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Sorce G, Chierigo F, Flammia RS, Hoeh B, Hohenhorst L, Tian Z, Goyal JA, Graefen M, Terrone C, Gallucci M, Chun FKH, Saad F, Shariat SF, Montorsi F, Briganti A, Karakiewicz PI. Survival trends in chemotherapy exposed metastatic bladder cancer patients and chemotherapy effect across different age, sex, and race/ethnicity. Urol Oncol 2022; 40:380.e19-380.e27. [PMID: 35431135 DOI: 10.1016/j.urolonc.2022.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To test for survival differences in metastatic urothelial carcinoma of the urinary bladder (mUCUB) patients, according to years of diagnosis, age, sex, and race/ethnicity over time and for the effect of chemotherapy on overall mortality (OM). MATERIALS AND METHODS Within the Surveillance, Epidemiology, and End Results (2000-2016), we identified 6860 mUCUB patients. Of those, 3,249 were exposed to chemotherapy. Kaplan-Meier plots and Cox regression models focused on OM. First, we tested the effect of years of diagnosis (historical [2000-2005] vs. intermediate [2006-2011] vs. contemporary [2012-2016]) in chemotherapy exposed mUCUB patients. Second, we tested the effect of chemotherapy in all mUCUB patients. RESULTS In chemotherapy exposed mUCUB patients according to historical vs. intermediate vs. contemporary years, median overall survival was 11 vs. 13 vs. 14 months respectively, which translated into hazard ratios (HR) of 0.86 (P = 0.005) and 0.75 (P < 0.001) in intermediate and contemporary vs. historical, respectively. Subgroup analyses in <70 years old, males and Caucasians were in agreement regarding statistically significant differences between historical vs. intermediate vs. contemporary, respectively. In multivariable Cox regression models fitted in the entire mUCUB cohort, chemotherapy exposure reduced OM (HR: 0.46; P < 0.001). Virtually the same results were recorded in age, sex, and race/ethnicity subgroups analyses. CONCLUSIONS Contemporary chemotherapy exposed mUCUB patients exhibited better survival than their historical and intermediate counterparts. Chemotherapy reduced mortality by half, across all patient types.
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Affiliation(s)
- Gabriele Sorce
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Francesco Chierigo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Rocco Simone Flammia
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Jordan A Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Departments of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Praga, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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Abstract
Following platinum-based regimens becoming the reference standard of care, it has taken almost four decades to find a systemic treatment that improved overall survival in metastatic urothelial tumors. Single-agent immune checkpoint inhibitors have not only improved overall survival but also the quality of life of patients with metastatic urothelial tumors after failure of platinum-based regimens and as a maintenance therapy after four to six cycles of standard first-line chemotherapy. In addition, very promising data are emerging when single-agent immunotherapy is offered as adjuvant or neoadjuvant treatment for patients with muscle-invasive disease and also in the non-muscle-invasive setting. There is an extensive debate about the role of PD-L1 expression as a reliable biomarker to predict the activity of immune-based regimens. Furthermore, the lack of consensus concerning its utility means that there is a need for more and better tools to identify patients who are likely to benefit from these novel approaches. The field of urothelial tumors now additionally exploits novel antibody-drug conjugates and fibroblast growth factor-receptor inhibitors that are being tested in combination with immunotherapy. This added complexity contributes to an enormous increase in the challenges that will be faced shortly.
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Moorthy HK, Prabhu GGL, Venugopal P. Clinical and therapeutic implications of sex steroid hormone receptor status in urothelial bladder cancer. Indian J Urol 2020; 36:171-178. [PMID: 33082631 PMCID: PMC7531383 DOI: 10.4103/iju.iju_320_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/02/2020] [Accepted: 03/31/2020] [Indexed: 12/24/2022] Open
Abstract
Studies on the clinical profile of urothelial bladder cancer (UBC) have shown significant gender differences, namely, higher occurrence in males (male-to-female ratio of 3.5:1) and an advanced stage of disease at the time of diagnosis with rapid progression of the disease after initial diagnosis seen more commonly in females. The relationship between gender and UBC is complex and probably influenced by biological and epidemiological factors. Potential contributory factors such as sex steroid hormone pathway, gender difference in environmental carcinogen exposure, metabolic enzyme activity, and disparities in the intensity of diagnostic evaluation could probably explain the demographic trends in UBC. This comprehensive review of Medline publications during the period 2009–2019 attempts to identify the possible role of sex hormone receptors in gender variation and sexual dimorphism in the occurrence and progression of UBC. The clinical implications of identifying sex steroid receptors on factors such as disease prognostication and the therapeutic role of anti-androgens in the prevention and progression of UBC are critically reviewed. There is now significant evidence in literature to suggest the possible role of sex steroid hormone receptor-mediated signals in the genesis and progression of UBC. These receptors include androgen receptors, estrogen receptors, progesterone receptors, and various other orphan receptors. Excessive or reduced expression of these receptors, as well as alterations in their upstream or downstream pathways, correlate well with the clinical and therapeutic outcomes of UBC.
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Affiliation(s)
| | - G G Laxman Prabhu
- Department of Urology, Kasturba Medical College (A Unit of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - P Venugopal
- Department of Urology, Kasturba Medical College (A Unit of Manipal Academy of Higher Education), Mangalore, Karnataka, India
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4
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Nakayama M, Ito Y, Hatano K, Nakai Y, Kakimoto KI, Miyashiro I, Nishimura K. Impact of sex difference on survival of bladder cancer: A population-based registry data in Japan. Int J Urol 2019; 26:649-654. [PMID: 30916420 DOI: 10.1111/iju.13955] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/03/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the impact of sex on the prognosis of bladder cancer in Japan. METHODS In total, 18 728 patients diagnosed as having bladder cancer from 1993 to 2006 were registered in population-based cancer registries of six prefectures in Japan. We estimated relative survival by sex, age, clinical stage at initial diagnosis and pathology. RESULTS Patients included 14 203 men (75.8%) and 4525 women (24.2%). The stage at initial diagnosis in women was significantly higher than in men (P < 0.0001). Pathologically, women were more likely to have non-urothelial cancer than men (women 18.0%, men 9.5%, P < 0.0001). The 5-year relative survival was 80.3% for men and 67.7% for women. The 5-year relative survival was 93.0% for men and 87.7% for women in the localized cancer group, 34.8% for men and 23.9% for women in the locally advanced cancer group, and 7.1% for men and 8.3% for women in the metastatic cancer group. The relative survival of women was worse than that of men in the localized cancer group (hazard ratio 1.29, 95% confidence interval 1.05-1.57; P = 0.0145) and locally advanced cancer group (hazard ratio 1.32, 95% confidence interval 1.15-1.52; P = 0.0001), but not different in the metastatic cancer group (hazard ratio 1.04, 95% confidence interval 0.87-1.25; P = 0.6555). CONCLUSIONS Population-based registry data in Japan show that the cancer stage at initial diagnosis is higher in women than in men, and women with localized or locally advanced bladder cancer have a worse prognosis compared with men.
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Affiliation(s)
- Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuri Ito
- Department of Medical Statistics, Research & Development Center, Osaka Medical College, Osaka, Japan.,Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Hatano
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Ken-Ichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
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5
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Wong YNS, Joshi K, Khetrapal P, Ismail M, Reading JL, Sunderland MW, Georgiou A, Furness AJS, Ben Aissa A, Ghorani E, Oakes T, Uddin I, Tan WS, Feber A, McGovern U, Swanton C, Freeman A, Marafioti T, Briggs TP, Kelly JD, Powles T, Peggs KS, Chain BM, Linch MD, Quezada SA. Urine-derived lymphocytes as a non-invasive measure of the bladder tumor immune microenvironment. J Exp Med 2018; 215:2748-2759. [PMID: 30257862 PMCID: PMC6219732 DOI: 10.1084/jem.20181003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/03/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022] Open
Abstract
Despite the advances in cancer immunotherapy, only a fraction of patients with bladder cancer exhibit responses to checkpoint blockade, highlighting a need to better understand drug resistance and identify rational immunotherapy combinations. However, accessibility to the tumor prior and during therapy is a major limitation in understanding the immune tumor microenvironment (TME). Herein, we identified urine-derived lymphocytes (UDLs) as a readily accessible source of T cells in 32 patients with muscle invasive bladder cancer (MIBC). We observed that effector CD8+ and CD4+ cells and regulatory T cells within the urine accurately map the immune checkpoint landscape and T cell receptor repertoire of the TME. Finally, an increased UDL count, specifically high expression of PD-1 (PD-1hi) on CD8+ at the time of cystectomy, was associated with a shorter recurrence-free survival. UDL analysis represents a dynamic liquid biopsy that is representative of the bladder immune TME that may be used to identify actionable immuno-oncology (IO) targets with potential prognostic value in MIBC.
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Affiliation(s)
- Yien Ning Sophia Wong
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
- Department of Oncology, UCL Cancer Institute, London, England, UK
- Department of Oncology, University College London Hospital, London, England, UK
| | - Kroopa Joshi
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
- Division of Infection and Immunity, University College London, London, England, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, England, UK
| | - Pramit Khetrapal
- Department of Urology, University College London Hospital at Westmoreland Street, London, England, UK
- Division of Surgical and Interventional Sciences, University College London, London, England, UK
| | - Mazlina Ismail
- Division of Infection and Immunity, University College London, London, England, UK
| | - James L Reading
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Mariana Werner Sunderland
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Andrew Georgiou
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Andrew J S Furness
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, England, UK
| | - Assma Ben Aissa
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Ehsan Ghorani
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Theres Oakes
- Division of Infection and Immunity, University College London, London, England, UK
| | - Imran Uddin
- Division of Infection and Immunity, University College London, London, England, UK
| | - Wei Shen Tan
- Department of Urology, University College London Hospital at Westmoreland Street, London, England, UK
- Division of Surgical and Interventional Sciences, University College London, London, England, UK
| | - Andrew Feber
- Division of Surgical and Interventional Sciences, University College London, London, England, UK
| | - Ursula McGovern
- Department of Oncology, University College London Hospital, London, England, UK
| | | | - Alex Freeman
- Department of Cellular Pathology, University College London Hospital, London, England, UK
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London, England, UK
| | - Timothy P Briggs
- Department of Urology, University College London Hospital at Westmoreland Street, London, England, UK
| | - John D Kelly
- Department of Urology, University College London Hospital at Westmoreland Street, London, England, UK
- Division of Surgical and Interventional Sciences, University College London, London, England, UK
| | - Thomas Powles
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, England, UK
| | - Karl S Peggs
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Benjamin M Chain
- Division of Infection and Immunity, University College London, London, England, UK
| | - Mark D Linch
- Department of Oncology, UCL Cancer Institute, London, England, UK
- Department of Oncology, University College London Hospital, London, England, UK
| | - Sergio A Quezada
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
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Zhang G, Li R, Deng Y, Zhao L. Conditional survival of patients with hepatocellular carcinoma: results from the Surveillance, Epidemiology, and End Results registry. Expert Rev Gastroenterol Hepatol 2018. [PMID: 29543072 DOI: 10.1080/17474124.2018.1453806] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Compared with overall survival, conditional survival is a more relevant measure of prognosis in surviving patients over time. The aim of this study was to describe the conditional survival of patients with hepatocellular carcinoma according to different prognostic variables through an analysis of a national population-based cancer registry. METHODS We analyzed data from 3,082 hepatocellular carcinoma patients who were diagnosed between 2004 and 2014. RESULTS The conditional overall and cause-specific survival improved from 37.6% to 68.9% and 45% to 79.1%, respectively, in the entire study population. The conditional overall and cause-specific survival improved from 32.6% to 69.3% and 40.1% to 74.8%, respectively, in patients aged 65 to 74 years. The conditional overall and cause-specific survival improved from 8.4% to 44.1% and 12.1% to 66.1%, respectively, in the stage IVB group. The conditional overall and cause-specific survival improved from 32.8% to 71.4% and 40.3% to 78.4%, respectively, in the positive/elevated AFP group. CONCLUSIONS Conditional survival exhibited an improved prognosis over time. For hepatocellular carcinoma patients who survived for a specific period of time after diagnosis, more dramatic improvements occurred in patients aged 65-74 years, patients with AJCC stage IVB, and patients with a positive/elevated AFP value.
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Affiliation(s)
- Guoqing Zhang
- a Department of Hepatobiliary and pancreatic surgery , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Renfeng Li
- a Department of Hepatobiliary and pancreatic surgery , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Yilei Deng
- a Department of Hepatobiliary and pancreatic surgery , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Longshuan Zhao
- a Department of Hepatobiliary and pancreatic surgery , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
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Atezolizumab in Metastatic Urothelial Carcinoma Outside Clinical Trials: Focus on Efficacy, Safety, and Response to Subsequent Therapies. Target Oncol 2018; 13:353-361. [DOI: 10.1007/s11523-018-0561-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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8
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Perez-Gracia JL, Loriot Y, Rosenberg JE, Powles T, Necchi A, Hussain SA, Morales-Barrera R, Retz MM, Niegisch G, Durán I, Théodore C, Grande E, Shen X, Wang J, Nelson B, Derleth CL, van der Heijden MS. Atezolizumab in Platinum-treated Locally Advanced or Metastatic Urothelial Carcinoma: Outcomes by Prior Number of Regimens. Eur Urol 2017; 73:462-468. [PMID: 29273410 DOI: 10.1016/j.eururo.2017.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/27/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with metastatic urothelial carcinoma (mUC) who progress after platinum-based chemotherapy have had few treatment options and uniformly poor outcomes. Atezolizumab (anti-programmed death-ligand 1) was approved in the USA for cisplatin-ineligible and platinum-treated mUC based on IMvigor210, a phase 2, single-arm, two-cohort study. OBJECTIVE To evaluate the efficacy and safety of atezolizumab by the number of prior lines of systemic therapy in patients with pretreated mUC. DESIGN, SETTING, AND PARTICIPANTS IMvigor210 enrolled 315 patients with mUC with progression during or following platinum-based therapy at 70 international sites between May 2014 and November 2014. Key inclusion criteria included age ≥18 yr, creatinine clearance ≥30ml/min, and Eastern Cooperative Oncology Group performance status 0-1, with no limit on prior lines of treatment. INTERVENTION Patients in this cohort received atezolizumab 1200mg intravenously every 3 wk until loss of clinical benefit. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Centrally assessed Response Evaluation Criteria In Solid Tumors v1.1 objective response rate (ORR), median duration of response, overall survival (OS), and adverse events were evaluated by prior treatment. Potential differences between subgroups were evaluated using log-rank (for OS) and chi-square (for ORR and adverse events frequencies) testing. RESULTS AND LIMITATIONS Three hundred and ten patients were efficacy and safety evaluable (median follow-up, 21 mo). Objective responses and prolonged OS occurred across all prespecified subgroups; median duration of response was not reached in most subgroups. In patients without prior systemic mUC therapy (first-line subgroup), ORR was 25% (95% confidence interval: 14-38), and median OS was 9.6 mo (95% confidence interval: 5.9-15.8). No significant differences in efficacy or toxicity by therapy line were observed. CONCLUSIONS Atezolizumab demonstrated comparable efficacy and safety in previously treated patients with mUC across all lines of therapy evaluated. PATIENT SUMMARY We investigated effects of previous treatment in patients with metastatic urothelial carcinoma that progressed after platinum-based therapy. Atezolizumab was active and tolerable no matter how many treatment regimens patients had received. ClinicalTrials.gov, NCT02108652.
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Affiliation(s)
| | - Yohann Loriot
- Gustave Roussy, Université Paris-Saclay, Département de Médecine, Villejuif, France
| | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Andrea Necchi
- Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Syed A Hussain
- Plymouth University, Peninsula Schools of Medicine and Dentistry, Plymouth University Hospitals NHS Trust, Devon, UK
| | - Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Margitta M Retz
- Urologische Klinik und Poliklinik, Technical University Munich, Munich, Germany
| | - Günter Niegisch
- Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ignacio Durán
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
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9
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Patel V, Collazo Lorduy A, Stern A, Fahmy O, Pinotti R, Galsky MD, Gakis G. Survival after Metastasectomy for Metastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Bladder Cancer 2017; 3:121-132. [PMID: 28516157 PMCID: PMC5409038 DOI: 10.3233/blc-170108] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Cisplatin-based combination chemotherapy is standard treatment for metastatic urothelial carcinoma; however, the vast majority of patients experience disease progression. As systemic therapy alone is rarely curative for the treatment of metastatic urothelial cancer, not only are new therapies needed but also refinement of general treatment principles. Herein, we conducted a systematic review and meta-analysis to explore the role of metastasectomy in metastatic urothelial carcinoma. Methods: We conducted a systematic review of the literature regarding local treatment for metastatic urothelial carcinoma. An online electronic search of the PubMed/MEDLINE and EMBASE databases was performed to identify peer-reviewed articles. All procedures were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Information was then extracted including number of patients, gender, the site of the primary urothelial tumor, site of metastasis, chemotherapy before or after metastasectomy, overall survival (OS), and disease specific survival (DSS) after metastasectomy. A meta-analysis was performed with those studies with sufficient survival data to obtain pooled overall survival. The article quality was assessed using the Cochrane Handbook “risk of bias” tool. Results: Seventeen out of 3963 articles were eligible for review between 1990–2015, including a total of 412 patients. The mean time to recurrence after metastasectomy was 14.25 months. The overall survival from time of metastasectomy ranged from 2 to 60 months. Pooled analyses of studies reported survival data revealed an improved overall survival for patients treated with metastasectomy compared with non-surgical treatment of metastatic lesions (HR 0.63; 95% CI, 0.49–0.81). All, except for three studies, were retrospective and non-randomized, leading to a high risk of bias associated with patient selection, patient attrition, and reporting. Such high potential of selection bias may lead to higher OS than expected. Additionally, treatment and outcome details reported across studies was highly variable. Conclusions: Limited conclusions can be drawn from the available literature exploring the role of metastasectomy in the management of metastatic urothelial cancer due to lack of uniform reporting elements and multiple sources of bias particularly related to a lack of prospective randomized trials. As a subset of patients treated with metastasectomy achieve durable disease control, this approach may be considered for select patients.
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Affiliation(s)
- Vaibhav Patel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana Collazo Lorduy
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Spanish Society of Medical Oncology, Madrid, Spain
| | - Aaron Stern
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Omar Fahmy
- Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia
| | - Rachel Pinotti
- Information and Education Service, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew D Galsky
- Icahn School of Medicine at Mount Sinai, Division of Hematology and Medical Oncology, Tisch Cancer Institute, New York, NY, USA
| | - Georgios Gakis
- Urology and Nephrology Center, University of Mansoura, Mansoura, Egypt
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10
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Marks P, Soave A, Shariat SF, Fajkovic H, Fisch M, Rink M. Female with bladder cancer: what and why is there a difference? Transl Androl Urol 2016; 5:668-682. [PMID: 27785424 PMCID: PMC5071204 DOI: 10.21037/tau.2016.03.22] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
While men are at a considerable higher risk of developing urothelial carcinoma of the bladder (UCB), women present with more advanced disease stages and seem to experience unfavorable outcomes. Evaluating specific differences in the UCB incidence and outcomes between both genders in the non-muscle invasive, muscle-invasive or locally advanced and metastatic setting, as well as determining the underlying causes of disease, may allow optimizing treatment and improving the quality of urological care among both genders. In this review we summarize the best evidence and most recent findings on gender-specific differences in UCB incidence and outcomes. In addition, we present a comprehensive overview on established and potential reasons for differences in gender-specific UCB outcomes, including disparities in the pelvic anatomy, the diagnostic work-up, the modality and quality of treatment, the exposure to risk factors, the degradation of carcinogens as well as the sex-hormone signaling.
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Affiliation(s)
- Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Harun Fajkovic
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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