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Skelton WP, Masur J, Thomas J, Fallah P, Jain RK, Ravi P, Mantia C, McGregor BA, Nuzzo PV, Adib E, Zarif TE, Preston MA, Clinton TN, Li R, Steele GS, Kassouf W, Freeman D, Pond GR, Jain RK, Sonpavde GP. Impact of Angiotensin Converting Enzyme Inhibitors on Pathologic Complete Response With Neoadjuvant Chemotherapy for Muscle Invasive Bladder Cancer. Clin Genitourin Cancer 2024; 22:102143. [PMID: 39032202 DOI: 10.1016/j.clgc.2024.102143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION The renin-angiotensin system (RAS) has been demonstrated to modulate cell proliferation, desmoplasia, angiogenesis and immunosuppression. We examined the association of RAS inhibitors (RASi)-namely angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB)-with neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) preceding radical cystectomy (RC). PATIENTS AND METHODS We retrospectively investigated concurrent RASi use with NAC prior to RC in 302 patients with MIBC from 3 academic institutions. Outcomes included pathologic complete response (pCR) and overall survival (OS). Pathologic features, performance status (PS), clinical stage, type/number of cycles of NAC, and toxicities were collected. RESULTS Overall pCR rate was 26.2% and 5-year OS was 62%. Concurrent ACEi intake with NAC approached significance for association with pCR (odds ratio [OR] = 1.71; 95% CI, 0.94-3.11; P = .077). Patients with cT3/4N0-N1 disease receiving ACEi had higher pCR rates (30.8% vs. 17.7%, P = .056) than those not on ACEi. Female sex had a statistically significant favorable interaction for pCR with ACEi intake (P = .044). ACEi intake was not associated with OS, while pCR, PS and lower clinical stage were significantly associated with improved OS. CONCLUSION ACEi intake is potentially associated with increased pCR in patients with MIBC receiving NAC prior to RC, and this association is more pronounced in patients with higher clinical stage of disease at the initiation of therapy and female sex. Our data suggest the potential relevance of the RAS as a therapeutic target in aggressive MIBC.
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Affiliation(s)
- William Paul Skelton
- University of Virginia Comprehensive Cancer Center, Department of Oncology, Charlottesville, VA; H. Lee Moffitt Cancer Center and Research Institute, Department of Oncology, Tampa, FL
| | - Jack Masur
- University of Virginia Comprehensive Cancer Center, Department of Oncology, Charlottesville, VA
| | - Jonathan Thomas
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Parvaneh Fallah
- McGill University, Department of Oncology, Montreal, Quebec, Canada
| | - Rohit K Jain
- H. Lee Moffitt Cancer Center and Research Institute, Department of Oncology, Tampa, FL
| | - Praful Ravi
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Charlene Mantia
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | | | | | - Elio Adib
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Talal El Zarif
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Mark A Preston
- Brigham and Women's Hospital, Department of Oncology, Boston, MA
| | | | - Roger Li
- H. Lee Moffitt Cancer Center and Research Institute, Department of Oncology, Tampa, FL
| | - Graeme S Steele
- Brigham and Women's Hospital, Department of Oncology, Boston, MA
| | - Wassim Kassouf
- McGill University, Department of Oncology, Montreal, Quebec, Canada
| | - Dory Freeman
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | | | - Rakesh K Jain
- Massachusetts General Hospital, Department of Oncology, Boston, MA
| | - Guru P Sonpavde
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA; AdventHealth Cancer Institute and the University of Central Florida, Department of Oncology, Orlando, FL.
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Teke K, Yılmaz H, Baltacı S, Akgül M, Şahin B, Türkeri L, Bozkurt O, Yücetaş U, Aslan G, Bolat D, İzol V, Özkan TA, Eskiçorapçi S. Analysis of risk factors for cancer-specific survival in neoadjuvant chemotherapy nonresponsive disease of muscle-invasive bladder cancer: A multicentre study from the Turkish Urooncology Association Bladder Tumor study group. Urol Oncol 2024:S1078-1439(24)00647-1. [PMID: 39353827 DOI: 10.1016/j.urolonc.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 08/16/2024] [Accepted: 09/05/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVE To investigate the risk factors affecting cancer-specific survival (CSS) in nonresponsive disease to neoadjuvant chemotherapy (NAC) among patients with muscle-invasive bladder cancer (MIBC) who were treated with NAC and radical cystectomy (RC). METHODS Patients with MIBC who underwent NAC and RC were retrospectively examined. By comparing clinical and pathological stages, patients whose pathological stage was lower than clinical stage were categorized as "NAC-responsive" and the remainder as "NAC-non-responsive." Apart from pathologic staging, variables compared between groups included age, gender, Eastern Cooperative Oncology Group (ECOG) score, clinical stages, NAC type and cycle number, durations between MIBC diagnosis and NAC initiation and RC, presence of hydronephrosis, number of lymph nodes removed, and variant histology of urothelial bladder cancer. CSS analysis was performed by construction of Kaplan-Meier survival curves and multivariable Cox regression was performed to identify the prognosticators in the NAC-non-responsive-group. RESULTS Ninety-two patients were included with a mean age was 61.5 ± 8.5 years, of whom 84.8% were men. The NAC regimen used was predominantly gemcitabine-cisplatin (88%) and the median cycle number was 4. Fifty-six (60.9%) patients were NAC-non-responsive. There was a significantly lower proportion of patients receiving ≥4 cycles (46.4% vs. 66.7%) and a higher rate of patients with ECOG score ˃1 (33.9% vs. 11.1%) in the NAC-non-responsive-group compared to the NAC-responsive-group (both P < 0.05). Other variables were similar between groups. In multivariable analysis, only ypN+ was found to be an independent prognosticator for CSS in NAC-non-responsive-group (HR: 2.725, CI95%:1.017-7.303). CONCLUSION Although higher ECOG scores and lower cycle numbers appears to be associated factors in NAC-non-responsive disease, only ypN(+) status was a prognosticator for CSS in this population.
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Affiliation(s)
- Kerem Teke
- Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey.
| | - Hasan Yılmaz
- Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Sümer Baltacı
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Akgül
- Department of Urology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Bahadır Şahin
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Levent Türkeri
- Department of Urology, Acıbadem M.A. Aydınlar University Altuzinade Hospital, Istanbul, Turkey
| | - Ozan Bozkurt
- Department of Urology, Dokuz Eylül Üniversitesi School of Medicine, İzmir, Turkey
| | - Uğur Yücetaş
- Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Güven Aslan
- Department of Urology, Dokuz Eylül Üniversitesi School of Medicine, İzmir, Turkey
| | - Deniz Bolat
- Department of Urology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Volkan İzol
- Department of Urology, Çukurova University School of Medicine, Adana, Turkey
| | - T Alp Özkan
- Private Uro-Tıp Uroloji Diagnosis Center, Kocaeli, Turkey
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Pikul M, Gordiichuk P, Stakhovsky E. Urothelial cancer: state of art in Ukraine and improvement pathways. Ann Med Surg (Lond) 2024; 86:5137-5144. [PMID: 39238972 PMCID: PMC11374189 DOI: 10.1097/ms9.0000000000002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/25/2024] [Indexed: 09/07/2024] Open
Abstract
Aim This study aims to assess the effectiveness of urothelial cancer treatment in Ukraine, utilizing population-based data from the National Cancer Registry. The primary goal is to evaluate trends and approaches to therapy, with a focus on overall survival rates in patients with urothelial tumors. Materials and methods A retrospective cross-sectional analysis was conducted based on the National Cancer Registry, involving 12 698 patients (2008-2020) with urothelial tumors of the upper urinary tract (UTUC) and bladder cancer (BC) who underwent surgical treatment. Demographic indicators, surgical interventions, complications, and survival rates were analyzed. Results The average age for all patients was 70 years. The number of patients undergoing radical treatment was 1820 (15%) among BC and 573 (59%) among UTUC. The 30-day readmission rate was low for both, with a slightly higher preference for UTUC (2.3 vs. 4.6%). Whereas grade III or higher Cl-Dindo complications were seen in only 0.2% of cases. Notable findings include low frequency of neoadjuvant (7%) and adjuvant chemotherapy (28%) among patients with invasive urothelial carcinomas. Median eGFR for invasive UTUC before and after surgery was 63.2 and 51.4 ml/min, respectively (P=0.00054). The directly opposite trend was seen in BC-61.2 and 68.7 ml/min, respectively (P=0.0026).For BC, the overall survival rates by stages were: I-73%, II-49%, III-18%, and IV-11% (χ2=1807.207; P=0.000001). As for UTUC, the 5-year overall survival rates corresponded to the literature data, but there was a pronounced negative trend towards a decrease in this indicator after a 10-year period for all stages (χ2=146.298; P=0.000003). Conclusion The study emphasizes the importance of effective systemic treatments, adherence to treatment guidelines, and the need for multidisciplinary consultations among Ukrainian patients with urothelial cancer.
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Affiliation(s)
- Maksym Pikul
- Department of Plastic and Reconstructive Oncourology, National Cancer Institute of Ukraine
- Department of Oncology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Prokip Gordiichuk
- Department of Oncology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Eduard Stakhovsky
- Department of Plastic and Reconstructive Oncourology, National Cancer Institute of Ukraine
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Eule CJ, Warren A, Molina Kuna E, Callihan EB, Kim SP, Flaig TW. Neoadjuvant Cisplatin-based Chemotherapy in Nonmetastatic Muscle-invasive Bladder Cancer: A Systematic Review and Pooled Meta-analysis to Determine the Preferred Regimen. Urology 2024; 188:118-124. [PMID: 38685388 DOI: 10.1016/j.urology.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/01/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To determine whether neoadjuvant gemcitabine and cisplatin (GC) vs dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) before radical cystectomy improves overall survival (OS), progression-free survival (PFS), and pathologic complete response (pCR) for patients with muscle-invasive bladder cancer with secondary analyses of pathological downstaging and toxicity. MATERIALS AND METHODS This systematic review and meta-analysis identified studies of patients with muscle-invasive bladder cancer treated with neoadjuvant GC compared to ddMVAC from PubMed, Web of Science, and EMBASE. Random-effect models for pooled log-transformed hazard ratios (HR) for OS and PFS and pooled odds ratios for pCR and downstaging were developed using the generic inverse variance method and Mantel-Haenszel method, respectively. RESULTS Ten studies were identified (4 OS, 2 PFS, and 6 pCR clinical endpoints). Neoadjuvant ddMVAC improved OS (HR 0.71 [95% confidence intervals 0.56; 0.90]), PFS (HR 0.76 [95% confidence intervals 0.60; 0.97]), and pathological downstaging (odds ratio 1.34 [95% confidence interval 1.01; 1.78]) as compared to GC. There was no significant difference between regimens for pCR rates (odds ratio 1.38 [95% confidence interval 0.90; 2.12]). Treatment toxicity was greater with ddMVAC. Limitations result from differences in number of ddMVAC cycles and patient selection between studies. CONCLUSION Neoadjuvant ddMVAC is associated with improved OS and PFS vs gemcitabine/cisplatin for patients with muscle-invasive bladder cancer before radical cystectomy. Although rates of pathological complete response were not significantly different, pathological downstaging correlated with OS. ddMVAC should be preferred over gemcitabine/cisplatin for patients with muscle-invasive bladder cancer who can tolerate its greater toxicity.
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Affiliation(s)
- Corbin J Eule
- University of Colorado Cancer Center, Division of Medical Oncology, Department of Medicine, Aurora, CO.
| | - Adam Warren
- University of Colorado Cancer Center, Population Health Shared Resource, Aurora, CO.
| | - Elizabeth Molina Kuna
- University of Colorado Cancer Center, Population Health Shared Resource, Aurora, CO.
| | - Eryn B Callihan
- University of Colorado Cancer Center, Division of Medical Oncology, Department of Medicine, Aurora, CO.
| | - Simon P Kim
- University of Colorado Cancer Center, Division of Urology, Department of Surgery, Aurora, CO.
| | - Thomas W Flaig
- University of Colorado Cancer Center, Division of Medical Oncology, Department of Medicine, Aurora, CO.
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Elkarta A, Awadalla A, El-Hefnawy A, Mosbah A, Abolenein H, Shokeir A. Predictors of Response Following Neoadjuvant Cisplatin-Based Chemotherapy for Muscle Invasive Urothelial Bladder Cancer Using Molecular Profile: A Prospective Clinical Study. Clin Genitourin Cancer 2024; 22:38-46.e1. [PMID: 37758560 DOI: 10.1016/j.clgc.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/09/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES To predict response of patients with muscle invasive bladder cancer (MIBC) to neoadjuvant chemotherapy (NAC) through analysis of molecular profile assessed clinically (radiologically and by pathological examination of transurethral resection biopsy [TURBT] specimens) and definitively with histopathological examination after radical cystectomy (RC). METHODS In a prospective study, tumor biopsies were obtained from patients with urothelial MIBC (T2-4a N0-2 M0) during TURBT. Patients were eligible for RC received 4 cycles of cisplatin-based NAC. DNA repair genes (BRACA1, ERCC1) & CTR gene m-RNA expression levels were assessed in resected tissue. The response to chemotherapy was assessed clinically (radiologically & TURBT) following NAC. Response was re-assessed for 64 patients who underwent RC and predictors of cancer-free survival (CFS) were calculated. Receiver operating characteristic (ROC) curve was used to delineate cutoff value copes with the best sensitivity and specificity for prediction of response to NAC. RESULTS The study included 104 patients, 42 (40.4%) responded well to NAC clinically. Out of 64 patients who underwent RC, 26 (40.6%) showed good response to NAC. CFS at 18 months for patients who underwent RC was 60%. Statistical analysis showed that molecular profile was an independent predictor of good response to NAC both clinically and pathologically and also predicted better CFS. CONCLUSION Molecular profile could play a decisive role in early detection of patients with MIBC who will get benefit from preoperative NAC.
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Affiliation(s)
- Ahmed Elkarta
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amira Awadalla
- Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed El-Hefnawy
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Mosbah
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hassan Abolenein
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Shokeir
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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Huang S, Huang Y, Li C, Liang Y, Huang M, Luo R, Liang W. Efficacy and safety of neoadjuvant PD-1 inhibitors or PD-L1 inhibitors for muscle invasive bladder cancer: a systematic review and meta-analysis. Front Immunol 2024; 14:1332213. [PMID: 38264649 PMCID: PMC10803485 DOI: 10.3389/fimmu.2023.1332213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction This meta-analysis aims to evaluate the efficacy and safety of neoadjuvant PD-1 inhibitors or PD-L1 inhibitors [PD-(L)1 inhibitors] for muscle-invasive bladder carcinoma (MIBC). Materials and methods Four databases (Medline, Embase, Web of Science, and 21 CENTRAL) were searched for articles studying neoadjuvant PD-(L)1 inhibitors for MIBC. The search time period was from the establishment of each database to 21 July 2023. Meta-analyses of pCR, pPR, Grade≥ 3 irAEs rate, RFS, and OS were performed. Results In total, 22 studies were included for meta-analysis. The overall pooled pCR of neoadjuvant PD-(L)1 inhibitors was 0.36 (95%CI=0.30-0.42, p=0.00). In subgroup meta-analysis, the pooled PCR of PD-(L)1 inhibitors alone, PD-(L)1 inhibitors plus other ICI, and PD-(L)1 inhibitors plus chemotherapy was 0.27 (95%CI=0.19-0.35, p=0.1), 0.41 (95%CI=0.21-0.62, p=0.01), 0.43 (95%CI=0.35-0.50, p=0.06), respectively. The overall pooled pPR of neoadjuvant PD-(L)1 inhibitors was 0.53 (95%CI=0.46-0.60, p=0.00). In subgroup meta-analysis, the pooled pPR of PD-(L)1 inhibitors alone, PD-(L)1 inhibitors plus other ICI, and PD-(L)1 inhibitors plus chemotherapy was 0.36 (95%CI=0.22-0.51, p=0.01), 0.51 (95%CI=0.39-0.62, p=0.43), and 0.61 (95%CI=0.53-0.69, p=0.01), respectively. Kaplan-Meier curves for OS and RFS were reconstructed, but there was no significant difference among three groups in terms of OS or RFS. The pooled result of Grade≥ 3 irAEs rate for neoadjuvant PD-(L)1 inhibitors was 0.15 (95%CI=0.09-0.22, p=0.00%). In subgroup analysis, the pooled result of Grade≥ 3 irAEs rate for PD-(L)1 inhibitors alone, PD-(L)1 inhibitors plus other ICI, and PD-(L)1 inhibitors plus chemotherapy was 0.07 (95%CI=0.04-0.11, p=0.84), 0.31 (95%CI=0.16-0.47, p=0.06), and 0.17 (95%CI=0.06-0.31, I2 = 71.27%, p=0.01), respectively. Conclusion Neoadjuvant PD-(L)1 inhibitors were feasible and safe for muscle invasive bladder cancer. Compared with PD-(L)1 inhibitors alone, PD-(L)1 inhibitors plus other ICI and PD-(L)1 inhibitors plus chemotherapy were associated with higher pCR and pPR, but higher Grade≥3 irAEs. Kaplan-Meier curves for OS and RFS indicated that neoadjuvant PD-(L)1 inhibitors had an acceptable long-term prognostic, but it was not possible to discern statistical differences between the three neoadjuvant subgroups. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023452437, identifier PROSPERO (CRD42023452437).
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Affiliation(s)
| | | | | | | | | | | | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, China
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Kamat AM, Apolo AB, Babjuk M, Bivalacqua TJ, Black PC, Buckley R, Campbell MT, Compérat E, Efstathiou JA, Grivas P, Gupta S, Kurtz NJ, Lamm D, Lerner SP, Li R, McConkey DJ, Palou Redorta J, Powles T, Psutka SP, Shore N, Steinberg GD, Sylvester R, Witjes JA, Galsky MD. Definitions, End Points, and Clinical Trial Designs for Bladder Cancer: Recommendations From the Society for Immunotherapy of Cancer and the International Bladder Cancer Group. J Clin Oncol 2023; 41:5437-5447. [PMID: 37793077 DOI: 10.1200/jco.23.00307] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/10/2023] [Accepted: 08/12/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE There is a significant unmet need for new and efficacious therapies in urothelial cancer (UC). To provide recommendations on appropriate clinical trial designs across disease settings in UC, the Society for Immunotherapy of Cancer (SITC) and the International Bladder Cancer Group (IBCG) convened a multidisciplinary, international consensus panel. METHODS Through open communication and scientific debate in small- and whole-group settings, surveying, and responses to clinical questionnaires, the consensus panel developed recommendations on optimal definitions of the disease state, end points, trial design, evaluations, sample size calculations, and pathology considerations for definitive studies in low- and intermediate-risk nonmuscle-invasive bladder cancer (NMIBC), high-risk NMIBC, muscle-invasive bladder cancer in the neoadjuvant and adjuvant settings, and metastatic UC. The expert panel also solicited input on the recommendations through presentations and public discussion during an open session at the 2021 Bladder Cancer Advocacy Network (BCAN) Think Tank (held virtually). RESULTS The consensus panel developed a set of stage-specific bladder cancer clinical trial design recommendations, which are summarized in the table that accompanies this text. CONCLUSION These recommendations developed by the SITC-IBCG Bladder Cancer Clinical Trial Design consensus panel will encourage uniformity among studies and facilitate drug development in this disease.
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Affiliation(s)
- Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrea B Apolo
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD
| | - Marek Babjuk
- Department of Urology, Teaching Hospital Motol, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Trinity J Bivalacqua
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter C Black
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Roger Buckley
- Department of Urology, North York General Hospital, Toronto, Ontario, Canada
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Shilpa Gupta
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Neil J Kurtz
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | - Donald Lamm
- Patient Advocate, Bladder Cancer Advocacy Network (BCAN), Bethesda, MD
| | | | - Roger Li
- Scott Department of Urology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX
| | - David J McConkey
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL
| | - Joan Palou Redorta
- Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD
| | - Thomas Powles
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Neal Shore
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
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Lu L, Chen C, Cheng H, Ding H, Tian J, Wang H, Wang Z. Comparison of 3 and 4 cycles of neoadjuvant gemcitabine and cisplatin for muscle-invasive bladder cancer: a systematic review and meta-analysis. BMC Cancer 2023; 23:1066. [PMID: 37932689 PMCID: PMC10626748 DOI: 10.1186/s12885-023-11572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND In muscle-invasive bladder cancer (MIBC), neoadjuvant chemotherapy (NAC) combined with radical cystectomy (RC) is critical in reducing disease recurrence, with GC (gemcitabine and cisplatin) being one of the most commonly used NACs. Different GC schedules have been used, but the best neoadjuvant regimen is still unknown. The clinical outcomes of 3 and 4 cycles of neoadjuvant GC are compared in this systematic review and meta-analysis to determine which is best for patients with MIBC. METHODS We searched PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, WAN FANG DATA, and meeting abstracts to identify relevant studies up to March 2023. Studies that compared 3 and 4 cycles of neoadjuvant GC for MIBC were included. The primary outcomes were pCR, pDS, OS, and CSS. The secondary outcome was recurrence and SAEs. RESULTS A total of 3 studies, with 1091 patients, were included in the final analysis. Patients that received 4 cycles of GC had a higher pCR (OR = 0.66; 95% CI, 0.50-0.87; p = 0.003) and pDS (OR = 0.63; 95% CI, 0.48-0.84; p = 0.002) than those who received 3 cycles. Regarding recurrence rate (OR = 1.23; 95% CI, 0.91-1.65; p = 0.18), there were no appreciable differences between the 3 and 4 cycles of GC. Survival parameters such as OS (HR, 1.35; 95% CI, 0.86-2.12; p = 0.19) and CSS (HR, 1.06; 95% CI, 0.82-1.38; p = 0.20) were similar. Only one trial reported on the outcomes of SAEs. And there were no statistically significant differences in thrombocytopenia, infection rate, neutropenic fever, anemia, or decreased renal function between patients. The neutropenia of patients was statistically different (OR = 0.72; 95% CI, 0.52-0.99; p = 0.04). CONCLUSION The 4-cycle GC regimen was superior to the 3-cycle regimen in only the pCR and pDS results. Survival and recurrence rates were similar between the two regimens. In both treatment regimes, the toxicity profile was manageable. However, due to the inherent drawbacks of retrospective research, this should be regarded with caution.
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Affiliation(s)
- Lanpeng Lu
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Gansu Province for Urological Diseases, Lanzhou, China
| | - Chaohu Chen
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Gansu Province for Urological Diseases, Lanzhou, China
| | - Hui Cheng
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Gansu Province for Urological Diseases, Lanzhou, China
| | - Hui Ding
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Gansu Province for Urological Diseases, Lanzhou, China
| | - Junqiang Tian
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Gansu Province for Urological Diseases, Lanzhou, China
| | - Hanzhang Wang
- Department of Pathology and Laboratory Medicine, UConn Health Farmington, Farmington, CT, USA
| | - Zhiping Wang
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China.
- Key Laboratory of Gansu Province for Urological Diseases, Lanzhou, China.
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Gil-Jimenez A, van Dorp J, Contreras-Sanz A, van der Vos K, Vis DJ, Braaf L, Broeks A, Kerkhoven R, van Kessel KEM, Ribal MJ, Alcaraz A, Wessels LFA, Seiler R, Wright JL, Mengual L, Boormans J, van Rhijn BWG, Black PC, van der Heijden MS. Assessment of Predictive Genomic Biomarkers for Response to Cisplatin-based Neoadjuvant Chemotherapy in Bladder Cancer. Eur Urol 2023; 83:313-317. [PMID: 35965206 DOI: 10.1016/j.eururo.2022.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/03/2022] [Accepted: 07/26/2022] [Indexed: 01/21/2023]
Abstract
Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy is recommended for patients with muscle-invasive bladder cancer (MIBC). It has been shown that somatic deleterious mutations in ERCC2, gain-of-function mutations in ERBB2, and alterations in ATM, RB1, and FANCC are correlated with pathological response to NAC in MIBC. The objective of this study was to validate these genomic biomarkers in pretreatment transurethral resection material from an independent retrospective cohort of 165 patients with MIBC who subsequently underwent NAC and radical surgery. Patients with ypT0/Tis/Ta/T1N0 disease after surgery were defined as responders. Somatic deleterious mutations in ERCC2 were found in nine of 68 (13%) evaluable responders and two of 95 (2%) evaluable nonresponders (p = 0.009; FDR = 0.03). No correlation was observed between response and alterations in ERBB2 or in ATM, RB1, or FANCC alone or in combination. In an exploratory analysis, no additional genomic alterations discriminated between responders and nonresponders to NAC. No further associations were identified between the aforementioned biomarkers and pathological complete response (ypT0N0) after surgery. In conclusion, we observed a positive association between deleterious mutations in ERCC2 and pathological response to NAC, but not overall survival or recurrence-free survival. Other previously reported genomic biomarkers were not validated. PATIENT SUMMARY: It is currently unknown which patients will respond to chemotherapy before definitive surgery for bladder cancer. Previous studies described several gene mutations in bladder cancer that correlated with chemotherapy response. This study confirmed that patients with bladder cancer with a mutation in the ERCC2 gene often respond to chemotherapy.
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Affiliation(s)
- Alberto Gil-Jimenez
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands; Oncode Institute, Utrecht, The Netherlands
| | - Jeroen van Dorp
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alberto Contreras-Sanz
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Kristan van der Vos
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniel J Vis
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands; Oncode Institute, Utrecht, The Netherlands
| | - Linde Braaf
- Core Facility Molecular Pathology & Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annegien Broeks
- Core Facility Molecular Pathology & Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ron Kerkhoven
- Core Facility Genomics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kim E M van Kessel
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - María José Ribal
- Laboratory and Department of Urology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Laboratory and Department of Urology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Lodewyk F A Wessels
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands; Oncode Institute, Utrecht, The Netherlands; Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, The Netherlands
| | - Roland Seiler
- Department of BioMedical Research, University of Bern, Bern, Switzerland; Department of Urology, Hospital Center Biel, Biel, Switzerland
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Lourdes Mengual
- Laboratory and Department of Urology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Joost Boormans
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Peter C Black
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Michiel S van der Heijden
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Survival outcomes of patients with muscle-invasive bladder cancer according to pathological response at radical cystectomy with or without neo-adjuvant chemotherapy: a case-control matching study. Int Urol Nephrol 2022; 54:3145-3152. [PMID: 35997906 PMCID: PMC9606088 DOI: 10.1007/s11255-022-03339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022]
Abstract
Objectives To assess survival of patients with muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy (RC) with or without neo-adjuvant chemotherapy (NAC) according to the pathological response at RC. Methods 965 patients with MIBC (cT2-4aN0M0) who underwent RC with or without NAC were analyzed. Among the collected data were comorbidity, clinical and pathological tumor stage, tumor grade, nodal status (y)pN, and OS. Case–control matching of 412 patients was performed to compare oncological outcomes. Kaplan–Meier curves were created to estimate OS for patients who underwent RC with or without NAC, and for those with complete response (pCR), partial response (pPR), or residual or progressive disease (PD). Results Patients with a pCR or pPR at RC, with or without NAC, had better OS than patients who had PD (both p values < 0.001). Moreover, the incidence of pCR was significantly higher in patients receiving NAC prior to RC than in patients undergoing RC only (31% versus 15%, respectively; p < 0.001). Case–control matching displayed better OS of patients who underwent RC with NAC, median survival not reached, than of those who underwent RC only, median 4.5 years (p = 0.023). Conclusions This study showed that patients with MIBC who underwent NAC with RC had a significant better OS than those who underwent RC only. The proportion of patients with a pCR was higher in those who received NAC and RC than in those who were treated by RC only. The favorable OS rate in the NAC and RC cohort was probably attributed to the higher observed pCR rate. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-022-03339-6.
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Gabrielson AT, Daniels MJ, Rowe J, Alam R, Lee EJ, Matoso A, De Felice A, Hahn N, Hoffman-Censits J, Bivalacqua TJ, Kates M. Residual CIS after neoadjuvant chemotherapy and radical cystectomy for muscle invasive bladder cancer: Implications for neoadjuvant trials. Urol Oncol 2022; 40:164.e9-164.e16. [DOI: 10.1016/j.urolonc.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/21/2021] [Accepted: 11/26/2021] [Indexed: 11/26/2022]
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Qian H, Wang Y, Ma Z, Qian L, Shao X, Jin D, Cao M, Liu S, Chen H, Pan J, Xue W. Surface-Enhanced Raman Spectroscopy of Pretreated Plasma Samples Predicts Disease Recurrence in Muscle-Invasive Bladder Cancer Patients Undergoing Neoadjuvant Chemotherapy and Radical Cystectomy. Int J Nanomedicine 2022; 17:1635-1646. [PMID: 35411143 PMCID: PMC8994599 DOI: 10.2147/ijn.s354590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/14/2022] [Indexed: 01/01/2023] Open
Abstract
Objective To explore the value of surface-enhanced Raman spectroscopy analysis of pretreated plasma samples in prediction of bladder cancer (BCa) recurrence after neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Patients and Methods SERS was used to analyze plasma samples collected before biopsy and treatment in BCa patients undergoing NAC and RC. The value of clinicopathological parameters and distinctive SERS peaks in the prediction of disease recurrence were analyzed in Cox regression proportional hazard analysis and Log rank test. Principal component analysis and linear discriminant analysis (PCA-LDA) were employed to process spectral data and construct diagnostic algorithms. Results A total of 88 patients with 440 plasma SERS spectra were collected. The SRES spectra from recurrent patients were compared with patients who remained recurrence free. The SERS demonstrated higher levels of circulating free nucleic acid components in recurrent population, which is represented by significantly higher intensities at SERS peaks of 725 cm−1, 1328 cm−1 and 1455 cm−1. The SERS also detected significantly lower levels of tryptophan shown as lower significantly intensities at the 1558 cm−1, which is proved to be an independent predictor of BCa recurrence. The addition of SERS peaks of 1558 cm−1 to classic clinicopathological predictors including pathological tumor stage, lymph node metastasis and pathological downstaging can significantly enhance the power of the predictive model from 0.66 to 0.76 in the area under curve (AUC) of receiver operating characteristic (ROC) curves. Meanwhile, the PCA-LDA diagnostic model based on SERS spectra reveals a high accuracy of 85.2% in prediction of disease recurrence and the AUC of 0.92 in the ROC curve. When validated in the leave-one-out cross-validation method, the accuracy of the model remained 84.1%. Conclusion We show that SERS analysis of plasma before NAC treatment can accurately classify patients with different risks of disease recurrence after surgery and improve the power of clinicopathological predictive models, thus refining clinical decision-making.
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Affiliation(s)
- Hongyang Qian
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Yiqiu Wang
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Zehua Ma
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Lei Qian
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Xiaoguang Shao
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Di Jin
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Ming Cao
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Shupeng Liu
- Shanghai Institute for Advanced Communication and Data Science, Key Laboratory of Specialty Fiber Optics and Optical Access Networks, School of Communication and Information Engineering, Shanghai University, Shanghai, People’s Republic of China
| | - Haige Chen
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Jiahua Pan
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Wei Xue
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
- Correspondence: Wei Xue; Jiahua Pan, Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630 Dongfang Road, Shanghai, 200127, People’s Republic of China, Tel +86 21 6838 3375, Email ;
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