizumab. RESULTS Data were available from 340 patients receiving sunitinib, everolimus, docetaxel + vandetanib, docetaxel + placebo, pazopanib, paclitaxel, or docetaxel. Calibration and prognostic ability were acceptable (c index = 0.634; 95% confidence interval [CI], 0.596-0.652). Observed 12-month survival for patients receiving pemetrexed (n = 127, 23.5%; 95% CI, 16.2-31.7) was similar to nomogram-predicted survival (19%; 95% CI, 16.5-21.5; P > .05), while observed results with atezolizumab (n = 403, 39.0%; 95% CI, 34.1-43.9) exceeded predicted results (24.6%; 95% CI, 23.4-25.8; P < .001). CONCLUSION This nomogram may be a useful tool to interpret results of nonrandomized phase 2 trials of salvage therapy for metastatic urothelial carcinoma by assessing the OS contributions of drug intervention independent of prognostic variables.
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Dong F, Shen Y, Gao F, Xu T, Wang X, Zhang X, Zhong S, Zhang M, Chen S, Shen Z. Prognostic value of site-specific metastases and therapeutic roles of surgery for patients with metastatic bladder cancer: a population-based study. Cancer Manag Res 2017; 9:611-626. [PMID: 29180897 PMCID: PMC5694197 DOI: 10.2147/cmar.s148856] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background We aimed to evaluate the prognostic value of site-specific metastases in patients with metastatic bladder cancer and analyze the roles that surgeries play in the treatment of this malignancy. Materials and methods A population-based retrospective study using Surveillance, Epidemiology and End Results dataset was performed and metastatic bladder cancer patients were classified according to the sites of metastases (bone, brain, liver, lung and distant lymph nodes). Kaplan–Meier analysis with log-rank test was used for survival comparisons. Multivariate Cox regression model was employed to analyze the effect of distant metastatic sites on overall survival (OS) and cancer-specific survival (CSS). Results A total of 1862 patients with metastatic bladder cancer from 2010 to 2014 were identified. Bone, lung and distant lymph nodes were the most common metastatic sites. Patients with bone, brain, liver and lung involvement had worse OS and CSS compared to patients without the corresponding sites of metastases. Multivariate analysis showed that bone, brain, liver and lung metastases were independent prognostic factors for both OS and CSS, while distant node metastasis was not. Moreover, patients with a single metastatic site had more favorable OS (p<0.001) and CSS (p<0.001) than patients with multisite metastases. Among single-site metastatic patients, distant nodes and liver metastases represented the best and the worst prognosis, respectively. Moreover, radical cystectomy was an independent predictor for better OS and CSS, while in patients with liver metastasis and multiple metastatic sites, RC did not bring benefits. Besides, in patients with a single metastatic site, metastasectomy seemed to be associated with favorable OS (p=0.042), especially for patients with age <65 years (p=0.006) and for muscle-invasive bladder cancer patients (p=0.031). Conclusion Distant metastatic sites have differential impact on survival outcomes in patients with metastatic bladder cancer. Surgeries, including radical cystectomy and metastasectomy, might still lead to survival benefits for highly selected patients.
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Affiliation(s)
- Fan Dong
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Yifan Shen
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Fengbin Gao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tianyuan Xu
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xianjin Wang
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Xiaohua Zhang
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Shan Zhong
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Minguang Zhang
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Shanwen Chen
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Zhoujun Shen
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
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Faltas BM, Gennarelli RL, Elkin E, Nguyen DP, Hu J, Tagawa ST. Metastasectomy in older adults with urothelial carcinoma: Population-based analysis of use and outcomes. Urol Oncol 2017; 36:9.e11-9.e17. [PMID: 28988653 DOI: 10.1016/j.urolonc.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Metastatic urothelial carcinoma of the bladder, ureter, or renal pelvis is a highly aggressive disease with poor outcomes. Even with platinum-based chemotherapy, the median overall survival is 15 months and the 5-year survival is only 15%. The role of metastasectomy in urothelial carcinoma is currently undefined. OBJECTIVE To examine the use and outcomes of metastasectomy in older patients with urothelial carcinoma in a large population-based dataset. DESIGN, SETTING, AND PARTICIPANTS We conducted a SEER-Medicare study, and from 70,648 urothelial carcinoma patients who met inclusion criteria, we identified 497 patients who had at least 1 metastasectomy during a median follow-up of 40 months. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary study endpoints were metastasectomy use, the length of stay for metastasectomy, complications, and overall survival following metastasectomy. Secondary outcomes included 30-day mortality and readmission rate following metastasectomy. RESULTS AND LIMITATIONS We identified 497 patients meeting inclusion criteria who had at least 1 metastasectomy during the study period including 24 patients who had more than 1 procedure resulting in a total of 523 metastasectomies. The median overall survival after the first metastasectomy was 19 months (95% CI: 15-23; interquartile range: 4-74). In this selected patient population, over a third of patients were alive at 3 years. In the 476 patients who had evaluable discharge dates, the median length of stay after metastasectomy was 7 days (IQR: 4-12), and 10% of patients had at least 1 complication within 30 days of discharge. Thirty-day mortality after metastasectomy was 10% (n = 53/523) and was largely driven by the mortality associated with resections of urothelial cancer brain metastases. CONCLUSIONS In well-selected patients with urothelial carcinoma with a reasonable life expectancy, resection of metastatic lesions is safe and is associated with long-term survival and potential cures.
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Affiliation(s)
- Bishoy M Faltas
- Division of Hematology and Medical Oncology, Weill-Cornell Medicine, New York, NY
| | - Renee L Gennarelli
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena Elkin
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jim Hu
- Department of Urology, Weill-Cornell Medicine, New York, NY
| | - Scott T Tagawa
- Division of Hematology and Medical Oncology, Weill-Cornell Medicine, New York, NY; Department of Urology, Weill-Cornell Medicine, New York, NY.
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18
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Sethakorn N, O'Donnell PH. Spectrum of genomic alterations in FGFR3: current appraisal of the potential role of FGFR3 in advanced urothelial carcinoma. BJU Int 2016; 118:681-691. [PMID: 27271022 DOI: 10.1111/bju.13552] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Molecular analysis has identified subsets of urothelial carcinoma (UC) expressing distinct genetic signatures. Genomic alterations in the oncogenic fibroblast growth factor receptor 3 (FGFR3) pathway are among the most well described in UC and have led to extensive and ongoing investigation of FGFR3-targeted therapies in this disease, although no new drugs have yet been approved. Given the unmet need for effective treatments in advanced and metastatic UC, a better understanding of the known molecular alterations of FGFR3 and of the previous and ongoing clinical investigations of this promising target in UC deserves attention. The objective of the present review is to describe the landscape of alterations and biology of FGFR3 in UC, comprehensively summarize the current state of UC clinical trials of FGFR3 inhibitors, and discuss future therapeutic applications. Using the Pubmed and Clinicaltrials.gov databases, articles describing the spectrum and biological activity of FGFR3 genomic alterations and trials of FGFR3 inhibitors in UC were identified. Search terms included 'FGFR3 genomic alterations' and 'urothelial cancer' or 'bladder cancer'. Genomic alterations, including translocations and activating mutations, are increasingly described in advanced and metastatic UC. The majority of clinical trials have been performed in unselected populations; however, recent studies have reported encouraging preliminary data. We argue that routine use of molecular genomic tumour analysis in UC may inform selection of patients for appropriate trials and we further investigate the potential of FGFR3 as a meaningful clinical target for this difficult disease.
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Affiliation(s)
- Nan Sethakorn
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Peter H O'Donnell
- Department of Medicine Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA. .,Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, IL, USA.
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19
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Holmsten K, Dohn L, Jensen NV, Shah CH, Jäderling F, Pappot H, Ullén A. Vinflunine treatment in patients with metastatic urothelial cancer: A Nordic retrospective multicenter analysis. Oncol Lett 2016; 12:1293-1300. [PMID: 27446429 PMCID: PMC4950730 DOI: 10.3892/ol.2016.4775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 04/18/2016] [Indexed: 11/20/2022] Open
Abstract
In 2009, vinflunine was introduced as a second-line treatment to be used after the failure of platinum therapy in patients with metastatic urothelial carcinoma (mUC). The present study investigated the administered vinflunine to patients with mUC in standard clinical practice with the aim of evaluating treatment patterns, response, survival parameters and side-effects. Data were collected retrospectively from the first 100 mUC patients treated with vinflunine at three Nordic cancer centers associated with the Nordic Urothelial Cancer Oncology Group. The overall response rate was 23% and complete response was observed in one patient. The median progression-free survival (mPFS) and median overall survival (mOS) were 2.8 (range, 0.5–34.3) and 6.3 (range, 0.3–39.7) months, respectively. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2 was present in 20% of the patients, and those patients exhibited significantly shorter mOS (4.1 vs. 7.0 months, P=0.001) and a significantly higher degree of grade 3/4 toxicity (P=0.026) compared with ECOG PS 0–1 patients. Furthermore, patients without visceral metastases had significantly longer mOS than patients with visceral metastases (10.6 vs. 6.0 months, P=0.008). The median number of cycles of vinflunine was 3 (range, 1–28). The current data confirms that vinflunine is an active agent for second-line treatment in an unselected clinical cohort of patients with mUC. ECOG PS and presence of visceral metastases were significant prognostic parameters. In particular, patients with ECOG PS 2 receiving vinflunine had a shorter mOS and a higher frequency of severe toxicity, and, thus, should be treated with caution. Furthermore, the present study observed large inter-individual differences in radiological response and OS, indicating the need for further development of improved patient selection tools to optimize vinflunine treatment in platinum-refractory mUC patients.
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Affiliation(s)
- Karin Holmsten
- Department of Oncology and Pathology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Line Dohn
- Department of Oncology, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Niels Viggo Jensen
- Department of Oncology, Odense University Hospital, 5000 Odense, Denmark
| | - Carl-Henrik Shah
- Department of Oncology and Pathology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Fredrik Jäderling
- Department of Radiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Anders Ullén
- Department of Oncology and Pathology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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20
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Quality of life in patients with cisplatin-resistant urothelial cancer: Typical ailments and effect of paclitaxel-based salvage therapy. Urol Oncol 2016; 34:256.e15-21. [DOI: 10.1016/j.urolonc.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/22/2016] [Accepted: 02/01/2016] [Indexed: 01/06/2023]
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Abstract
INTRODUCTION Docetaxel has had a significant impact on the management of urothelial carcinoma (UC). Multiple phase II trials have been conducted to evaluate the efficacy of docetaxel in the treatment of metastatic UC. Docetaxel is an accepted community standard for the therapy of platinum-treated patients with metastatic UC. AREAS COVERED This review focuses on the data supporting a role for docetaxel in the therapy of advanced UC. It also explores the future development of docetaxel and describes the ongoing clinical trials in the treatment of UC. EXPERT OPINION Docetaxel plays an important role as one of the standard agents used in the comparator arms of randomized trials evaluating new agents as salvage therapy for metastatic UC. Furthermore, biologic agents are being developed in chemo-biologic regimens using docetaxel as the platform. In the context of emerging novel agents such as T-cell checkpoint inhibitors, docetaxel may continue to play a role as a salvage therapy in select patients ineligible for immunotherapy or following checkpoint inhibitors.
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Affiliation(s)
- Costantine Albany
- a Department of Medicine, Section of Hematology-Oncology , Indiana University Simon Cancer Center , Indianapolis , IN 46202 , USA
| | - Guru Sonpavde
- b Department of Medicine, Section of Hematology-Oncology , Veterans Affairs Medical Center, Birmingham , AL , USA.,c Department of Medicine, Section of Hematology-Oncology , University of Alabama at Birmingham (UAB) Comprehensive Cancer Center , Birmingham , AL 35294 , USA
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22
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Kim YS, Lee SI, Park SH, Park S, Hwang IG, Lee SC, Sun JM, Lee J, Lim HY. A Phase II Study of Weekly Docetaxel as Second-Line Chemotherapy in Patients With Metastatic Urothelial Carcinoma. Clin Genitourin Cancer 2015; 14:76-81. [PMID: 26454620 DOI: 10.1016/j.clgc.2015.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/13/2015] [Accepted: 09/11/2015] [Indexed: 11/18/2022]
Abstract
UNLABELLED The present multicenter phase II study evaluated the efficacy and safety of weekly docetaxel as second-line chemotherapy for metastatic urothelial carcinoma. Weekly docetaxel was well tolerated but demonstrated modest activity, with a response rate of 6%, a median progression-free survival (PFS) of 1.4 months, and a median overall survival (OS) of 8.3 months. The dichotomy between PFS and OS was likely associated with subsequent platinum-based chemotherapy received by 58% of the patients. BACKGROUND Docetaxel is commonly used for second-line therapy for metastatic urothelial carcinoma (UC). However, myelosuppression is a substantial concern when the traditional 3-week docetaxel cycle is used. The present multicenter phase II study evaluated the efficacy and safety of weekly docetaxel as second-line chemotherapy for metastatic UC. PATIENTS AND METHODS Patients with progression after previous platinum-based chemotherapy for advanced or metastatic disease were treated with docetaxel 30 mg/m(2) on days 1 and 8 every 21 days. The primary endpoint was the response rate. RESULTS The study enrolled 31 patients. Their median age was 64 years (range, 40-79 years). An Eastern Cooperative Oncology Group performance status of 1, liver metastasis, and a hemoglobin level < 10 g/dL were observed in 100%, 32%, and 23% of patients, respectively. Previous platinum-based chemotherapy had been administered for metastatic disease in 29 patients (94%). Although fatigue (13%) and anorexia (6%) were the most frequently observed grade 3 to 4 toxicities, the safety profiles were generally mild and manageable. Two patients (6%) achieved an objective response, which was maintained for 3.0 to 7.8 months. Eight patients experienced disease stabilization (disease control rate, 32%). The median progression-free survival (PFS) and overall survival (OS) were 1.4 months (95% confidence interval [CI], 1.3-1.6) and 8.3 months (95% CI, 5.9-10.6), respectively. A relatively long OS was associated with further salvage platinum-based chemotherapy (n = 18, 58%) showing an encouraging activity (response rate, 44%; median PFS, 4.0 months). CONCLUSION Second-line chemotherapy with weekly docetaxel was well tolerated but demonstrated modest activity in patients with metastatic UC. A platinum-based combination as second-line treatment might be considered for selected patients.
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Affiliation(s)
- Young Saing Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Soon Il Lee
- Division of Hematology-Oncology, Department of Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea.
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Silvia Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Gyu Hwang
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Cheol Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho Yeong Lim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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23
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Pal SK, Lin YI, Yuh B, DeWalt K, Kazarian A, Vogelzang N, Nelson RA. Conditional Survival in de novo Metastatic Urothelial Carcinoma. PLoS One 2015; 10:e0136622. [PMID: 26308952 PMCID: PMC4550434 DOI: 10.1371/journal.pone.0136622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/03/2015] [Indexed: 11/26/2022] Open
Abstract
Background Second-line therapy is frequently utilized for metastatic urothelial carcinoma, but there are limited data to guide this approach. While an assessment of overall survival based on registry data may not capture the impact of second- and third-line therapies on clinical outcome, this may be reflected in relative conditional survival (RCS). Methods Patients with stage IV urothelial carcinoma diagnosed from 1990–2010 were identified from the Surveillance, Epidemiology and End Results (SEER) dataset. The association of clinicopathologic variables with disease specific survival (DSS) was explored through univariate and multivariate analyses. DSS in subgroups divided by time period (1990–2000 v 2001–2010) was compared using the Kaplan-Meier method and log-rank test. One-year RCS at annual landmarks up to 5 years was compared in subgroups divided by time period. Results Of 261,987 patients diagnosed with urothelial carcinoma from 1990–2010, 3,110 patients met criteria for the current analysis. Characteristics of patients diagnosed between 1990 and 2000 (n = 810) and 2001 to 2010 (n = 2,300) were similar and there was no significant difference in DSS between the two groups. On multivariate analysis, older age (age ≥ 80) was associated with shorter DSS (HR 1.79, 95%CI 1.48–2.15), but no association was found between time period of diagnosis and outcome. One-year RCS improved substantially through successive annual landmarks up to 5 years, but no differences were seen in subgroups divided by time of diagnosis. Conclusions No difference in RCS was observed amongst patients with stage IV urothelial carcinoma diagnosed from 1990–2000 and 2001–2010. A lack of difference in RCS (more so than cumulative DSS) may reflect a lack of progress in salvage therapies for the disease.
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Affiliation(s)
- Sumanta Kumar Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
- * E-mail:
| | - Yulan Ingrid Lin
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
| | - Bertram Yuh
- Division of Urology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
| | - Kara DeWalt
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
| | - Austin Kazarian
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
| | - Nicholas Vogelzang
- US Oncology Research, Comprehensive Cancer Centers, Las Vegas, Nevada, United States of America
| | - Rebecca A. Nelson
- Division of Biostatistics, Department of Information Science, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
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24
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Taguchi S, Nakagawa T, Uemura Y, Matsumoto A, Nagase Y, Kawai T, Tanaka Y, Yoshida K, Yamamoto S, Enomoto Y, Nose Y, Sato T, Ishikawa A, Fujimura T, Fukuhara H, Kume H, Homma Y. Validation of major prognostic models for metastatic urothelial carcinoma using a multi-institutional cohort of the real world. World J Urol 2015; 34:163-71. [PMID: 26135306 DOI: 10.1007/s00345-015-1631-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/23/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Several prognostic models predicting survival of patients with metastatic urothelial carcinoma (UC) have been developed; however, of them, the first model by Bajorin in 1999 is still the most representative and widely used, and validations of newer models are lacking. This study aimed to validate three major prognostic models for metastatic UC constructed based on clinical trials. METHODS We reviewed 200 patients with metastatic UC who received first-line chemotherapy at our five affiliate institutions between 2003 and 2011. Using this multi-institutional cohort, we validated the following models: the "Bajorin model," a model consisting of visceral metastasis and performance status; the "Apolo model," a nomogram including visceral metastasis, performance status, albumin and hemoglobin; and the "Galsky model," a nomogram including leukocyte count, number of sites of visceral metastases, site of primary tumor, performance status and lymph node metastasis. Harrell's c-index was calculated for each model. Cox proportional hazards regression model was used for multivariate analysis. RESULTS Among 200 patients, 171 (85.5%) died during the follow-up, with a median survival of 12.0 months. Multivariate analysis demonstrated ECOG performance status, visceral metastasis and leukocyte count to be independent predictors of overall survival. C-index results (95% confidence interval) were Bajorin: 0.86 (0.74-0.95); Apolo: 0.89 (0.78-0.98); and Galsky: 0.82 (0.69-0.93). CONCLUSIONS All models were demonstrated to have high external validities in real-world patients, and of them, the "Apolo model" achieved the highest c-index in the present population. Further studies with larger populations are needed for establishment of the next standard model.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yukari Uemura
- Central Coordinating Unit, Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiko Matsumoto
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yasushi Nagase
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yoshinori Tanaka
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kanae Yoshida
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Sachi Yamamoto
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yutaka Enomoto
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yorito Nose
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Toshikazu Sato
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Akira Ishikawa
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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25
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Bambury RM, Benjamin DJ, Chaim JL, Zabor EC, Sullivan J, Garcia-Grossman IR, Regazzi AM, Ostrovnaya I, Apollo A, Xiao H, Voss MH, Iyer G, Bajorin DF, Rosenberg JE. The safety and efficacy of single-agent pemetrexed in platinum-resistant advanced urothelial carcinoma: a large single-institution experience. Oncologist 2015; 20:508-15. [PMID: 25845990 DOI: 10.1634/theoncologist.2014-0354] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/05/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pemetrexed is a commonly used treatment for platinum-resistant advanced urothelial carcinoma (UC) based on objective response rates of 8% and 28% in two small phase II studies. To address the discrepancy in reported response rates and to assess efficacy and toxicity outside of a clinical trial setting, we performed a large retrospective analysis of pemetrexed use at Memorial Sloan Kettering Cancer Center. We also investigated candidate prognostic factors for overall survival in this setting to explore whether the neutrophil-lymphocyte ratio (NLR) had independent prognostic significance. PATIENTS AND METHODS Patients receiving pemetrexed for platinum-resistant advanced UC between 2008 and 2013 were identified. The Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1) were used to determine response rate. Kaplan-Meier and Cox regression analyses were used to examine the association of various factors with efficacy and survival outcomes. Hematologic toxicity and laboratory abnormalities were recorded. RESULTS One hundred and twenty-nine patients were treated with pemetrexed. The objective response rate was 5% (95% confidence interval: 1%-9%), and the median duration of response was 8 months. Median progression-free survival (PFS) was 2.4 months, and the 6-month PFS rate was 14%. There was no significant difference in response rate by age, Eastern Cooperative Oncology Group (ECOG) performance status, or number of prior therapies. On multivariable analysis, ECOG performance status (p < .01), liver metastases (p = .02), and NLR (p < .01) had independent prognostic significance for overall survival. CONCLUSION This 129-patient series is the largest reported data set describing pemetrexed use in advanced UC. Activity was modest, although discovery of molecular biomarkers predictive of response would be valuable to identify the small subset of patients who do gain significant benefit. Overall, the data highlight the urgent need to develop novel therapies for these patients.
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Affiliation(s)
- Richard M Bambury
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - David J Benjamin
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joshua L Chaim
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emily C Zabor
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - John Sullivan
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ilana R Garcia-Grossman
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ashley M Regazzi
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Irina Ostrovnaya
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aryln Apollo
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Han Xiao
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Martin H Voss
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Gopa Iyer
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Dean F Bajorin
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jonathan E Rosenberg
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
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26
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Sonpavde G, Pond GR, Rosenberg JE, Bajorin DF, Regazzi AM, Choueiri TK, Qu AQ, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Fougeray R, Dreicer R, Chen YH, Wong YN, Sridhar SS, Ko YJ, Milowsky MI, Galsky MD, Bellmunt J. Complete Response as an Intermediate End Point in Patients Receiving Salvage Systemic Therapy for Urothelial Carcinoma. Clin Genitourin Cancer 2015; 13:185-92. [DOI: 10.1016/j.clgc.2014.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/25/2014] [Indexed: 12/01/2022]
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27
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Pond G, Bellmunt J, Rosenberg J, Bajorin D, Regazzi A, Choueiri T, Qu A, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Fougeray R, Wong YN, Sridhar S, Ko YJ, Milowsky M, Galsky M, Sonpavde G. Impact of the Number of Prior Lines of Therapy and Prior Perioperative Chemotherapy in Patients Receiving Salvage Therapy for Advanced Urothelial Carcinoma: Implications for Trial Design. Clin Genitourin Cancer 2015; 13:71-9. [DOI: 10.1016/j.clgc.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/29/2014] [Accepted: 06/03/2014] [Indexed: 11/16/2022]
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28
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Sonpavde G, Pond GR, Fougeray R, Bellmunt J. Nomogram to predict the benefit from salvage systemic therapy for advanced urothelial carcinoma. BJU Int 2015; 115:854-5. [PMID: 25195625 DOI: 10.1111/bju.12922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Guru Sonpavde
- UAB Comprehensive Cancer Center, Birmingham, AL, USA.,McMaster University, Hamilton, Ontario, Canada
| | | | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,University Hospital del Mar-IMIM, Barcelona, Spain
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29
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Sonpavde G, Jones BS, Bellmunt J, Choueiri TK, Sternberg CN. Future directions and targeted therapies in bladder cancer. Hematol Oncol Clin North Am 2014; 29:361-76, x. [PMID: 25836940 DOI: 10.1016/j.hoc.2014.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There are substantial unmet needs for patients with metastatic urothelial carcinoma (UC). First-line cisplatin-based chemotherapy regimens yield a median survival of 12 to 15 months and long-term survival in 5% to 15%. Salvage systemic therapy yields a median survival of 6 to 8 months. Hence, the discovery of novel therapeutic targets is of paramount importance. Recent molecular analyses have provided insights regarding molecular tumor tissue alterations on multiple platforms. A multidisciplinary effort using innovative clinical trial designs and exploiting preclinical signals of robust activity guided by predictive biomarkers may provide much needed clinical advances in therapy for advanced UC.
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Affiliation(s)
- Guru Sonpavde
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, 1720 2nd Ave. S., Birmingham, AL 35294, USA
| | - Benjamin S Jones
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, 1720 2nd Ave. S., Birmingham, AL 35294, USA
| | - Joaquim Bellmunt
- Bladder Cancer Institute, Dana Farber Cancer Institute, Dana-Farber/Brigham and Women's Cancer Center, Boston, 450, Brookline Ave, MA 02215, USA
| | - Toni K Choueiri
- Bladder Cancer Institute, Dana Farber Cancer Institute, Dana-Farber/Brigham and Women's Cancer Center, Boston, 450, Brookline Ave, MA 02215, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Padiglioni Flajani, 1st Floor, Circonvallazione Gianicolense 87, Rome 00152, Italy.
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30
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Sonpavde G, Bellmunt J, Rosenberg JE, Regazzi AM, Bajorin DF, Choueiri TK, Qu AQ, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Fougeray R, Wong YN, Sridhar SS, Ko YJ, Milowsky MI, Galsky MD, Pond GR. Patient eligibility and trial design for the salvage therapy of advanced urothelial carcinoma. Clin Genitourin Cancer 2014; 12:395-8. [PMID: 25035282 DOI: 10.1016/j.clgc.2014.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/28/2014] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Angela Q Qu
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | - Yoo-Joung Ko
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | | | - Matthew D Galsky
- Tisch Cancer Center Institute, Mount Sinai School of Medicine, New York, NY
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31
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Castellano DE, Bellmunt J, Maroto JP, Font-Pous A, Morales-Barrera R, Ghanem I, Suarez C, Martín Lorente C, Etxaniz O, Capdevila L, Coronado C, Alfaro V, Siguero M, Fernández-Teruel C, Carles J. Phase II clinical trial of PM00104 (Zalypsis®) in urothelial carcinoma patients progressing after first-line platinum-based regimen. Cancer Chemother Pharmacol 2014; 73:857-67. [DOI: 10.1007/s00280-014-2419-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/16/2014] [Indexed: 11/29/2022]
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