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Huang D, Jin YH, Weng H, Huang Q, Zeng XT, Wang XH. Combination of Intravesical Bacille Calmette-Guérin and Chemotherapy vs. Bacille Calmette-Guérin Alone in Non-muscle Invasive Bladder Cancer: A Meta-Analysis. Front Oncol 2019; 9:121. [PMID: 30881921 PMCID: PMC6405446 DOI: 10.3389/fonc.2019.00121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background: About 75% of newly diagnosed bladder cancer cases suffer from non-muscle invasive bladder cancer (NMIBC), which used to recur and progress despite transurethral resection of bladder tumor (TURBT). This meta-analysis was conducted to examine if combined application of intravesical bacille Calmette-Guérin (BCG) with chemotherapy is associated with better prognosis. Methods: Systematic searches of randomized controlled trials (RCTs) concerning NMIBC were performed in PubMed, EMbase, CENTRAL, CNKI, WanFang, VIP, CBM databases, and some specialized websites. Two researchers independently implemented study selection, quality assessment and data extraction. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for treatment effects on recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS) and disease-specific survival (DSS) were directly extracted, if available, or estimated using relevant data from included studies. Side effects, such as fever, gastrointestinal reaction, cystitis, irritative bladder symptoms and hematuria, were also extracted as outcome measurements, and associated relative risks (RRs) were calculated to assess treatment safety. RevMan 5.3 software was used to perform statistical analyses. Results: Thirteen RCTs containing 1,754 patients with NMIBC were included in this meta-analysis. Compared with BCG alone, the combination therapy significantly improved RFS (HR = 0.53, 95% CI: 0.43-0.66, P < 0.01), OS (HR = 0.66, 95%CI: 0.50-0.86, P = 0.002), and DSS (HR = 0.48, 95%CI: 0.29-0.80, P = 0.005). While PFS showed no obvious difference between combination therapy and BCG alone (HR = 0.65, 95%CI: 0.25-1.68, P = 0.38). The rate of fever (RR = 0.50, 95%CI: 0.27-0.91, P = 0.02), irritative bladder symptoms (RR = 0.69, 95%CI: 0.52-0.90, P = 0.007) and hematuria (RR = 0.50, 95%CI: 0.28-0.89, P = 0.02) were significantly decreased in patients treated with combination therapy compared to those with BCG alone. There were no statistically significant differences between combination therapy and BCG alone in toxicity (RR = 0.69, 95%CI: 0.34-1.40, P = 0.30), gastrointestinal reaction (RR = 2.54, 95%CI: 0.61-10.60, P = 0.20) or cystitis (RR = 0.67, 95%CI: 0.29-1.54, P = 0.34). Conclusions: Combined application of intravesical BCG and chemotherapy appears to be an effective treatment for patients with intermediate- to high-risk NMIBC, but not for those with tumor in situ alone or recurrent bladder cancer.
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Affiliation(s)
- Di Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hong Weng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xing-Huan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Jin B, Gong Y, Li H, Jiao L, Xin D, Gong Y, He Z, Zhou L, Jin Y, Wang X, Zhang Z. C/EBPβ promotes the viability of human bladder cancer cell by contributing to the transcription of bladder cancer specific lncRNA UCA1. Biochem Biophys Res Commun 2018; 506:674-679. [PMID: 30376994 DOI: 10.1016/j.bbrc.2018.10.152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/23/2018] [Indexed: 01/01/2023]
Abstract
Urothelial Carcinoma Antigen 1 (UCA1) is a cell and tissue specific long non-coding RNA (lncRNA) associated with the tumorigenesis and invasion of bladder cancer. However, the mechanism driving the over-transcription of UCA1 in bladder cancer cells remains unclear. It has been reported that C/EBPβ has a significant role of regulation in tumorigenesis. Here we report that the expression of UCA1 was dramatically inhibited in 5637 cells with C/EBPβ down-regulation. Additionally, the function tests indicated that C/EBPβ could promote 5637 cells growth and colony formation by inducing the expression level of UCA1. These data suggest that C/EBPβ was involved in transcriptional regulation of UCA1 and contributed substantially to its high expression and proliferation promoting in bladder cancer cells.
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Affiliation(s)
- Bo Jin
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, 100034, China
| | - Yanbing Gong
- Department of Central Laboratory, Peking University Shougang Hospital, Beijing, 100144, China
| | - Haixia Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, 100034, China
| | - Lili Jiao
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, 100034, China
| | - Dianqi Xin
- Department of Urology, Peking University First Hospital & Institute of Urology, Peking University, Beijing, 100034, China
| | - Yanqing Gong
- Department of Urology, Peking University First Hospital & Institute of Urology, Peking University, Beijing, 100034, China
| | - Zhisong He
- Department of Urology, Peking University First Hospital & Institute of Urology, Peking University, Beijing, 100034, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital & Institute of Urology, Peking University, Beijing, 100034, China
| | - Yaqiong Jin
- Biobank for Clinical Data and Samples in Pediatric, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiujuan Wang
- Department of Clinical Laboratory, Shandong Academy of Medical Sciences, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, 250117, Shandong, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital & Institute of Urology, Peking University, Beijing, 100034, China.
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3
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Leone A, Diorio G, Sexton W, Schell M, Alexandrow M, Fahey JW, Kumar NB. Sulforaphane for the chemoprevention of bladder cancer: molecular mechanism targeted approach. Oncotarget 2018; 8:35412-35424. [PMID: 28423681 PMCID: PMC5471065 DOI: 10.18632/oncotarget.16015] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/22/2017] [Indexed: 12/11/2022] Open
Abstract
The clinical course for both early and late stage Bladder Cancer (BC) continues to be characterized by significant patient burden due to numerous occurrences and recurrences requiring frequent surveillance strategies, intravesical drug therapies, and even more aggressive treatments in patients with locally advanced or metastatic disease. For these reasons, BC is also the most expensive cancer to treat. Fortunately, BC offers an excellent platform for chemoprevention interventions with potential to optimize the systemic and local exposure of promising agents to the bladder mucosa. However, other than smoking cessation, there is a paucity of research that systematically examines agents for chemoprevention of bladder cancers. Adopting a systematic, molecular-mechanism based approach, the goal of this review is to summarize epidemiological, in vitro, and preclinical studies, including data regarding the safety, bioavailability, and efficacy of agents evaluated for bladder cancer chemoprevention. Based on the available studies, phytochemicals, specifically isothiocyanates such as sulforaphane, present in Brassicaceae or “cruciferous” vegetables in the precursor form of glucoraphanin are: (a) available in standardized formulations; (b) bioavailable- both systemically and in the bladder; (c) observed to be potent inhibitors of BC carcinogenesis through multiple mechanisms; and (d) without toxicities at these doses. Based on available evidence from epidemiological, in vitro, preclinical, and early phase trials, phytochemicals, specifically isothiocyanates (ITCs) such as sulforaphane (SFN) represent a promising potential chemopreventitive agent in bladder cancer.
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Affiliation(s)
- Andrew Leone
- Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Inc., Tampa, FL, USA
| | - Gregory Diorio
- Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Inc., Tampa, FL, USA
| | - Wade Sexton
- Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Inc., Tampa, FL, USA
| | - Michael Schell
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Inc., Tampa, FL, USA
| | - Mark Alexandrow
- Cancer Biology and Evolution, H. Lee Moffitt Cancer Center & Research Institute, Inc., Tampa, FL, USA
| | - Jed W Fahey
- Clinical Pharmacology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nagi B Kumar
- Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Inc., Tampa, FL, USA
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4
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Long-term outcomes of the FinnBladder-4 study. Eur Urol 2015; 68:618-9. [PMID: 25890484 DOI: 10.1016/j.eururo.2015.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/01/2015] [Indexed: 11/23/2022]
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Solsona E, Madero R, Chantada V, Fernandez JM, Zabala JA, Portillo JA, Alonso JM, Astobieta A, Unda M, Martinez-Piñeiro L, Rabadan M, Ojea A, Rodriguez-Molina J, Beardo P, Muntañola P, Gomez M, Montesinos M, Martinez Piñeiro JA. Sequential Combination of Mitomycin C Plus Bacillus Calmette-Guérin (BCG) Is More Effective but More Toxic Than BCG Alone in Patients with Non–Muscle-invasive Bladder Cancer in Intermediate- and High-risk Patients: Final Outcome of CUETO 93009, a Randomized Prospective Trial. Eur Urol 2015; 67:508-16. [DOI: 10.1016/j.eururo.2014.09.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
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Veeranki OL, Bhattacharya A, Tang L, Marshall JR, Zhang Y. Cruciferous vegetables, isothiocyanates, and prevention of bladder cancer. ACTA ACUST UNITED AC 2015; 1:272-282. [PMID: 26273545 DOI: 10.1007/s40495-015-0024-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Approximately 80% of human bladder cancers (BC) are non-muscle invasive when first diagnosed and are usually treated by transurethral tumor resection. But 50-80% of patients experience cancer recurrence. Agents for prevention of primary BC have yet to be identified. Existing prophylactics against BC recurrence, e.g., Bacillus Calmette-Guerin (BCG), have limited efficacy and utility; they engender significant side effects and require urethral catheterization. Many cruciferous vegetables, rich sources of isothiocyanates (ITCs), are commonly consumed by humans. Many ITCs possess promising chemopreventive activities against BC and its recurrence. Moreover, orally ingested ITCs are selectively delivered to bladder via urinary excretion. This review is focused on urinary delivery of ITCs to the bladder, their cellular uptake, their chemopreventive activities in preclinical and epidemiological studies that are particularly relevant to prevention of BC recurrence and progression, and their chemopreventive mechanisms in BC cells and tissues.
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Affiliation(s)
- Omkara L Veeranki
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Arup Bhattacharya
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - James R Marshall
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Yuesheng Zhang
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
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Svatek RS, Zhao XR, Morales EE, Jha MK, Tseng TY, Hugen CM, Hurez V, Hernandez J, Curiel TJ. Sequential intravesical mitomycin plus Bacillus Calmette-Guérin for non-muscle-invasive urothelial bladder carcinoma: translational and phase I clinical trial. Clin Cancer Res 2014; 21:303-11. [PMID: 25424854 DOI: 10.1158/1078-0432.ccr-14-1781] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the safety and toxicities of sequential MMC (mitomycin C) + BCG (bacillus Calmette-Guérin) in patients with non-muscle-invasive bladder cancer (NMIBC) and explore evidence for potentiation of BCG activity by MMC. EXPERIMENTAL DESIGN A 3 + 3 phase I dose-escalation trial of six weekly treatments was conducted in patients with NMIBC. MMC (10, 20, or 40 mg) was instilled intravesically for 30 minutes, followed by a 10-minute washout with gentle saline irrigation and then instillation of BCG (half or full strength) for 2 hours. Urine cytokines were monitored and compared with levels in a control cohort receiving BCG only. Murine experiments were carried out as described previously. RESULTS Twelve patients completed therapy, including 3 patients receiving full doses. The regimen was well tolerated with no treatment-related dose-limiting toxicities. Urinary frequency and urgency, and fatigue were common. Eleven (91.7%) patients were free of disease at a mean (range) follow-up of 21.4 (8.4-27.0) months. Median posttreatment urine concentrations of IL2, IL8, IL10, and TNFα increased over the 6-week treatment period. A greater increase in posttreatment urinary IL8 during the 6-week period was observed in patients receiving MMC + BCG compared with patients receiving BCG monotherapy. In mice, intravesical MMC + BCG skewed tumor-associated macrophages (TAM) toward a beneficial M1 phenotype. CONCLUSIONS Instillation of sequential MMC + BCG is safe tolerable up to 40-mg MMC plus full-strength BCG. This approach could provide improved antitumor activity over BCG monotherapy by augmenting beneficial M1 TAMs.
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Affiliation(s)
- Robert S Svatek
- The Cancer Therapy and Research Center/Adult Cancer Program, The University of Texas Health Science Center San Antonio, San Antonio, Texas. Department of Urology, The University of Texas Health Science Center San Antonio, San Antonio, Texas.
| | - Xiang Ru Zhao
- The Cancer Therapy and Research Center/Adult Cancer Program, The University of Texas Health Science Center San Antonio, San Antonio, Texas. Department of Urology, The University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Edwin E Morales
- Department of Urology, The University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Mithilesh K Jha
- Department of Urology, The University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Timothy Y Tseng
- Department of Urology, The University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Cory M Hugen
- Department of Urology, The University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Vincent Hurez
- Department of Medical Oncology, The University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Javier Hernandez
- Department of Urology, The University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Tyler J Curiel
- The Cancer Therapy and Research Center/Adult Cancer Program, The University of Texas Health Science Center San Antonio, San Antonio, Texas. Department of Medical Oncology, The University of Texas Health Science Center San Antonio, San Antonio, Texas
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Wang X, Long M, Dong K, Lin F, Weng Y, Ouyang Y, Liu L, Wei J, Chen X, He T, Zhang HZ. Chemotherapy agents-induced immunoresistance in lung cancer cells could be reversed by trop-2 inhibition in vitro and in vivo by interaction with MAPK signaling pathway. Cancer Biol Ther 2013; 14:1123-32. [PMID: 24025415 DOI: 10.4161/cbt.26341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Chemotherapy has been widely used in cancer treatment, but the prognosis of the cancer patients following chemotherapy has not been substantially improved. Alternative strategies such as immunotherapy and their combinations with chemotherapy are now being considered; however, the effects of chemotherapy on the immune responses of cancer cells are not fully understood. In the present studies, we reveal a potential link between chemotherapy and cancer immunoresistance, we first examined the effects of chemopreventive agent DDP on the expression of a cell surface glycopreotein Trop-2 in lung cancer cells, and found that DDP not only induce Trop-2 surface expression in human lung cancer cells, but also induce T-cell apoptosis effectively. In order to investigate the relationship between DDP-induced Trop-2 expression and T-cell apoptosis, we stably transfected A549 and PC14 lung cancer cells with Trop-2 shRNA, the DDP-induced Trop-2 surface expression was effectively decreased in stably transfected cell lines, but chemotherapeutic reagent-induced cell proliferation inhibition and apoptosis were increased through inhibition of the MAPK signaling pathway. In vivo animal experiments showed that Trop-2 knockdown tumors displayed a slower growth rate than the control xenografts. Importantly, DDP treatment exhibited a strong antitumor activity in the mice with Trop-2 knockdown tumors, but only a marginal effect in the control group. Taken together, our data show that DDP resistance in lung cancer cells could be induced through increased surface expression of Trop-2, which at least partially by interfering with MAPK pathway. These results provide novel insight into the function of Trop-2 and encourage the design and testing of approaches targeting this protein and its partners.
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Affiliation(s)
- Xi Wang
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Min Long
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Ke Dong
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Fang Lin
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Yuanyuan Weng
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Yongri Ouyang
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Li Liu
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Junxia Wei
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Xi Chen
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Ting He
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
| | - Hui-Zhong Zhang
- Department of Clinical Diagnosis; Tangdu Hospital; Fourth Military Medical University; Xi'an, PR China
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Finger E. A termodinâmica como princípio motriz do sistema imune. EINSTEIN-SAO PAULO 2012; 10:386-8. [DOI: 10.1590/s1679-45082012000300024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 04/03/2012] [Indexed: 11/22/2022] Open
Abstract
Nos últimos 120 anos, poucas coisas contribuíram tanto para a compreensão do funcionamento do sistema imune quanto o estudo de seu comportamento na relação hospedeiro/parasita. Apesar do avanço, algumas questões permanecem sem resposta clara, como, por exemplo: qual o objetivo do sistema imune? Qual o princípio de sua atuação? Se perguntarmos aleatoriamente, a maioria imediatamente responderá: "defender o organismo contra invasores externos", mas exatamente do que nos defendemos? Como esses invasores nos prejudicam? Quais critérios determinam o que é um invasor? Por outro lado, se o sistema imune existe para nos defender de invasores externos, como qualificar sua atuação contra processos "internos", como as neoplasias? Por que morremos de câncer? Ou de infecção? Ou mesmo: por que morremos? Essas perguntas aparentemente óbvias não são simples nem triviais e a dificuldade em respondê-las revela a complexa realidade que o sistema imune administra. O objetivo deste artigo foi articular, para o leitor, algo que ele instintivamente já sabe: que as decisões do sistema imune são tomadas segundo princípios termodinâmicos. Adicionalmente, discutiremos como esta aparente mudança de paradigma altera conceitos como saúde, doença e terapêutica.
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