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Borys F, Joachimiak E, Krawczyk H, Fabczak H. Intrinsic and Extrinsic Factors Affecting Microtubule Dynamics in Normal and Cancer Cells. Molecules 2020; 25:E3705. [PMID: 32823874 PMCID: PMC7464520 DOI: 10.3390/molecules25163705] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 12/18/2022] Open
Abstract
Microtubules (MTs), highly dynamic structures composed of α- and β-tubulin heterodimers, are involved in cell movement and intracellular traffic and are essential for cell division. Within the cell, MTs are not uniform as they can be composed of different tubulin isotypes that are post-translationally modified and interact with different microtubule-associated proteins (MAPs). These diverse intrinsic factors influence the dynamics of MTs. Extrinsic factors such as microtubule-targeting agents (MTAs) can also affect MT dynamics. MTAs can be divided into two main categories: microtubule-stabilizing agents (MSAs) and microtubule-destabilizing agents (MDAs). Thus, the MT skeleton is an important target for anticancer therapy. This review discusses factors that determine the microtubule dynamics in normal and cancer cells and describes microtubule-MTA interactions, highlighting the importance of tubulin isoform diversity and post-translational modifications in MTA responses and the consequences of such a phenomenon, including drug resistance development.
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Affiliation(s)
- Filip Borys
- Laboratory of Cytoskeleton and Cilia Biology Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland;
- Department of Organic Chemistry, Faculty of Chemistry, Warsaw University of Technology, 3 Noakowskiego Street, 00-664 Warsaw, Poland;
| | - Ewa Joachimiak
- Laboratory of Cytoskeleton and Cilia Biology Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland;
| | - Hanna Krawczyk
- Department of Organic Chemistry, Faculty of Chemistry, Warsaw University of Technology, 3 Noakowskiego Street, 00-664 Warsaw, Poland;
| | - Hanna Fabczak
- Laboratory of Cytoskeleton and Cilia Biology Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland;
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Fischer C, Hofmann R, Hegele A. Chemotherapy of Locally Advanced or Metastatic Urothelial Cell Carcinoma: Monocentric Real-Life Data. Cancer Manag Res 2020; 12:5077-5084. [PMID: 32636673 PMCID: PMC7334140 DOI: 10.2147/cmar.s231508] [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] [Received: 09/18/2019] [Accepted: 01/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background/Aim Up to 30% of all patients will present with an advanced or a metastatic stage (mUCC) at the moment of the initial diagnosis of urothelial cell carcinoma of the bladder (UCC). We investigated the numbers, the efficacy and toxicity of different chemotherapies for mUCC in daily practice and “real-life” conditions and evaluated them substance-specifically. Patients and Methods All patients with a mUCC, who were treated between January 1, 2006 and October 31, 2016 at the Department of Urology and Pediatric Urology at University Hospital Marburg (Germany), were retrospectively analyzed. We set the focus on demographic and tumor-specific data as well as on effectiveness, therapy sequences, and drug tolerance. Results Forty-one patients were identified. Of the 41 patients, 85.4% of the patients in first-line therapy received gemcitabine/cisplatin. A large proportion of 85.4% received a second-line therapy and 40% a third-line therapy due to progress or relapse. Median overall survival (mOS) was 18 months including all patients and increased up to 29.5 months in the cases of three therapy lines. Conclusion Our data reveal that chemotherapy of mUCC is effective and side effects are manageable in daily clinical practice.
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Affiliation(s)
- Christine Fischer
- Department of Urology and Pediatric Urology, University Medical Center, Marburg, Germany
| | - Rainer Hofmann
- Department of Urology and Pediatric Urology, University Medical Center, Marburg, Germany
| | - Axel Hegele
- Department of Urology and Pediatric Urology, University Medical Center, Marburg, Germany
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Čermák V, Dostál V, Jelínek M, Libusová L, Kovář J, Rösel D, Brábek J. Microtubule-targeting agents and their impact on cancer treatment. Eur J Cell Biol 2020; 99:151075. [PMID: 32414588 DOI: 10.1016/j.ejcb.2020.151075] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023] Open
Abstract
Microtubule-targeting agents (MTAs) constitute a diverse group of chemical compounds that bind to microtubules and affect their properties and function. Disruption of microtubules induces various cellular responses often leading to cell cycle arrest or cell death, the most common effect of MTAs. MTAs have found a plethora of practical applications in weed control, as fungicides and antiparasitics, and particularly in cancer treatment. Here we summarize the current knowledge of MTAs, the mechanisms of action and their role in cancer treatment. We further outline the potential use of MTAs in anti-metastatic therapy based on inhibition of cancer cell migration and invasiveness. The two main problems associated with cancer therapy by MTAs are high systemic toxicity and development of resistance. Toxic side effects of MTAs can be, at least partly, eliminated by conjugation of the drugs with various carriers. Moreover, some of the novel MTAs overcome the resistance mediated by both multidrug resistance transporters as well as overexpression of specific β-tubulin types. In anti-metastatic therapy, MTAs should be combined with other drugs to target all modes of cancer cell invasion.
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Affiliation(s)
- Vladimír Čermák
- Department of Cell Biology, Charles University, Viničná 7, 12843 Prague, Czech Republic; Biotechnology and Biomedicine Centre of the Academy of Sciences and Charles University (BIOCEV), Průmyslová 595, 25242 Vestec u Prahy, Czech Republic
| | - Vojtěch Dostál
- Department of Cell Biology, Charles University, Viničná 7, 12843 Prague, Czech Republic
| | - Michael Jelínek
- Department of Biochemistry, Cell and Molecular Biology & Center for Research of Diabetes, Metabolism, and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Libusová
- Department of Cell Biology, Charles University, Viničná 7, 12843 Prague, Czech Republic
| | - Jan Kovář
- Department of Biochemistry, Cell and Molecular Biology & Center for Research of Diabetes, Metabolism, and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Daniel Rösel
- Department of Cell Biology, Charles University, Viničná 7, 12843 Prague, Czech Republic; Biotechnology and Biomedicine Centre of the Academy of Sciences and Charles University (BIOCEV), Průmyslová 595, 25242 Vestec u Prahy, Czech Republic
| | - Jan Brábek
- Department of Cell Biology, Charles University, Viničná 7, 12843 Prague, Czech Republic; Biotechnology and Biomedicine Centre of the Academy of Sciences and Charles University (BIOCEV), Průmyslová 595, 25242 Vestec u Prahy, Czech Republic.
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De Luca R, Profita G, Vella M, Cicero G. Vinflunine in Metastatic Urothelial Carcinoma of the Bladder in Progression after a Platinum-Containing Regimen. Oncology 2019; 97:341-347. [PMID: 31461721 DOI: 10.1159/000502116] [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: 06/11/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vinflunine is a microtubule inhibitor of the vinca alkaloid class approved for the treatment of urothelial bladder carcinoma after a platinum-containing regimen. METHODS To evaluate the effectiveness of vinflunine, we enrolled 80 subjects with a histologically confirmed diagnosis of metastatic urothelial bladder carcinoma that had previously undergone chemotherapy with a platinum-containing regimen and had measurable lesions according to the Response Evaluation Criteria in Solid Tumors (RECIST). The patients (n = 80) received vinflunine (Javlor®) every 3 weeks at 320 mg/m2 via 20-min intravenous infusion. The endpoints were progression-free survival (PFS), objective response rate, overall survival (OS), and tolerability. The cumulative survival of the patients was analyzed using the Kaplan-Meier method. RESULTS In this retrospective study, vinflunine treatment was well tolerated and resulted in a good level of disease control (complete response + partial response + stable disease >50%), with a manageable toxicity profile. The median PFS and OS were 3.2 and 6.8 months, respectively. A significant correlation between pain and PFS was also noted. The major hematologic adverse event was neutropenia, observed in 47% of the patients. The most common nonhematologic adverse events were constipation in 48% of the patients and fatigue in 26%. DISCUSSION In this real-word non-randomized clinical trial setting, the data showed that vinflunine is an efficacious and safe therapeutic option for second-line treatment of patients with metastatic urothelial carcinoma of the bladder after a platinum-containing regimen.
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Affiliation(s)
- Rossella De Luca
- Division of Medical Oncology, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Profita
- Division of Surgical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marco Vella
- Division of Urological Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Cicero
- Division of Medical Oncology, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy,
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Bamias A, Hegele A, Medioni J, Castellano D, Doni L, Passalacqua R, Zagouri F, Tzannis K, Hussain S, Ullen A. Vinflunine in the treatment of relapsed metastatic urothelial cancer: A systematic review and meta-analysis of real-world series. Crit Rev Oncol Hematol 2019; 140:80-87. [PMID: 31133463 DOI: 10.1016/j.critrevonc.2019.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/26/2019] [Accepted: 05/10/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Vinflunine (VFL) is approved in Europe as second-line treatment of metastatic urothelial cancer after failure of platinum-containing therapy. We performed a systematic review and meta-analysis of real-world data (RWD) to assess utilization, efficacy and safety of VFL. METHODS We performed a MEDLINE search for the period of 1/1/2000-31/8/2017. Full-length articles providing post-marketing RWD on VFL in patients failing previous chemotherapy were eligible. Interventional clinical trials were excluded. RESULTS Ten studies with 797 patients were identified. According to pooled REs analysis, overall response rate was 19%, most frequent, all-grade toxicities were fatigue (41%), constipation (39%), nausea/vomiting (25%), and most prevalent Grade 3-4 toxicities were neutropenia (13%), anaemia (9%), fatigue (8%). Median OS was comparable to results reported in recent randomized studies. CONCLUSION Our findings confirm the efficacy and safety of VFL in an unselected population and support the use of VFL in the changing treatment paradigm of relapsed mUC.
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Affiliation(s)
- Aristotelis Bamias
- Department of Clinical Therapeutics, University of Athens, National and Kapodistrian University of Athens Alexandra Hospital, 80 Vas. Sofias Avenue, 11528 Athens, Greece.
| | - Axel Hegele
- Department of Urology and Pediatric Urology, University Medical Center, Baldingerstreet, 35033 Marburg, Germany.
| | - Jacques Medioni
- Centre d'Essais Précoces en Cancérologie, Hopital European Georges Pompidou, Paris-Descartes University, 20, rue Leblanc, 75015 Paris, France.
| | - Daniel Castellano
- Hospital Universitario 12 de Octubre, Av Cordoba s/n, 28041 Madrid, Spain.
| | - Laura Doni
- Aienda Ospedaliera Careggi U.O., Medical Oncology, 3, Largo Brambilla, 50134 Firenze, Italy.
| | - Rodolfo Passalacqua
- Oncology Department, ASST Istituti Ospitalieri, Viale Concordia 1, 26100 Cremona, Italy.
| | - Flora Zagouri
- Department of Clinical Therapeutics, University of Athens, National and Kapodistrian University of Athens Alexandra Hospital, 80 Vas. Sofias Avenue, 11528 Athens, Greece.
| | - Kimon Tzannis
- Department of Clinical Therapeutics, University of Athens, National and Kapodistrian University of Athens Alexandra Hospital, 80 Vas. Sofias Avenue, 11528 Athens, Greece.
| | - Syed Hussain
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
| | - Anders Ullen
- Karolinska University Hospital, Eugeniavägen 3, PO Bäckencancer, Theme Cancer, Solna 17176, Sweden.
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Houédé N, Milano G. [Care of advanced or metastatic bladder cancer in second line: A specific place for vinflunine]. Bull Cancer 2019; 106:431-435. [PMID: 30981463 DOI: 10.1016/j.bulcan.2019.02.007] [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: 11/12/2018] [Revised: 01/25/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
Urothelial carcinoma of the bladder are rare but aggressive tumors with a high metastatic potential. The prognosis of these tumors has not drastically changed over the past 30 years, with an overall survival of less than two years in advanced or metastatic situations. Even though immune checkpoints inhibitors have changed this picture, it is beneficial for less than 30% of patients and there is no reliable biomarkers to identify this specific population of responders. Vinflunine is a vinca-alkaloid that was specifically developed as second line treatment post-platinum. As of today, it is the sole anticancer agent for which clinical trials have been pushed to phase III and that was approved for patients in good conditions. Unfortunately, it has been withdrawn from the list of reimbursed drugs, which impairs its prescription. Based on the results of phase III clinical trials with immunotherapies, this review provides the reader with argumentations in favor of patients' and clinicians' request to reimburse vinflunine for the treatment of advanced or metastatic urothelial carcinoma of the bladder.
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Affiliation(s)
- Nadine Houédé
- Montpellier university, centre hospitalier universitaire Carremeau Nîmes, place du Pr Robert-Debré, 30029 Nîmes, France.
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Schmitt A, Nguyen L, Zorza G, Ferré P, Pétain A. Better characterization of vinflunine pharmacokinetics variability and exposure/toxicity relationship to improve its use: Analyses from 18 trials. Br J Clin Pharmacol 2018; 84:900-910. [PMID: 29341179 PMCID: PMC5903240 DOI: 10.1111/bcp.13518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 01/22/2023] Open
Abstract
AIMS Vinflunine is a novel tubulin-targeted inhibitor indicated as a single agent for the treatment of bladder cancers after failure of prior platinum-based therapy. Its pharmacokinetics (PK) and pharmacodynamics (PD) have been independently characterized through several phase I and phase II studies. However, no global pharmacometric analysis had been conducted as yet. METHODS Vinflunine concentrations and safety data from 18 phase I and phase II studies were used to conduct population PK and PK/PD analysis, using Nonmem. A four-compartment model was used to describe vinflunine PK and several covariates were tested to explain interindividual variability. In terms of PK/PD relationship, a semiphysiological population PK/PD model was applied to describe time course of absolute neutrophil counts (ANC) after vinflunine administration and logistic regression models were used to test the relationship between vinflunine exposure and toxicities. RESULTS Vinflunine clearance is explained by creatinine clearance, body surface area and combination with PEGylated doxorubicin, leading to a decrease from 28.2 to 25.3% of the interindividual variability. When vinflunine dose is decreased, simulations of ANC time course (via a semiphysiological model) after vinflunine administration show a risk of neutropenia grade 3-4 at cycle 2 always lower than when dose is delayed. As an example, for moderate renal impaired patients, the risk is 42.1% when vinflunine is dosed at 320 mg m-2 once every 4 weeks vs. 23.3% for 280 mg m-2 once every 3 weeks. CONCLUSIONS We propose for the first time a global comprehensive clinical pharmacological analysis for intravenous vinflunine that may help drive dose adjustment.
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Affiliation(s)
- Antonin Schmitt
- Centre Georges‐François LeclercDijonFrance
- INSERM U1231University of Burgundy Franche‐ComtéDijonFrance
| | | | | | - Pierre Ferré
- Institut de Recherche Pierre FabreToulouseFrance
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Niegisch G, Gerullis H, Lin SW, Pavlova J, Gondos A, Rudolph A, Haas G, Hennies N, Kramer MW. A Real-World Data Study to Evaluate Treatment Patterns, Clinical Characteristics and Survival Outcomes for First- and Second-Line Treatment in Locally Advanced and Metastatic Urothelial Cancer Patients in Germany. J Cancer 2018; 9:1337-1348. [PMID: 29721042 PMCID: PMC5929077 DOI: 10.7150/jca.23162] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/30/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Worldwide, urothelial carcinoma (UC) is a common cause of morbidity and mortality. In particular, the incidence of bladder cancer varies widely across Europe; Germany has the ninth highest international age-standardized incidence. For advanced UC or metastatic UC (mUC), platinum-based combination chemotherapy is the standard first-line (1L) treatment; however, there is wide heterogeneity of second-line (2L) treatments, ranging from vinflunine in parts of Europe to taxanes and other agents elsewhere in Europe, in the United States and globally. Limited data exist on treatment patterns and outcomes in patients with advanced UC or mUC in the routine clinical setting in Germany. The objective of this study was to describe clinical characteristics, treatment patterns and subsequent outcomes in this setting. Methods: This retrospective observational cohort analysis evaluated 1L and 2L treatment patterns and overall survival (OS) in patients aged ≥18 years with advanced UC or mUC (T4b, N2-3 and/or M1) at office-based urology and academic as well as nonacademic urology clinics throughout Germany between 1 November 2009 and 2 June 2016. Data were obtained through the GermanOncology database and additional treatment centers using similar electronic case report forms. Results: Among the 435 patients included in the analysis, 435 received 1L treatment and 125 received 2L treatment. Median age at start of 1L treatment was 69 years, 75% of patients were male, 75% were current or ex-smokers, 15% had hemoglobin <10 g/dL and 44% had creatinine clearance<60 mL/min/1.73; proportions were similar with 2L treatment. Cardiovascular disease was the most frequently reported comorbidity (65%), followed by diabetes (19%). Most patients (77%) received 1L platinum-based combination treatment (most commonly gemcitabine + cisplatin, 83%). Of those treated with 2L treatment, 66% received a single agent (most commonly vinflunine, 71%). Median OS (95% CI) with 1L treatment was 16.1 months (13.7-19.2) overall and 17.7 months (14.4-24.2) with 1L cisplatin + gemcitabine. In the 1L setting, 12-month OS was 61%, 24-month OS was 39% and 36-month OS was 26%. Median (95% CI) OS with 2L treatment was 9.2 months (5.5-11.6) overall and 5.9 months (4.1-12.6) with 2L vinflunine. In the 2L setting, OS rates for the same time periods were 40%, 22% and 8%, respectively. Median (95% CI) progression-free survival was 7 months (6.4-8.1) and 4 months (3.0-4.8), respectively, in the 1L and 2L settings. Objective response rates were 34% in the 1L setting and 14% in the 2L setting. No difference in OS by sex or smoking status was noted. Patients with or without renal impairment had a 12-month OS of 54% or 69%, respectively. OS at 12 months was 63% among patients with an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 to 1 vs 53% among patients with an ECOG PS of ≥2. Cox regression analysis found no difference in OS between vinflunine and other 2L treatments (P = 0.69). Conclusions: This study provides a contemporary multicenter assessment of real-world treatment patterns and outcomes among palliatively treated patients with UC in Germany. The findings were generally consistent with the poor treatment outcomes observed globally, underscoring the need for effective 1L and 2L treatment for advanced UC or mUC.
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Affiliation(s)
- Günter Niegisch
- Department of Urology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Holger Gerullis
- School of Medicine and Health Sciences, University Hospital for Urology, Carl von Ossietzky University Oldenburg, Germany
| | | | | | - Adam Gondos
- Real World Insights, QuintilesIMS, Frankfurt, Germany
| | - Anja Rudolph
- Real World Insights, QuintilesIMS, Frankfurt, Germany
| | - Gabriele Haas
- Real World Insights, QuintilesIMS, Frankfurt, Germany
| | - Nora Hennies
- Real World Insights, QuintilesIMS, Frankfurt, Germany
| | - Mario W. Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
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Brousell SC, Fantony JJ, Van Noord MG, Harrison MR, Inman BA. Vinflunine for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract: an evidence-based review of safety, efficacy, and place in therapy. CORE EVIDENCE 2018; 13:1-12. [PMID: 29416444 PMCID: PMC5790085 DOI: 10.2147/ce.s118670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background A systematic review and meta-analysis of the use of systemic vinflunine (VIN) in the treatment of urothelial carcinoma (UC) was performed to evaluate its efficacy based on current available clinical data. Methods This review was prospectively registered at the International Prospective Register of Systematic Reviews, PROSPERO (registration CRD42016049294). Electronic databases including MEDLINE®, Embase®, Cochrane Central Register of Controlled Trials, and Web of Science were searched through December 2016. We performed a meta-analysis of the published data. Primary end points were progression-free survival (PFS) and overall survival (OS). Numerous secondary clinical outcomes were analyzed including response and toxicity data. Results We identified 382 publications, of which 35 met inclusion criteria for this review representing 29 unique studies. A total of 2,255 patients received VIN for the treatment of UC in the included studies. OS and PFS were analyzed in a pooled Kaplan–Meier analysis. Response data were available for 1,416 VIN-treated patients with random effects proportion of complete response in 1%, partial response in 18%, and overall response rate of 21%. Toxicity analysis revealed fatigue (40.1%), nausea (33.9%), constipation (34.1%), and alopecia (26.0%) as the most prevalent overall non-hematologic adverse events (AEs). Most prevalent grade 3–4 AEs were fatigue (10.2%), abdominal pain (8.2%), myalgias (2.5%), and nausea (2.3%). Most common hematologic AEs of all grades were anemia (56.6%), neutropenia (46.0%), thrombocytopenia (25.5%), and febrile neutropenia (6.6%). Grade 3–4 hematologic AEs had the following pooled rates: neutropenia, 24.6%; anemia, 10.2%; febrile neutropenia, 5.4%; and thrombocytopenia, 3.0%. Conclusion VIN has been explored as a combination first-line treatment as well as a single-agent second-line, third-line, and maintenance therapy for advanced and metastatic UC. In first-line treatment of UC, either as a maintenance agent after cisplatin or as a primary combination therapy, VIN may be a promising alternative to current treatments. Further studies are needed to compare first-line combination VIN regimens to the current standard of care in order to assess long-term survival outcomes. Second- and third-line VIN monotherapy does provide a proven, although limited, survival benefit in platinum-refractory patients.
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Affiliation(s)
| | | | | | - Michael R Harrison
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
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Vau N, Volavsek M, Blanca A, Montironi R, Raspollini MR, Massari F, Cheng M, Scarpelli M, Lopez-Beltran A. Prospects for precision therapy of bladder urothelial carcinoma. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1389273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Nuno Vau
- Urologic Oncology, Champalimaud Clinical Center, Lisbon, Portugal
| | - Metka Volavsek
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Blanca
- Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Rodolfo Montironi
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy
| | - Maria R. Raspollini
- Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy
| | | | - Monica Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Scarpelli
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy
| | - Antonio Lopez-Beltran
- Department of Pathology, Unit of Anatomical Pathology, Department of Surgery, Faculty of Medicine, Cordoba, Spain
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Passalacqua R, Lazzarelli S, Donini M, Montironi R, Tambaro R, De Giorgi U, Pignata S, Palumbo R, Ceresoli GL, Del Conte G, Tonini G, Morelli F, Nolè F, Panni S, Rondini E, Guida A, Zucali PA, Doni L, Iezzi E, Caminiti C. Real-life clinical practice results with vinflunine in patients with relapsed platinum-treated metastatic urothelial carcinoma: an Italian multicenter study (MOVIE-GOIRC 01-2014). BMC Cancer 2017; 17:493. [PMID: 28724419 PMCID: PMC5517798 DOI: 10.1186/s12885-017-3466-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/30/2017] [Indexed: 01/06/2023] Open
Abstract
Background Vinflunine is the only chemotherapeutic agent shown to improve survival in platinum-refractory patients with metastatic transitional cell carcinoma of the urothelium (TCCU) in a phase III clinical trial, which led to product registration for this indication in Europe. The aim of this study was to assess the efficacy of vinflunine and to evaluate the prognostic significance of risk factors in a large, unselected cohort of patients with metastatic TCCU treated according to routine clinical practice. Methods This was a retrospective multicenter study. Italian cancer centers were selected if, according to the Registry of the Italian Medicines Agency (AIFA), at least four patients had been treated with vinflunine between February 2011 and June 2014, after first- or second-line platinum-based chemotherapy. The primary objective was to test whether the efficacy measured by overall survival (OS) in the registration study could be confirmed in routine clinical practice. Multivariate analysis was carried out using Cox proportional hazard model. Results A total of 217 patients were treated in 28 Italian centers. Median age was 69 years (IQR 62–76) and 84% were male; Eastern Cooperative Oncology Group performance status (ECOG PS) was ≥ 1 in 53% of patients. The median number of cycles was 4 (IQR 2–6); 29%, 35%, and 36% received an initial dose of 320 mg/m2, 280 mg/m2 or a lower dose, respectively. Median progression-free survival (PFS) and OS for the entire population was 3.2 months (2.6–3.7) and 8.1 months (6.3–8.9). A complete response was observed in six patients, partial response in 21, stable disease in 60, progressive disease in 108, with a disease control rate of 40%. Multivariate analysis showed that ECOG PS, number of metastatic sites and liver involvement were unfavorable prognostic factors for OS. Toxicity was mild, and grade 3–4 adverse effects were mainly: neutropenia (9%), anemia (6%), asthenia/fatigue (7%) and constipation (5%). Conclusions In routine clinical practice the results obtained with VFL seem to be better than the results of the registration trial and reinforce evidence supporting its use after failure of a platinum-based chemotherapy. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3466-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Silvia Lazzarelli
- Division of Oncology, ASST- Istituti Ospitalieri Cremona, Cremona, Italy
| | - Maddalena Donini
- Division of Oncology, ASST- Istituti Ospitalieri Cremona, Cremona, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Rosa Tambaro
- Department of Urogynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | - Ugo De Giorgi
- Oncologia Genitourinaria, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- Department of Urogynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | | | | | | | - Giuseppe Tonini
- Dipartimento di Oncologia, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Franco Morelli
- Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Franco Nolè
- Oncologia, Istituto Europeo di Oncologia, Milan, Italy
| | - Stefano Panni
- Division of Oncology, ASST- Istituti Ospitalieri Cremona, Cremona, Italy
| | - Ermanno Rondini
- Oncologia, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Annalisa Guida
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Laura Doni
- Oncologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Elisa Iezzi
- Ricerca e Innovazione, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Caterina Caminiti
- Ricerca e Innovazione, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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12
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Bellmunt J, Kerst J, Vázquez F, Morales-Barrera R, Grande E, Medina A, González Graguera M, Rubio G, Anido U, Fernández Calvo O, González-Billalabeitia E, Van den Eertwegh A, Pujol E, Perez-Gracia J, González Larriba J, Collado R, Los M, Maciá S, De Wit R. A randomized phase II/III study of cabazitaxel versus vinflunine in metastatic or locally advanced transitional cell carcinoma of the urothelium (SECAVIN). Ann Oncol 2017; 28:1517-1522. [DOI: 10.1093/annonc/mdx186] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Indexed: 12/17/2022] Open
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13
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Aoun F, Rassy EE, Assi T, Albisinni S, Katan J. Advances in urothelial bladder cancer immunotherapy, dawn of a new age of treatment. Immunotherapy 2017; 9:451-460. [PMID: 28357911 DOI: 10.2217/imt-2017-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Urothelial bladder cancer displays a high number of somatic mutations that render these tumors more responsive to immunotherapy. Several immunotherapeutic agents were examined in patients with advanced stage urothelial bladder cancer and recently atezolizumab - an (PDL-1) immune checkpoint inhibitor antibody - was approved for the treatment of patients with metastatic disease progressing after platinum combination therapy. Despite the great success, there are still some unanswered questions and ongoing trials that are in progress to define the role of combination therapy and sequencing strategies. The objective of our manuscript is to summarize the most recent data on immunotherapy in advanced urothelial cancer. Current challenges and future perspectives of immunotherapy as a monotherapy or in combination strategies will also be analyzed.
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Affiliation(s)
- Fouad Aoun
- Department of Urology, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon.,Department of Urology, Jules Bordet Institute, 1 Rue Héger Bordet, 1000 Brussels, Belgium
| | - Elie El Rassy
- Department of Oncology, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Tarek Assi
- Department of Oncology, Gustave Roussy Institute, Paris, France
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute, 1 Rue Héger Bordet, 1000 Brussels, Belgium
| | - Joseph Katan
- Department of Oncology, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
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14
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Gerullis H, Wawroschek F, Köhne CH, Ecke TH. Vinflunine in the treatment of advanced urothelial cancer: clinical evidence and experience. Ther Adv Urol 2016; 9:28-35. [PMID: 28042310 DOI: 10.1177/1756287216677903] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Vinflunine (VFL) has been approved in Europe for second-line treatment of metastatic and advanced urothelial cancer after failure of platin-containing therapy. Since approval, the drug has been investigated in few clinical trials. Most of the currently available reports describe experiences with VFL in a daily clinical setting. This review gives a short overview on clinical experiences and clinical trials involving VFL since the approval of this drug in 2009.
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Affiliation(s)
- Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany
| | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Claus-Henning Köhne
- University Hospital of Oncology/Haematology, Oncology Center Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
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15
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Houédé N, Locker G, Lucas C, Parra HS, Basso U, Spaeth D, Tambaro R, Basterretxea L, Morelli F, Theodore C, Lusuardi L, Lainez N, Guillot A, Tonini G, Bielle J, Del Muro XG. Epicure: a European epidemiological study of patients with an advanced or metastatic Urothelial Carcinoma (UC) having progressed to a platinum-based chemotherapy. BMC Cancer 2016; 16:752. [PMID: 27664126 PMCID: PMC5035464 DOI: 10.1186/s12885-016-2782-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/14/2016] [Indexed: 01/31/2023] Open
Abstract
Background Platinum-based systemic chemotherapy is considered the backbone for management of advanced urothelial carcinomas. However there is a lack of real world data on the use of such chemotherapy regimens, on patient profiles and on management after treatment failure. Methods Fifty-one randomly selected physicians from 4 European countries registered 218 consecutive patients in progression or relapse following a first platinum-based chemotherapy. Patient characteristics, tumor history and treatment regimens, as well as the considerations of physicians on the management of urothelial carcinoma were recorded. Results A systemic platinum-based regimen had been administered as the initial chemotherapy in 216 patients: 15 in the neoadjuvant setting, 61 in adjuvant therapy conditions, 137 in first-line advanced setting and 3 in other conditions. Of these patients, 76 (35 %) were initially considered as cisplatin-unfit, mainly because of renal impairment (52 patients). After platinum failure, renal impairment was observed in 44 % of patients, ECOG Performance Status ≥ 2 in 17 %, hemoglobinemia < 10 g/dL in 16 %, hepatic metastases in 13 %. 80 % of these patients received further anticancer therapy. Immediately after failure of adjuvant/neoadjuvant chemotherapy, most subsequent anticancer treatments were chemotherapy doublets (35/58), whereas after therapy failure in the advanced setting most patients receiving further anticancer drugs were treated with a single agent (80/114). After first progression to chemotherapy, treatment decisions were mainly driven by Performance Status and prior response to chemotherapy (>30 % patients). The most frequent all-settings second anticancer therapy regimen was vinflunine (70 % of single-agent and 42 % of all subsequent treatments), the main reasons evoked by physicians (>1 out of 4) being survival benefit, safety and phase III evidence. Conclusion In this daily practice experience, a majority of patients with urothelial carcinoma previously treated with a platinum-based therapy received a second chemotherapy regimen, most often a single agent after an initial chemotherapy in the advanced setting and preferably a cytotoxic combination after a neoadjuvant or adjuvant chemotherapy. Performance Status and prior response to chemotherapy were the main drivers of further treatment decisions.
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Affiliation(s)
- N Houédé
- Institut de Cancérologie du Gard - CHU Caremeau, 30029, Nîmes, Cedex 9, France.
| | - G Locker
- Department of Internal Medicine I, Währinger Gürtel.18-20, 1090, Vienne, Austria
| | - C Lucas
- Institut de Recherche Pierre Fabre, 45 place Abel Gance, 92100, Boulogne-Billancourt, France
| | - H Soto Parra
- Oncologia Medica, P.O Gaspare Rodolico, Via Santa Sofia 78, 95123, Catania, Italy
| | - U Basso
- Istituto Oncologico Veneto IOV-IRCCS, Dipartmento di Oncologia Clinica e Sperimentale, Oncologia Medica 1, via Gattamelata 64, 35128, Padova, Italy
| | - D Spaeth
- Centre d'Oncologie de Gentilly, 2 rue Marie Marvingt, 54100, Nancy, France
| | - R Tambaro
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Via Mariano Semmola, 80131, Napoli, Italy
| | - L Basterretxea
- Hospital Universitario Donostia, Begiristain Doktorea Pasealekua 117-20080, Donostia, Gipuzkoa - San Sebastián, Spain
| | - F Morelli
- Fondazione Casa Sollievo della Sofferenza Oncologia, Viale Cappuccini 1, San Giovanni Rotondo, Foggia, Italy
| | - C Theodore
- Hopital Foch, 40 rue Worth, 92150, Suresnes, France
| | - L Lusuardi
- Reparto di Urologia - Ospedale di Bressanone, Via Dante 51, 39042, Bressanone, Italy
| | - N Lainez
- Hospital de Navarra - Virgen del Camino, Oncología Médica, Calle de Irunlarrea, 4 planta baja, 31008, Pamplona, Spain
| | - A Guillot
- Institut de cancérologie de la Loire, 108 bis avenue Albert Raimond, 42271, Saint Priest en Jarez, Cedex, France
| | - G Tonini
- Policlinico Universitario Campus Bio-medico Oncologia Medica, Via Alvaro del Portillo 200, 00128, Roma, Italy
| | - J Bielle
- Institut de Recherche Pierre Fabre, 45 place Abel Gance, 92100, Boulogne-Billancourt, France
| | - X Garcia Del Muro
- ICO L'Hospitalet, Avinguda Granvia, 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
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16
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Facchini G, Della Pepa C, Cavaliere C, Cecere SC, Di Napoli M, D'Aniello C, Crispo A, Iovane G, Maiolino P, Tramontano T, Piscitelli R, Pisconti S, Montella M, Berretta M, Sorrentino D, Perdonà S, Pignata S. From Clinical Trials to the Front Line: Vinflunine for Treatment of Urothelial Cell Carcinoma at the National Cancer Institute of Naples. Front Pharmacol 2016; 7:110. [PMID: 27199753 PMCID: PMC4853416 DOI: 10.3389/fphar.2016.00110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/11/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The efficacy of Vinflunine, after failure of platinum-based chemotherapy in patients with metastatic or recurrent Transitional Cell Cancer of the Urothelial Tract, TCCU, has been demonstrated in an international, randomized, phase III trial comparing Vinflunine plus Best Supportive Care, BSC, with BSC alone. On the basis of that study vinflunine has been approved by the European Medicine Association, EMA, for treatment of TCCU patients after failure of a platinum treatment. However, since data in clinical trials often differ from routine clinical practice due to unselected population and less strict monitoring, "real life" experiences are very helpful to verify the efficacy of a new therapy. METHODS This was a spontaneous, observational, retrospective study involving 43 patients with metastatic TCCU treated with vinflunine at our cancer center, data about demographics, disease characteristics, and previous treatments were collected and outcome and toxicities of vinflunine were analyzed. RESULTS 41 of 43 patients were eligible for RR analysis, the Overall RR was 12%, the Disease Control Rate was 29%; when including only patients treated in II line the DCR rose to 33%; the median PFS and the median OS were 2.2 and 6.9 months, respectively. CONCLUSION Our findings were consistent with the outcome data emerged in the phase III randomized trial and in the other observational studies conducted all around Europe in the last 2-3 years. This experience supports the use of vinflunine in patients with advanced TTCU as effective and manageable antineoplastic drug.
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Affiliation(s)
- Gaetano Facchini
- Division of MedicalOncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale Naples, Italy
| | - Chiara Della Pepa
- Division of MedicalOncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale Naples, Italy
| | - Carla Cavaliere
- Division of MedicalOncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale Naples, Italy
| | - Sabrina C Cecere
- Division of MedicalOncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale Naples, Italy
| | - Marilena Di Napoli
- Division of MedicalOncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale Naples, Italy
| | - Carmine D'Aniello
- Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto Taranto, Italy
| | - Anna Crispo
- Unit of Epidemiology, Struttura Complessa di Statistica Medica, Biometria e Bioinformatica, Fondazione Istituto Nazionale Tumori Naples, Italy
| | - Gelsomina Iovane
- Division of MedicalOncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale Naples, Italy
| | - Piera Maiolino
- Pharmacy Unit, Istituto Nazionale Tumori, Istituto Nazionale Tumori-Fondazione G. Pascale Naples, Italy
| | - Teresa Tramontano
- Pharmacy Unit, Istituto Nazionale Tumori, Istituto Nazionale Tumori-Fondazione G. Pascale Naples, Italy
| | - Raffaele Piscitelli
- Pharmacy Unit, Istituto Nazionale Tumori, Istituto Nazionale Tumori-Fondazione G. Pascale Naples, Italy
| | - Salvatore Pisconti
- Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto Taranto, Italy
| | - Maurizio Montella
- Unit of Epidemiology, Struttura Complessa di Statistica Medica, Biometria e Bioinformatica, Fondazione Istituto Nazionale Tumori Naples, Italy
| | | | - Domenico Sorrentino
- Division of Urology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale Naples, Italy
| | - Sisto Perdonà
- Division of Urology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale Naples, Italy
| | - Sandro Pignata
- Division of MedicalOncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale Naples, Italy
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17
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Médioni J, Di Palma M, Guillot A, Spaeth D, Théodore C. Efficacy and safety of Vinflunine for advanced or metastatic urothelial carcinoma in routine practice based on the French multi-centre CURVE study. BMC Cancer 2016; 16:217. [PMID: 26975779 PMCID: PMC4792100 DOI: 10.1186/s12885-016-2262-9] [Citation(s) in RCA: 16] [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: 03/09/2015] [Accepted: 03/09/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To retrospectively assess the efficacy and safety of Vinflunine (VFL) under routine conditions and identify overall survival (OS) prognostic factors. METHODS Twenty centres participated in the retrospective study (minimum 4 patients undergoing VFL treatment for advanced/metastatic UC after platinum-based regimen progression. Primary endpoint was OS. Secondary endpoints: progression-free survival (PFS), radiological response rate (RR) RECIST criteria and toxicity (CTC NCI v3). RESULTS These centres enrolled 134 patients. Prior chemotherapy (CT) lines (≥ 1 palliative): 1 and ≥ 2 in 69% and 26% of patients, respectively. Performance status (PS): 0, 1, 2 in 25%, 46% and 23% of patients. Median OS = 8.2 months [6.5-9.4], PFS = 4.2 months and RR 22%, median number of 5 cycles. In risk groups based on 0-3 presence of adverse prognostic factors (PS ≥ 1, haemoglobin ≤ 10 g/dl and liver metastasis), median OS: 13.2, 9.9, 3.6, and 2.4 months (P < .0001), respectively; 3.3 months (1.9-5.6) in PS ≥ 2 subgroup. CONCLUSION This study reflects routine UC management and confirmed VFL patient efficacy. The drug is safe with gastro-intestinal and haematological prophylaxis. Analysis of prognostic factors for OS is consistent with pivotal trials.
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Affiliation(s)
- Jacques Médioni
- />Medical Oncology Department, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Mario Di Palma
- />Department of Medicine, Gustave Roussy Institute, 114 Rue Édouard Vaillant, 94805 Villejuif, France
| | - Aline Guillot
- />Lucien Neuwirth Institute of Cancerology, 108 B Avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, France
| | - Dominique Spaeth
- />Gentilly Oncology Centre, 2 rue Marie Marvingt, 54100 Nancy, France
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