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D'Andrea D, Soria F, Moschini M, Laukhtina E, Hurle R, Mancon S, Antonelli A, Teoh JYC, Shariat SF, Pradere B. Addition of neoadjuvant chemotherapy to a 'quadrifecta' composite in radical cystectomy. BJU Int 2024; 134:459-464. [PMID: 38483124 DOI: 10.1111/bju.16331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
OBJECTIVES To evaluate the impact of incorporating neoadjuvant chemotherapy (NAC) into the 'quadrifecta' outcomes composite for reporting outcomes of radical cystectomy (RC) creating a pentafecta score. PATIENTS AND METHODS This is a retrospective multicentre analysis of patients treated with RC, with or without NAC, for bladder cancer between 2002 and 2023. The primary outcome was the effect of adding NAC to a quadrifecta outcomes composite on cancer-specific (CSS) and overall survival (OS). The quadrifecta outcomes composite included a yield of ≥16 lymph nodes, negative soft tissue surgical margin, absence of major complication within 30 days from surgery, and no delay in RC. RESULTS A total of 590 patients were included in the analyses. A total of 233 (39.5%) patients achieved all quadrifecta outcomes and 82 (13.9%) patients were additionally treated with NAC, achieving the pentafecta. Achieving the quadrifecta outcomes composite was significantly associated with better CSS (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.32-0.75; P = 0.001) and OS (HR 0.48, 95% CI 0.34-0.69; P < 0.01). The addition of NAC to the quadrifecta composite outcomes significantly improved the discrimination of patients more likely to have better CSS (HR 0.21, 95% CI 0.08-0.57; P = 0.002) and OS (HR 0.26, 95% CI 0.12-0.55; P < 0.01). CONCLUSION We propose a new pentafecta that may serve as a tool for standardising outcomes reporting and measuring the quality of RC.
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Affiliation(s)
- David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Francesco Soria
- Department of Urology, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Marco Moschini
- Department of Urology, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | | | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Stefano Mancon
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alessandro Antonelli
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Departments of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, University of Jordan, Amman, Jordan
| | - Benjamin Pradere
- Department of Urology, Croix Du Sud Hospital, Quint-Fonsegrives, France
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Zhang M, Wu J, Zhang Y, Shang H. Recent Advances of Neoadjuvant Immunotherapy for Urothelial Bladder Cancer. Ann Surg Oncol 2024; 31:5851-5859. [PMID: 38995447 DOI: 10.1245/s10434-024-15725-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/19/2024] [Indexed: 07/13/2024]
Abstract
Urothelial bladder cancer is one of the most common malignant tumors of the urinary system, which accounts for 90~95% of urothelial carcinoma. Despite the current standard neoadjuvant management for localized urothelial MIBC (T2-4cN0M0) is cisplatin-based chemotherapy before radical cystectomy, there still had poor performances and less overall survival benefits in patients with localized urothelial MIBC. Moreover, nearly half of MIBC patients were ineligible for receiving cisplatin because of chronic kidney disease and performance status. Although immunotherapy, immune checkpoint inhibitors (ICIs) has been identified as first or second-line treatments for localized and metastasis bladder cancer based on less adverse reactions and favorable outcomes, neoadjuvant immunotherapy had rarely used for the treatment of these patients because of less large-scale clinical randomized studies and limited outcomes. Therefore, we reviewed the advances of efficacy and safety with neoadjuvant immunotherapy for urothelial bladder cancer depended on published articles and clinical studies, which could provide more theoretical evidences and promising strategy for clinical therapeutic development.
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Affiliation(s)
- Mengjie Zhang
- The Affiliated Henan Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian Wu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongxin Zhang
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Haojie Shang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Yamane H, Morizane S, Honda M, Muraoka K, Oono H, Isoyama T, Ono K, Sejima T, Kadowaki H, Takenaka A. Preoperative risk stratification models after radical cystectomy for bladder cancer: A multi-center study. Int J Urol 2024. [PMID: 39140229 DOI: 10.1111/iju.15560] [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: 04/27/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE We investigated preoperative patient factors associated with prognosis in 263 bladder cancer (BC) patients undergoing radical cystectomy (RC). We also developed new risk stratification models for prognosis. METHODS This retrospective study included patients treated at Tottori University Hospital and affiliated hospitals between January 2010 and December 2019. The relationship between preoperative patient factors and overall recurrence-free and cancer-specific survival (CSS) was analyzed. The modified Glasgow prognosis score (mGPS) was calculated using serum albumin and C-reactive protein (CRP) levels. Statistical analyses included the log-rank test and Cox proportional hazards regression. RESULTS Eastern Cooperative Oncology Group performance status (ECOG-PS), mGPS, and clinical tumor stage independently predicted CSS in multivariate analysis. A new risk stratification model included ECOG-PS ≥2, clinical tumor stage ≥3, serum albumin <3.5 g/dL, and serum CRP >0.5 mg/dL. Risk groups were defined as 0 factors (low risk), 1-2 factors (intermediate risk), and 3-4 factors (high risk). High-risk patients showed significantly poorer 3-year cancer-free survival: 86.9% (low risk), 76.7% (intermediate risk), and 50.0% (high risk). CONCLUSIONS ECOG-PS, clinical tumor stage, and mGPS are predictive of poor cancer-free survival post-RC for BC. Our model offers the potential for prognostic prediction in these patients.
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Affiliation(s)
- Hiroshi Yamane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Kuniyasu Muraoka
- Department of Urology, Tottori Prefectural Central Hospital, Tottori, Tottori, Japan
| | - Hirofumi Oono
- Department of Urology, Japanese Red Cross Matsue Hospital, Matsue, Shimane, Japan
| | - Tadahiro Isoyama
- Department of Urology, Yonago Medical Center, Yonago, Tottori, Japan
| | - Koji Ono
- Department of Urology, Japanese Red Cross Tottori Hospital, Tottori, Tottori, Japan
| | - Takehiro Sejima
- Department of Urology, Matsue City Hospital, Matsue, Shimane, Japan
| | | | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
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Boutaleb I, Mjaess G, Roumeguère T. Perioperative chemotherapy and immunotherapy to optimize cystectomy outcomes in the curative intent of non-metastatic muscle-invasive bladder cancer: A systematic review and meta-analysis. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102704. [PMID: 39059767 DOI: 10.1016/j.fjurol.2024.102704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Perioperative systemic treatments play a crucial role in the comprehensive management of muscle-invasive bladder cancer. While neoadjuvant platinum-based chemotherapy has a proven efficacy, administering adjuvant chemotherapy can be challenging in patients with multiple comorbidities. Although immunotherapy has shown success in metastatic settings, its effectiveness in both neoadjuvant and adjuvant settings remains under investigation. This study aims to conduct a systematic literature review and meta-analysis to assess the impact of chemotherapy and/or immunotherapy in neoadjuvant and/or adjuvant settings. METHODS A systematic review and meta-analysis were conducted by consulting the PubMed, Scopus, and ClinicalTrial.gov databases for the period from 1994 to 2023. The analysis utilized Forest Plots for key points of interest: overall survival/pathologic response for neoadjuvant chemotherapy (NAC) and overall survival/disease-free survival for adjuvant chemotherapy (AC), employing random or fixed models. RESULTS The systematic review included 26 articles, and 14 were incorporated into the meta-analysis. For NAC, five studies assessed overall survival, yielding an overall hazard ratio (HR) of 0.84 [0.75-0.94]; P=0.002. Pathologic response under NAC was evaluated in five studies, resulting in an overall odds ratio (OR) of 0.3 [0.2-0.4]; P<0.001 compared to cystectomy and 0.86 [0.65-1.13]; P=0.28 for MVAC vs. GC. Regarding AC, six studies investigated overall survival, revealing an overall HR of 0.93 [0.77-1.12]; P=0.46. Disease-free survival under AC was examined in seven studies, with an overall OR of 0.58 [0.44-0.78]; P<0.001. Meta-analysis was not conducted for immunotherapy due to limited phase II studies in the neoadjuvant setting and only two available studies in the adjuvant setting. CONCLUSION This study reaffirms the efficacy of platinum-based chemotherapy in neoadjuvant and adjuvant scenarios, enhancing overall survival in muscle-invasive bladder cancer patients. Immunotherapy exhibits promising outcomes in tumor downstaging in the neoadjuvant setting and in disease-free survival, in the adjuvant setting.
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Affiliation(s)
- Ismail Boutaleb
- Department of Urology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Georges Mjaess
- Department of Urology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Thierry Roumeguère
- Department of Urology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium.
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Avudaiappan AP, Prabhakar P, Sandman MS, Rubens M, Garje R, Eldefrawy A, Manoharan M. Pathological response and survival outcomes after neoadjuvant chemotherapy with radical cystectomy in octogenarians for muscle-invasive bladder cancer: an observational database study. BMC Urol 2024; 24:150. [PMID: 39049001 PMCID: PMC11267756 DOI: 10.1186/s12894-024-01548-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). In recent years, octogenarians have been undergoing RC uneventfully, but studies showed older adults receive NAC less often. We studied the utilization and effect of RC with or without NAC in octogenarians and compared survival outcomes between responders and non-responders. METHODS In our retrospective study using the National Cancer Database (NCDB), we identified octogenarians with MIBC and urothelial histology who underwent RC with or without NAC between 2004 and 2018. The NAC cohort included patients who underwent RC with NAC, and the non-NAC cohort included those with or without adjuvant chemotherapy. The NAC cohort was subcategorized into responders and non-responders based on surgical pathology. Patients with comorbidity index > 1 were not included, thereby excluding patients with possible renal impairment. After propensity-matching, we compared the overall survival (OS) between NAC and non-NAC cohorts and responders and non-responders. RESULTS 33924 patients underwent RC, and 3056 octogenarians met our selection. Among them, 396 received NAC, and 2660 did not receive NAC. Among those who received NAC, 112(28.3%) experienced downstaging, and 223(56.4%) exhibited upstaging or no change (p < 0.001). After propensity-matching, the median OS of the NAC and non-NAC cohorts were 51.6 months and 31.3 months, respectively (p<0.001). Similarly, the median OS of responders and non-responders were 89.4 months and 26.5 months, respectively(p < 0.0001). CONCLUSION In our study, we observed that NAC with RC for MIBC may help to improve OS among healthy octogenarians. Similarly, responders had better OS than non-responders.
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Affiliation(s)
- Arjun Pon Avudaiappan
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Pushan Prabhakar
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
| | - Mayer Simcha Sandman
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Muni Rubens
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
| | - Rohan Garje
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
| | - Ahmed Eldefrawy
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Murugesan Manoharan
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
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Hattori Y, Fujiwara T, Hagimoto H, Kokubun H, Murata S, Makita N, Abe Y, Kubota M, Tohi Y, Tsutsumi N, Shibasaki N, Inoue K, Kawakita M, Yamasaki T. Efficacy and safety of dose-dense gemcitabine plus cisplatin as neoadjuvant chemotherapy for muscle-invasive bladder cancer. Int J Urol 2024. [PMID: 38961545 DOI: 10.1111/iju.15524] [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: 04/03/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy and safety of dose-dense gemcitabine and cisplatin (ddGC) as neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC). METHODS Patients with locally advanced MIBC (cT2aN0M0-cT4N1M0) who received ddGC between December 2017 and December 2023 were included. Regimens of ddGC with pegfilgrastim were administered every 2 weeks for 4 cycles, followed by radical cystectomy. The pathological complete response (CR) (pT0N0) and objective response (OR) ( RESULTS A total of 45 patients (cT2N0, 60%; cT3N0, 22%; cT4N0, 9%; and cTanyN1, 9%) were included. Of the 41 who underwent cystectomy, 38 (92.7%) completed all planned cycles, with a median RDI of 0.96 (interquartile range [IQR], 0.89-1.00). Overall, CR and OR were achieved in 12 (29.3%) and 17 (41.5%) patients, respectively, increasing to 32.4% and 45.9%, respectively, in cN0 patients. Severe AEs (grade ≥ 3) were observed in eight patients (17.8%), including four hematological toxicities. At a median follow-up of 31 months, 2-year DFS and OS were 70.8% and 89.2%, respectively. CONCLUSION Neoadjuvant ddGC demonstrated good tolerability, efficacy, and safety, suggesting its potential as a treatment option for MIBC.
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Affiliation(s)
- Yuto Hattori
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Tasuku Fujiwara
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Hiroki Hagimoto
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Hidetoshi Kokubun
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Shiori Murata
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Noriyuki Makita
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Yohei Abe
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Masashi Kubota
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Yoichiro Tohi
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Naofumi Tsutsumi
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Noboru Shibasaki
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Koji Inoue
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Toshinari Yamasaki
- Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan
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Skelton WP, Masur J, Thomas J, Fallah P, Jain RK, Ravi P, Mantia C, McGregor BA, Nuzzo PV, Adib E, Zarif TE, Preston MA, Clinton TN, Li R, Steele GS, Kassouf W, Freeman D, Pond GR, Jain RK, Sonpavde GP. Impact of Angiotensin Converting Enzyme Inhibitors on Pathologic Complete Response With Neoadjuvant Chemotherapy for Muscle Invasive Bladder Cancer. Clin Genitourin Cancer 2024; 22:102143. [PMID: 39032202 DOI: 10.1016/j.clgc.2024.102143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION The renin-angiotensin system (RAS) has been demonstrated to modulate cell proliferation, desmoplasia, angiogenesis and immunosuppression. We examined the association of RAS inhibitors (RASi)-namely angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB)-with neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) preceding radical cystectomy (RC). PATIENTS AND METHODS We retrospectively investigated concurrent RASi use with NAC prior to RC in 302 patients with MIBC from 3 academic institutions. Outcomes included pathologic complete response (pCR) and overall survival (OS). Pathologic features, performance status (PS), clinical stage, type/number of cycles of NAC, and toxicities were collected. RESULTS Overall pCR rate was 26.2% and 5-year OS was 62%. Concurrent ACEi intake with NAC approached significance for association with pCR (odds ratio [OR] = 1.71; 95% CI, 0.94-3.11; P = .077). Patients with cT3/4N0-N1 disease receiving ACEi had higher pCR rates (30.8% vs. 17.7%, P = .056) than those not on ACEi. Female sex had a statistically significant favorable interaction for pCR with ACEi intake (P = .044). ACEi intake was not associated with OS, while pCR, PS and lower clinical stage were significantly associated with improved OS. CONCLUSION ACEi intake is potentially associated with increased pCR in patients with MIBC receiving NAC prior to RC, and this association is more pronounced in patients with higher clinical stage of disease at the initiation of therapy and female sex. Our data suggest the potential relevance of the RAS as a therapeutic target in aggressive MIBC.
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Affiliation(s)
- William Paul Skelton
- University of Virginia Comprehensive Cancer Center, Department of Oncology, Charlottesville, VA; H. Lee Moffitt Cancer Center and Research Institute, Department of Oncology, Tampa, FL
| | - Jack Masur
- University of Virginia Comprehensive Cancer Center, Department of Oncology, Charlottesville, VA
| | - Jonathan Thomas
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Parvaneh Fallah
- McGill University, Department of Oncology, Montreal, Quebec, Canada
| | - Rohit K Jain
- H. Lee Moffitt Cancer Center and Research Institute, Department of Oncology, Tampa, FL
| | - Praful Ravi
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Charlene Mantia
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | | | | | - Elio Adib
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Talal El Zarif
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | - Mark A Preston
- Brigham and Women's Hospital, Department of Oncology, Boston, MA
| | | | - Roger Li
- H. Lee Moffitt Cancer Center and Research Institute, Department of Oncology, Tampa, FL
| | - Graeme S Steele
- Brigham and Women's Hospital, Department of Oncology, Boston, MA
| | - Wassim Kassouf
- McGill University, Department of Oncology, Montreal, Quebec, Canada
| | - Dory Freeman
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA
| | | | - Rakesh K Jain
- Massachusetts General Hospital, Department of Oncology, Boston, MA
| | - Guru P Sonpavde
- Dana-Farber Cancer Institute, Department of Oncology, Boston, MA; AdventHealth Cancer Institute and the University of Central Florida, Department of Oncology, Orlando, FL.
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Omura M, Kosaka T, Kobayashi H, Shigeta K, Matsumoto K, Hara S, Kikuchi E, Mikami S, Saya H, Sato Y, Oya M. ASO Author Reflections: Vasohibin-1 as a Biomarker for Chemotherapeutic Response in Patients with Advanced Bladder Cancer. Ann Surg Oncol 2024; 31:3914-3915. [PMID: 38564070 DOI: 10.1245/s10434-024-15122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Minami Omura
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Hiroaki Kobayashi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Shigeta
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | | | - Satoshi Hara
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shuji Mikami
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, Graduate School of Medicine, Keio University, Tokyo, Japan
| | - Yasufumi Sato
- Department of Vascular Biology, Institute of Development, Aging and Cancer, Tohoku University, Miyagi, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Hemenway G, Anker JF, Riviere P, Rose BS, Galsky MD, Ghatalia P. Advancements in Urothelial Cancer Care: Optimizing Treatment for Your Patient. Am Soc Clin Oncol Educ Book 2024; 44:e432054. [PMID: 38771987 DOI: 10.1200/edbk_432054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
The standard treatment paradigm for muscle invasive bladder cancer has been neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy. However, efforts are ongoing to personalize treatment by incorporating biomarkers to better guide treatment selection. In addition, bladder preservation strategies are aimed at avoiding cystectomy in well-selected patients. Similarly, in the metastatic urothelial cancer space, the standard frontline treatment option of platinum-based chemotherapy has changed with the availability of data from EV-302 trial, making the combination of enfortumab vedotin (EV) and pembrolizumab the preferred first-line treatment option. Here, we examine the optimization of treatment intensity and sequencing, focusing on the challenges and opportunities associated with EV/pembrolizumab therapy, including managing toxicities and exploring alternative dosing approaches. Together, these articles provide a comprehensive overview of contemporary strategies in bladder cancer management, highlighting the importance of individualized treatment approaches, ongoing research, and multidisciplinary collaboration to improve patient outcomes in this complex disease landscape.
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Affiliation(s)
| | - Jonathan F Anker
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paul Riviere
- UCSD Radiation Medicine and Applied Sciences, San Diego, CA
| | - Brent S Rose
- UCSD Radiation Medicine and Applied Sciences, San Diego, CA
| | - Matthew D Galsky
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Eule CJ, Warren A, Molina Kuna E, Callihan EB, Kim SP, Flaig TW. Neoadjuvant Cisplatin-based Chemotherapy in Nonmetastatic Muscle-invasive Bladder Cancer: A Systematic Review and Pooled Meta-analysis to Determine the Preferred Regimen. Urology 2024; 188:118-124. [PMID: 38685388 DOI: 10.1016/j.urology.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/01/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To determine whether neoadjuvant gemcitabine and cisplatin (GC) vs dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) before radical cystectomy improves overall survival (OS), progression-free survival (PFS), and pathologic complete response (pCR) for patients with muscle-invasive bladder cancer with secondary analyses of pathological downstaging and toxicity. MATERIALS AND METHODS This systematic review and meta-analysis identified studies of patients with muscle-invasive bladder cancer treated with neoadjuvant GC compared to ddMVAC from PubMed, Web of Science, and EMBASE. Random-effect models for pooled log-transformed hazard ratios (HR) for OS and PFS and pooled odds ratios for pCR and downstaging were developed using the generic inverse variance method and Mantel-Haenszel method, respectively. RESULTS Ten studies were identified (4 OS, 2 PFS, and 6 pCR clinical endpoints). Neoadjuvant ddMVAC improved OS (HR 0.71 [95% confidence intervals 0.56; 0.90]), PFS (HR 0.76 [95% confidence intervals 0.60; 0.97]), and pathological downstaging (odds ratio 1.34 [95% confidence interval 1.01; 1.78]) as compared to GC. There was no significant difference between regimens for pCR rates (odds ratio 1.38 [95% confidence interval 0.90; 2.12]). Treatment toxicity was greater with ddMVAC. Limitations result from differences in number of ddMVAC cycles and patient selection between studies. CONCLUSION Neoadjuvant ddMVAC is associated with improved OS and PFS vs gemcitabine/cisplatin for patients with muscle-invasive bladder cancer before radical cystectomy. Although rates of pathological complete response were not significantly different, pathological downstaging correlated with OS. ddMVAC should be preferred over gemcitabine/cisplatin for patients with muscle-invasive bladder cancer who can tolerate its greater toxicity.
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Affiliation(s)
- Corbin J Eule
- University of Colorado Cancer Center, Division of Medical Oncology, Department of Medicine, Aurora, CO.
| | - Adam Warren
- University of Colorado Cancer Center, Population Health Shared Resource, Aurora, CO.
| | - Elizabeth Molina Kuna
- University of Colorado Cancer Center, Population Health Shared Resource, Aurora, CO.
| | - Eryn B Callihan
- University of Colorado Cancer Center, Division of Medical Oncology, Department of Medicine, Aurora, CO.
| | - Simon P Kim
- University of Colorado Cancer Center, Division of Urology, Department of Surgery, Aurora, CO.
| | - Thomas W Flaig
- University of Colorado Cancer Center, Division of Medical Oncology, Department of Medicine, Aurora, CO.
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Biswas K, Biswas L, Gangopadhyay S, Jana A, Basak T, Manna D, Mandal S. Clinico-demographic Profile of Carcinoma Urinary Bladder-5-Year Experience from a Tertiary Care Centre of Eastern India. Indian J Surg Oncol 2024; 15:206-212. [PMID: 38741638 PMCID: PMC11088605 DOI: 10.1007/s13193-023-01861-2] [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: 05/17/2023] [Accepted: 12/06/2023] [Indexed: 05/16/2024] Open
Abstract
Urinary bladder carcinoma is a disease of the elderly and often presents at an advanced stage due to ignorance and manifestation of symptoms at later stages of the disease. In India, very little data is available regarding the clinico-epidemiological pattern of urinary bladder cancers. In this study, we analysed the clinico-demographic profile of patients with urinary bladder carcinoma, attending a tertiary care centre in Eastern India over the last 5 years. We analysed the database of Oncology OPD of a tertiary care centre in West Bengal in Eastern India and collected the demographic, clinical and treatment data of urinary bladder carcinoma patients who attended our OPD between 2017 and 2021. The objective was to assess the demographic and clinical profile of these patients and compare them with those reported from other parts of India as well as the rest of the world. Majority of patients (70%) were above 50 years of age with a strikingly huge male predominance (male:female = 6.6:1). Transitional cell carcinoma (TCC) was the most common (90%) histology. 67.2% of the cases were muscle-invasive disease at presentation, and 19.3% of the patients presented with metastatic disease with bone (42%) as the most common site of metastasis. Overall, around 22% of patients underwent surgery either with definitive or palliative intent. Sixty-five percent of the patients who received radiotherapy underwent definitive radiation as a part of bladder preservation protocol. Thirty-five percent of all patients received chemotherapy; most of them (50.5%) received chemotherapy as neoadjuvant treatment before definitive therapy. To conclude, it can be said that this study is one of its first from Eastern India and will act as a stepping stone for future studies concentrating on clinico-epidemiological profile, early diagnosis and treatment of carcinoma urinary bladder.
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Affiliation(s)
- Koustav Biswas
- Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, AJC Bose Road, Kolkata, 700014 West Bengal India
| | - Linkon Biswas
- Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, AJC Bose Road, Kolkata, 700014 West Bengal India
| | - Soham Gangopadhyay
- Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, AJC Bose Road, Kolkata, 700014 West Bengal India
| | - Arpan Jana
- Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, AJC Bose Road, Kolkata, 700014 West Bengal India
| | - Tanmoy Basak
- Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, AJC Bose Road, Kolkata, 700014 West Bengal India
| | - Debojyoti Manna
- Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, AJC Bose Road, Kolkata, 700014 West Bengal India
| | - Srikrishna Mandal
- Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, AJC Bose Road, Kolkata, 700014 West Bengal India
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12
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Guzman RA, Gonzalez M, Bakroun S, Bakroun Z, Othman F, Simon JA, Dash A. Small Bowel Obstruction Secondary to Metastatic Urothelial Cell Carcinoma With Plasmacytoid Features: A Case Report. Cureus 2024; 16:e63207. [PMID: 39070369 PMCID: PMC11277245 DOI: 10.7759/cureus.63207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Urothelial cell carcinoma (UCC) is a type of malignant cancer that affects thousands of people worldwide, especially those who smoke and have certain occupational exposures. Plasmacytoid urothelial carcinoma (PUC) is a rare histological variant of UCC that can present aggressively and insidiously. Small bowel obstruction secondary to malignancy is a rare presentation of UCC because the small bowel is a rare site of metastasis. We showcase a patient who presented with small bowel obstruction secondary to high-grade metastatic UCC with plasmacytoid features, exhibiting minimal urologic symptoms and no apparent risk factors. This case highlights the importance of high clinical suspicion for patients with possible malignancies that present with limited or unusual symptomatology and no risk factors. Further research into PUC to understand its symptoms and metastatic pattern is warranted to advance current early diagnostic criteria and further improve patient outcomes.
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Affiliation(s)
- Rafael A Guzman
- Medicine, St. George's University School of Medicine, True Blue, GRD
- General Surgery, Delray Medical Center, Delray Beach, USA
| | - Maikol Gonzalez
- Medicine, St. George's University School of Medicine, True Blue, GRD
- General Surgery, Delray Medical Center, Delray Beach, USA
| | - Sara Bakroun
- Medicine, St. George's University School of Medicine, True Blue, GRD
- General Surgery, Delray Medical Center, Delray Beach, USA
| | - Zinab Bakroun
- Medicine, St. George's University School of Medicine, True Blue, GRD
- General Surgery, Delray Medical Center, Delray Beach, USA
| | - Feras Othman
- General Surgery, University of Miami, Miami, USA
| | - Joshua A Simon
- General Surgery, Delray Medical Center, Delray Beach, USA
| | - Aruna Dash
- Pathology, Delray Medical Center, Delray Beach, USA
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13
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Czech AK, Gronostaj K, Frydrych J, Polok K, Fronczek J, Dudek P, Belch L, Chlosta M, Choragwicki D, Dymowski T, Ostachowski M, Piatek-Koziej K, Przydacz M, Pyrkosz P, Wiatr T, Wrozek M, Chlosta PL. The assessment of bladder cancer resectability with bimanual palpation: A prospective study in laparoscopy and open cystectomy patients. Urol Oncol 2024; 42:176.e1-176.e7. [PMID: 38508941 DOI: 10.1016/j.urolonc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/27/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To evaluate the value of examination under anesthesia (EUA) in the assessment of bladder resectability during cystectomy. MATERIALS AND METHODS This prospective study included consecutive patients undergoing cystectomy for bladder cancer at a single center between June 2017 and October 2020. EUA was conducted before cystectomy by two urologists who assessed the bladder for limited mobility. One examiner was blinded to the imaging results. Soft tissue surgical margin status in the pathological evaluation of a cystectomy specimen served as a measure of resectability. We used multivariable logistic regression models to assess whether EUA performed by blinded or non-blinded examiners is associated with soft tissue positive surgical margins (PSMs) and to calculate the fraction of new information added by such an examination in addition to selected clinical variables. RESULTS Among the 134 patients analyzed, limited bladder mobility was indicated by the blinded and non-blinded examiners in 23 (17.2%) and 21 (15.7%) cases, respectively. PSMs were identified in 22 (16.4%) patients, more often in patients with limited bladder mobility as assessed by the blinded (odds ratio [OR] 6.7; 95% confidence interval [CI], 1.9-24.2) and non-blinded examiners (OR 12.9; 95% CI, 2.9-57.5). The fraction of new information added by the blinded and non-blinded examiners was 48.6% and 57.7%, respectively. The enrichment of patients who underwent pure laparoscopic cystectomy (n = 102; 76%) and the inclusion of patients for emergent surgery may limit the generalizability of our findings. CONCLUSIONS The identification of limited bladder mobility during preoperative EUA yielded prognostic information on surgical margin status. Our findings suggest that EUA has the potential to provide valuable insights in the assessment of bladder resectability. However, further research in a larger cohort of patients is warranted to validate and expand on these findings.
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Affiliation(s)
- Anna K Czech
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland.
| | - Katarzyna Gronostaj
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Frydrych
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Kamil Polok
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Przemyslaw Dudek
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Lukasz Belch
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominik Choragwicki
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dymowski
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Ostachowski
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Pawel Pyrkosz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Wiatr
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Wrozek
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr L Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
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14
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López Valcárcel M, Barrado Los Arcos M, Ferri Molina M, Cienfuegos Belmonte I, Duque Santana V, Gajate Borau P, Fernández Ibiza J, Álvarez Maestro M, Sargos P, López Campos F, Couñago F. Is trimodal therapy the current standard for muscle-invasive bladder cancer? Actas Urol Esp 2024; 48:345-355. [PMID: 38575067 DOI: 10.1016/j.acuroe.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The aim of this review is to summarize the current evidence and future perspectives of bladder-sparing treatment for MIBC. METHODS A non-systematic literature search in Medline/Pubmed was performed in October 2023 with the following keywords "bladder cancer", "bladder-sparing", "trimodal therapy", "chemoradiation", "biomarkers", "immunotherapy", "neoadjuvant chemotherapy", "radiotherapy". RESULTS Urology guidelines recommend radical cystectomy as the standard curative treatment for muscle-invasive urothelial bladder cancer, reserving radiotherapy for patients who are unfit or who want to preserve their bladder. Given the morbidity and mortality of cystectomy and its impact on quality of life and bladder function, modern oncologic therapies are increasingly oriented toward organ preservation and maximizing functional outcomes while maintaining treatment efficacy. Trimodal therapy, which incorporates maximal transurethral resection followed by radiotherapy with concurrent radiosensitizing chemotherapy, is an effective regimen for bladder function preservation in well-selected patients. Despite the absence of comparative data from randomized trials, the two approaches seem to provide comparable oncologic outcomes. Studies are evaluating the expansion of eligibility criteria for trimodal therapy, the optimization of radiotherapy and immunotherapy delivery to further improve outcomes, and the validation of biomarkers to guide bladder preservation. CONCLUSIONS Trimodal therapy has shown acceptable outcomes for bladder preservation; therefore, it provides a valid treatment option in well-selected patients.
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Affiliation(s)
- M López Valcárcel
- Servicio de Oncología Radioterápica, Hospital Universitario Puerta de Hierro, Madrid, Spain, Miembro del GUARD Consortium.
| | - M Barrado Los Arcos
- Servicio de Oncología Radioterápica, Hospital Universitario de Navarra, Instituto de Investigación Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - M Ferri Molina
- Servicio de Oncología Radioterápica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Universidad de Cantabria, Spain
| | - I Cienfuegos Belmonte
- Servicio de Urología, Hospital Virgen del Puerto, Plasencia, Cáceres, Extremadura, Spain
| | - V Duque Santana
- Servicio de Oncología Radioterápica, Hospital Universitario Quironsalud y Hospital Universitario La Luz, Universidad Europea de Madrid, Spain
| | - P Gajate Borau
- Servicio de Oncología Médica, Hospital Universitario Ramon y Cajal, Instituto Ramon y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - J Fernández Ibiza
- Servicio de Oncología Radioterápica, GenesisCare Clínica Corachan, Barcelona, Spain
| | | | - P Sargos
- Servicio de Oncología Radioterápica, Institut Bergonié, Burdeos, France
| | - F López Campos
- Servicio de Oncología Radioterápica, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - F Couñago
- Servicio de Oncología Radioterápica, GenesisCare Madrid, Hospital Universitario San Francisco de Asis y Hospital Universitario La Milagrosa, Madrid, Spain
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15
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Sherif A. Don't throw out the baby with the bath water! Scand J Urol 2024; 59:117-118. [PMID: 38769693 DOI: 10.2340/sju.v59.40629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Amir Sherif
- Department of Diagnostics and Intervention, Urology and Andrology, Umeå University, Umeå, Sweden.
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16
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Xiao H, Huang X, Chen H, Zheng Y, Liu W, Chen J, Wei R, Lin M, Wang Q, Zhuang W. Establishment of a SUMO pathway related gene signature for predicting prognosis, chemotherapy response and investigating the role of EGR2 in bladder cancer. J Cancer 2024; 15:3841-3856. [PMID: 38911380 PMCID: PMC11190772 DOI: 10.7150/jca.96481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/06/2024] [Indexed: 06/25/2024] Open
Abstract
Background: Bladder cancer is a prevalent malignancy with significant clinical implications. Small Ubiquitin-like Modifier (SUMO) pathway related genes (SPRG) have been implicated in the development and progression of cancer. Methods: In this study, we conducted a comprehensive analysis of SPRG in bladder cancer. We analyzed gene expression and prognostic value of SPRG and developed a SPRG signature (SPRGS) prognostic model based on four genes (HDAC4, TRIM27, EGR2, and UBE2I) in bladder cancer. Furthermore, we investigated the relationship between SPRGS and genomic alterations, tumor microenvironment, chemotherapy response, and immunotherapy. Additionally, we identified EGR2 as a key SPRG in bladder cancer. The expression of EGR2 in bladder cancer was detected by immunohistochemistry, and the cell function experiment clarified the effect of knocking down EGR2 on the proliferation, invasion, and migration of bladder cancer cells. Results: Our findings suggest that SPRGS hold promise as prognostic markers and predictive biomarkers for chemotherapy response and immunotherapy efficacy in bladder cancer. The SPRGS prognostic model exhibited high predictive accuracy for bladder cancer patient survival. We also observed correlations between SPRG and genomic alterations, tumor microenvironment, and response to chemotherapy. Immunohistochemical results showed that EGR2 was highly expressed in bladder cancer tissues, and its overexpression was associated with poor prognosis. Knockdown of EGR2 inhibited bladder cancer cell proliferation, invasion, and migration. Conclusion: This study provides valuable insights into the landscape of SPRGS in bladder cancer and their potential implications for personalized treatment strategies. The identification of EGR2 as a key SPRG and its functional impact on bladder cancer cells further highlights its significance in bladder cancer development and progression. Overall, SPRGS may serve as important prognostic markers and predictive biomarkers for bladder cancer patients, guiding treatment decisions and improving patient outcomes.
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Affiliation(s)
- Han Xiao
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Xiaoan Huang
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - Heyi Chen
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - Ying Zheng
- Department of Obstetrics, Fuzhou Second Hospital, Fuzhou 350000, Fujian, China
| | - Weihui Liu
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - Jiabi Chen
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - Ran Wei
- School of Medical and Health Engineering, Changzhou University, Changzhou 213164, Jiangsu, China
| | - Ming Lin
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - Qingshui Wang
- The Second Affiliated Hospital of Fujian University of Traditional Chinese Medical University Medicine, Fujian-Macao Science and Technology Cooperation Base of Traditional Chinese Medicine-Oriented Chronic Disease Prevention and Treatment, Innovation and Transformation Center, Fujian University of Traditional Chinese Medicine, Fuzhou 350001, Fujian, China
| | - Wei Zhuang
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China
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17
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Sekar RR, Irani S, Maganty A, Montgomery JS, Herrel LA. Social Vulnerability and Receipt of Neoadjuvant Chemotherapy in Patients Undergoing Radical Cystectomy for Bladder Cancer. Urology 2024:S0090-4295(24)00359-5. [PMID: 38763474 DOI: 10.1016/j.urology.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To evaluate the association between a population-level measure of social determinants of health, the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), and receipt of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy. METHODS We queried our institutional database for patients with nonmetastatic MIBC treated with radical cystectomy between 2000 and 2022. Patients were assigned an SVI via ZIP code of residence and grouped into quintiles of SVI (ie, least vulnerable to most vulnerable). Multivariable logistic regression was performed to evaluate the association between SVI and receipt of neoadjuvant chemotherapy, adjusting for age, race, gender, and cancer stage. A sub-analysis was performed to evaluate the association between subthemes of SVI (socioeconomic status, household composition/disability, race/ethnicity/language, and housing/transportation) and receipt of neoadjuvant chemotherapy. RESULTS Of the 978 patients identified, 490 (50.1%) received neoadjuvant chemotherapy. Patients that received neoadjuvant chemotherapy had a lower SVI, were younger, and had >cT2 stage (all, P <.05). The most vulnerable patients had lower odds of receiving neoadjuvant chemotherapy (OR 0.61, 0.39-0.95) compared to the least vulnerable patients. Analysis of subthemes of SVI demonstrated similar associations by socioeconomic status (OR 0.56, 0.36-0.86) and household composition/disability (OR 0.57, 0.33-0.99). CONCLUSION Adverse social determinants of health, or social vulnerability, are associated with suboptimal and disparate utilization of neoadjuvant chemotherapy in patients with MIBC undergoing radical cystectomy. Strategies for identifying vulnerable populations may allow for more targeted interventions that would improve equity in bladder cancer care.
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Affiliation(s)
- Rishi R Sekar
- Department of Urology, University of Michigan, Ann Arbor, MI; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI.
| | - Sarosh Irani
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Avinash Maganty
- Department of Urology, University of Michigan, Ann Arbor, MI
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18
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Savchenko E, Bunimovich-Mendrazitsky S. Investigation toward the economic feasibility of personalized medicine for healthcare service providers: the case of bladder cancer. Front Med (Lausanne) 2024; 11:1388685. [PMID: 38808135 PMCID: PMC11130437 DOI: 10.3389/fmed.2024.1388685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
In today's complex healthcare landscape, the pursuit of delivering optimal patient care while navigating intricate economic dynamics poses a significant challenge for healthcare service providers (HSPs). In this already complex dynamic, the emergence of clinically promising personalized medicine-based treatment aims to revolutionize medicine. While personalized medicine holds tremendous potential for enhancing therapeutic outcomes, its integration within resource-constrained HSPs presents formidable challenges. In this study, we investigate the economic feasibility of implementing personalized medicine. The central objective is to strike a balance between catering to individual patient needs and making economically viable decisions. Unlike conventional binary approaches to personalized treatment, we propose a more nuanced perspective by treating personalization as a spectrum. This approach allows for greater flexibility in decision-making and resource allocation. To this end, we propose a mathematical framework to investigate our proposal, focusing on Bladder Cancer (BC) as a case study. Our results show that while it is feasible to introduce personalized medicine, a highly efficient but highly expensive one would be short-lived relative to its less effective but cheaper alternative as the latter can be provided to a larger cohort of patients, optimizing the HSP's objective better.
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19
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Lin P, Yang X, Wang L, Zou X, Mu L, Xu C, Yang X. Novel artesunate-metformin conjugate inhibits bladder cancer cell growth associated with Clusterin/SREBP1/FASN signaling pathway. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2024; 28:219-227. [PMID: 38682170 PMCID: PMC11058549 DOI: 10.4196/kjpp.2024.28.3.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 05/01/2024]
Abstract
Bladder cancer remains the 10th most common cancer worldwide. In recent years, metformin has been found to have potential anti-bladder cancer activity while high concentration of IC50 at millimolar level is needed, which could not be reached by regular oral administration route. Thus, higher efficient agent is urgently demanded for clinically treating bladder cancer. Here, by conjugating artesunate to metformin, a novel artesunate-metformin dimer triazine derivative AM2 was designed and synthesized. The inhibitory effect of AM2 on bladder cancer cell line T24 and the mechanism underlying was determined. Anti-tumor activity of AM2 was assessed by MTT, cloning formation and wound healing assays. Decreasing effect of AM2 on lipogenesis was determined by oil red O staining. The protein expressions of Clusterin, SREBP1 and FASN in T24 cells were evaluated by Western blotting. The results show that AM2 significantly inhibited cell proliferation and migration at micromolar level, much higher than parental metformin. AM2 reduced lipogenesis and down-regulated the expressions of Clusterin, SREBP1 and FASN. These results suggest that AM2 inhibits the growth of bladder cancer cells T24 by inhibiting cellular lipogenesis associated with the Clusterin/SREBP1/FASN signaling pathway.
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Affiliation(s)
- Peiyu Lin
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha 410000, Hunan, China
| | - Xiyue Yang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha 410000, Hunan, China
| | - Linghui Wang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha 410000, Hunan, China
| | - Xin Zou
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha 410000, Hunan, China
| | - Lingli Mu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha 410000, Hunan, China
| | - Cangcang Xu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha 410000, Hunan, China
| | - Xiaoping Yang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha 410000, Hunan, China
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20
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Omura M, Kosaka T, Kobayashi H, Shigeta K, Matsumoto K, Hara S, Kikuchi E, Mikami S, Saya H, Sato Y, Oya M. Vasohibin-1 Expression Can Predict Pathological Complete Remission of Advanced Bladder Cancer with Neoadjuvant Chemotherapy. Ann Surg Oncol 2024; 31:2951-2958. [PMID: 38376711 PMCID: PMC10997694 DOI: 10.1245/s10434-024-15009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/21/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE Neoadjuvant chemotherapy (NAC) is a well-established standard practice in invasive bladder cancer (BCa), however patient selection remains challenging. High expression of vasohibin-1 (VASH1), an endogenous regulator of angiogenesis, has been reported in high-grade and advanced BCa; however, its prognostic value for chemotherapy outcomes remains unexplored. In this study, we sought to identify biomarkers of chemotherapy response focusing on the relationship between angiogenesis and tissue hypoxia. METHODS Forty Japanese patients with BCa who underwent NAC and radical cystectomy were included in the present analysis. We compared the immunohistochemical expression of CD34, VASH1, and carbonic anhydrase 9 (CA9) between patients who achieved tumor clearance at operation (ypT0) and those with residual disease after cystectomy. RESULTS There were 19 patients in the ypT0 group, while the remaining 21 patients had residual tumors at operation. Patients in the ypT0 group had high microvessel density (p = 0.031), high VASH1 density (p < 0.001), and stronger CA9 staining (p = 0.046) than their counterparts. Multivariate analysis identified microvessel and VASH1 density as independent predictive factors for pathological ypT0 disease (p = 0.043 and 0.002, respectively). The 5-year recurrence-free survival rate was higher in the high VASH1 density group than in the low VASH1 density group (66.3% vs. 33.3%, p = 0.036). CONCLUSION VASH1 density is a potential therapeutic biomarker for chemotherapy response in BCa.
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Affiliation(s)
- Minami Omura
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Hiroaki Kobayashi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Shigeta
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | | | - Satoshi Hara
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shuji Mikami
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, Graduate School of Medicine, Keio University, Tokyo, Japan
| | - Yasufumi Sato
- Department of Vascular Biology, Institute of Development, Aging and Cancer, Tohoku University, Miyagi, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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21
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Kapriniotis K, Tzelves L, Lazarou L, Mitsogianni M, Mitsogiannis I. Circulating Tumour DNA and Its Prognostic Role in Management of Muscle Invasive Bladder Cancer: A Narrative Review of the Literature. Biomedicines 2024; 12:921. [PMID: 38672275 PMCID: PMC11048625 DOI: 10.3390/biomedicines12040921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Current management of non-metastatic muscle invasive bladder cancer (MIBC) includes radical cystectomy and cisplatin-based neoadjuvant chemotherapy (NAC), offers a 5-year survival rate of approximately 50% and is associated with significant toxicities. A growing body of evidence supports the role of liquid biopsies including circulating tumour DNA (ctDNA) as a prognostic and predictive marker that could stratify patients according to individualised risk of progression/recurrence. Detectable ctDNA levels prior to radical cystectomy have been shown to be correlated with higher risk of recurrence and worse overall prognosis after cystectomy. In addition, ctDNA status after NAC/neoadjuvant immunotherapy is predictive of the pathological response to these treatments, with persistently detectable ctDNA being associated with residual bladder tumour at cystectomy. Finally, detectable ctDNA levels post-cystectomy have been associated with disease relapse and worse disease-free (DFS) and overall survival (OS) and might identify a population with survival benefit from adjuvant immunotherapy.
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Affiliation(s)
| | - Lazaros Tzelves
- 2nd Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens (NKUA), 115 27 Athens, Greece; (L.L.); (I.M.)
| | - Lazaros Lazarou
- 2nd Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens (NKUA), 115 27 Athens, Greece; (L.L.); (I.M.)
| | - Maria Mitsogianni
- 4th Department of Medical Oncology, “Hygeia” Hospital, 151 23 Athens, Greece;
| | - Iraklis Mitsogiannis
- 2nd Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens (NKUA), 115 27 Athens, Greece; (L.L.); (I.M.)
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Cooke I, Abou Heidar N, Mahmood AW, Ahmad A, Jing Z, Stöckle M, Wagner AA, Roupret M, Kim E, Vasdev N, Balbay D, Rha KH, Aboumohamed A, Dasgupta P, Maatman TJ, Richstone L, Wiklund P, Gaboardi F, Li Q, Hussein AA, Guru K. The role of neoadjuvant chemotherapy for patients with variant histology muscle invasive bladder cancer undergoing robotic cystectomy: Data from the International Robotic Cystectomy Consortium. Urol Oncol 2024; 42:117.e17-117.e25. [PMID: 38429124 DOI: 10.1016/j.urolonc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To assess the role of neoadjuvant chemotherapy (NAC) before robot-assisted radical cystectomy (RARC) for patients with variant histology (VH) muscle-invasive bladder cancer (MIBC). METHODS Retrospective review of 988 patients who underwent RARC (2004-2023) for MIBC. Primary outcomes included the utilization of NAC among this cohort of patients, frequency of downstaging, and discordance between preoperative and final pathology in terms of the presence of VH. Secondary outcomes included disease-specific (DSS), recurrence-free (RFS), and overall survival (OS). RESULTS A total of 349 (35%) had VH on transurethral resection or at RARC. The 4 most common VH subgroups were squamous (n = 94), adenocarcinoma (n = 64), micropapillary (n = 34), and sarcomatoid (n = 21). There was no difference in OS (log-rank: P = 0.43 for adenocarcinoma, P = 0.12 for micropapillary, P = 0.55 for sarcomatoid, P = 0.29 for squamous), RFS (log-rank: P = 0.25 for adenocarcinoma, P = 0.35 for micropapillary, P = 0.83 for sarcomatoid, P = 0.79 for squamous), or DSS (log-rank P = 0.91 for adenocarcinoma, P = 0.15 for micropapillary, 0.28 for sarcomatoid, P = 0.92 for squamous) among any of the VH based on receipt of NAC. Patients with squamous histology who received NAC were more likely to be downstaged on final pathology compared to those who did not (P < 0.01). CONCLUSION Our data showed no significant difference in OS, RFS, or DSS for patients with VH MIBC cancer who received NAC before RARC. Patients with the squamous variant who received NAC had more pathologic downstaging compared to those who did not. The role of NAC among patients with VH is yet to be defined. Results were limited by small number in each individual group and lack of exact proportion of VH.
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Affiliation(s)
- Ian Cooke
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | - Ali Ahmad
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Zhe Jing
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | - Eric Kim
- Washington University St. Louis, St. Louis, MO
| | - Nikhil Vasdev
- Lister Hospital (ENHT NHS Trust), Stevenage, United Kingdom
| | - Derya Balbay
- Koç University Hospital, Zeytinburnu/İstanbul, Turkey
| | - Koon Ho Rha
- Yonsei Medical Health Care System, Sinchon-dong, Seodaemun District, South Korea
| | | | | | | | - Lee Richstone
- Arthur Smith Institute for Urology, Lake Success, NY
| | | | | | - Qiang Li
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Khurshid Guru
- Roswell Park Comprehensive Cancer Center, Buffalo, NY.
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Kim JM, Choi E, Sung SH, Jo J, Lee DH, Park S. Does Bladder Cancer Subtype Influence Pathologic Complete Response (pCR) and Pelvic Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) Response Evaluation After Neoadjuvant Chemotherapy? Pathological Perspective. Clin Genitourin Cancer 2024; 22:224-236. [PMID: 38042728 DOI: 10.1016/j.clgc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/04/2023] [Accepted: 11/04/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION We aimed to provide a pathological perspective on the management of muscle-invasive bladder cancer (MIBC) by correlating the prechemotherapy transurethral resection of bladder tumor findings and postchemotherapy radiologic evaluation with final radical cystectomy (RC) findings. MATERIALS AND METHODS This retrospective study included 79 MIBC patients treated with neoadjuvant chemotherapy (NAC) and RC. Pelvic diffusion-weighted magnetic resonance imaging (DW-MRI) and pathologic reports were retrieved from our institutional database. All pathology slides were reviewed based on diagnostic criteria with high interobserver reproducibility. RESULTS Pathologic complete response (pCR) was confirmed in 32 patients (40.5%). The concordance and discordance between MRI and RC findings occurred in 68.3% and 31.7% of cases, respectively. The 21.5% of cases that were clinical CR (cCR) on MRI actually achieved pCR on RC specimens and 46.8% of cases that were non-cCR on MRI were actually non-pCR on RC specimens. In 19.0% of cases, RC findings were pCR, but MRI demonstrated residual tumor and the opposite was 12.7%. The greatest discrepancy between the 2 methods (75%, 3/4) was for the plasmacytoid subtype. Plasmacytoid histology was the most common histological subtype identified in RC specimens after NAC, followed by micropapillary and squamous histologies. CONCLUSIONS We found that all cases with plasmacytoid and micropapillary subtypes, and squamous differentiation did not show pCR. In particular, the largest discrepancy between MRI findings and RC pathology after NAC was seen in the plasmacytoid subtype. An accurate pathologic diagnosis based on strict criteria to identify histological subtypes of MIBC is necessary for proper treatment.
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Affiliation(s)
- Ji Min Kim
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Yangcheon-Gu, Seoul, Republic of Korea
| | - Euno Choi
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Yangcheon-Gu, Seoul, Republic of Korea
| | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Yangcheon-Gu, Seoul, Republic of Korea
| | - Jungmin Jo
- Division of Hematology-Oncology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Dong-Hyeon Lee
- Department of Urology, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Sanghui Park
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Yangcheon-Gu, Seoul, Republic of Korea.
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24
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Nuijens ST, van Osch FHM, van Hoogstraten LMC, Witjes JA, Aben KKH, Hermans TJN. Longer time to radical cystectomy in patients treated with neoadjuvant chemotherapy is associated with worse oncological outcomes. Urol Oncol 2024; 42:117.e11-117.e16. [PMID: 38238116 DOI: 10.1016/j.urolonc.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/17/2023] [Accepted: 12/24/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Current muscle-invasive bladder cancer (MIBC) guidelines recommend not delaying radical cystectomy (RC) >3 months after diagnosis as it decreases overall survival (OS). However, literature investigating the impact of delay in RC in patients who receive NAC is limited, especially on a population-based level. OBJECTIVE To investigate the association between time from diagnosis of MIBC to RC (TTRC) in patients with urothelial bladder cancer (UBC) treated with NAC and RC and 1) 2-year OS and 2) pathological lymph node status (pN+) in a population-based cohort. METHODS Patients were selected from the Netherlands Cancer Registry. The study included 237 patients with cT2-T4aN0M0 UBC, treated with NAC and RC between November 2017 and October 2019. Association between TTRC and OS was assessed using multivariable Cox regression analyses. Schoenfeld and Martingale residuals were used to investigate the proportional hazards assumption and whether a cut-off in the TTRC could be identified. Association between TTRC and pN+ was assessed using multivariable logistic regression analyses. RESULTS Median TTRC was 23 weeks (interquartile range (IQR) 19-26). 2-year OS was 67% (95%CI 59%-74%). Each week of delay in the TTRC was independently associated with 2-year OS (HR 1.06; P = 0.03) in the Cox regression analysis. The sensitivity analyses, defining TTRC as the time between last cycle of NAC and RC, revealed that each week of delay between NAC and RC was associated with 2-year OS (Hazard ratio (HR) 1.13; P < 0.0001), and with pN+ (Odds ratio (OR) 1.21; P = 0.01) in the Cox and logistic regression analyses, respectively. CONCLUSIONS A longer TTRC is associated with worse oncological outcomes in patients treated with NAC and RC.
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Affiliation(s)
- Siberyn T Nuijens
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
| | - Frits H M van Osch
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands; Department of Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Lisa M C van Hoogstraten
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tom J N Hermans
- Department of Urology, VieCuri Medical Center, Venlo, the Netherlands; Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
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25
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Savin Z, Mano R, Lazarovich A, Rosenzweig B, Shashar R, Hoffman A, Pilosov I, Freifeld Y, Shpitzer SA, Golan S, Yossepowitch O, Sofer M. Assessing the Impact of Percutaneous Nephrostomy Presence on Neoadjuvant Treatment Quality in Patients With Muscle Invasive Bladder Cancer. Clin Genitourin Cancer 2024; 22:491-496. [PMID: 38267303 DOI: 10.1016/j.clgc.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/02/2024] [Accepted: 01/02/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Symptomatic hydronephrosis associated with muscle invasive bladder cancer (MIBC) necessitates percutaneous nephrostomy (PCN) insertion before neoadjuvant chemotherapy (NAC). This study assesses the impact of PCN presence on standard intended NAC quality, its related complications and outcome after radical cystectomy (RC). MATERIALS AND METHODS The study comprises a retrospective, multicenter cohort of 193 consecutive RCs performed between 2016 and 2019. Eighty (42%) of these patients received NAC and were divided in 2 comparison groups by presence (n = 26; 33%) or absence (n = 54; 67%) of PCN. Endpoints included completion of adequate NAC treatment (cisplatin-based chemotherapy for at least 4 courses), complications during NAC, post-RC complications and hospital stay. RESULTS Overall, patients with PCN (45/193; 23%) featured a higher referral rate to NAC (58% vs. 36%, P = .01), worse glomerular filtration rates (P < .001) and more adverse events (P = .04), in comparison to non-PCN patients. In the NAC cohort, PCN patients had less adequate treatment rates (54% vs. 85%, P = .005), and more infections (35% vs, 7%; P = .008) and hospitalizations (58% vs. 13%; P < .001) during chemotherapy. Post-RC outcome was similar for both comparison groups. PCN was an independent risk factor for inadequate NAC (OR = 3.9, P = .04), and infections (OR = 11.3, P = .01) and hospitalizations (OR = 7.5, P = .004) during NAC. CONCLUSIONS PCN in MIBC patients is a significant risk factor for inadequate NAC and adverse events during treatment. This finding may quire the rationale of NAC, potentially leading to consideration of NAC avoidance and upfront RC in PCN patients. Further survival studies with long follow-up are needed for elucidating this issue.
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Affiliation(s)
- Ziv Savin
- Departments of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Roy Mano
- Departments of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Alon Lazarovich
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Barak Rosenzweig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Reut Shashar
- Departments of Urology, Rambam Health Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Azik Hoffman
- Departments of Urology, Rambam Health Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Ilona Pilosov
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel; Carmel Medical Center, Haifa, Israel
| | - Yuval Freifeld
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel; Carmel Medical Center, Haifa, Israel
| | - Sagi Arieh Shpitzer
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Rabin Medical Center, Petach-Tikva, Israel
| | - Shay Golan
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Rabin Medical Center, Petach-Tikva, Israel
| | - Ofer Yossepowitch
- Departments of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mario Sofer
- Departments of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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26
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Elkarta A, Awadalla A, El-Hefnawy A, Mosbah A, Abolenein H, Shokeir A. Predictors of Response Following Neoadjuvant Cisplatin-Based Chemotherapy for Muscle Invasive Urothelial Bladder Cancer Using Molecular Profile: A Prospective Clinical Study. Clin Genitourin Cancer 2024; 22:38-46.e1. [PMID: 37758560 DOI: 10.1016/j.clgc.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/09/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES To predict response of patients with muscle invasive bladder cancer (MIBC) to neoadjuvant chemotherapy (NAC) through analysis of molecular profile assessed clinically (radiologically and by pathological examination of transurethral resection biopsy [TURBT] specimens) and definitively with histopathological examination after radical cystectomy (RC). METHODS In a prospective study, tumor biopsies were obtained from patients with urothelial MIBC (T2-4a N0-2 M0) during TURBT. Patients were eligible for RC received 4 cycles of cisplatin-based NAC. DNA repair genes (BRACA1, ERCC1) & CTR gene m-RNA expression levels were assessed in resected tissue. The response to chemotherapy was assessed clinically (radiologically & TURBT) following NAC. Response was re-assessed for 64 patients who underwent RC and predictors of cancer-free survival (CFS) were calculated. Receiver operating characteristic (ROC) curve was used to delineate cutoff value copes with the best sensitivity and specificity for prediction of response to NAC. RESULTS The study included 104 patients, 42 (40.4%) responded well to NAC clinically. Out of 64 patients who underwent RC, 26 (40.6%) showed good response to NAC. CFS at 18 months for patients who underwent RC was 60%. Statistical analysis showed that molecular profile was an independent predictor of good response to NAC both clinically and pathologically and also predicted better CFS. CONCLUSION Molecular profile could play a decisive role in early detection of patients with MIBC who will get benefit from preoperative NAC.
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Affiliation(s)
- Ahmed Elkarta
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amira Awadalla
- Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed El-Hefnawy
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Mosbah
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hassan Abolenein
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Shokeir
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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27
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Kaczmarek K, Małkiewicz B, Gurwin A, Krawczyk WM, Skonieczna-Żydecka K, Lemiński A. Prognostic Value of Postneoadjuvant Chemotherapy Neutrophil-to-Lymphocyte Ratio in Patients undergoing Radical Cystectomy. J Clin Med 2024; 13:1953. [PMID: 38610718 PMCID: PMC11012838 DOI: 10.3390/jcm13071953] [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: 02/18/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Neutrophil-to-lymphocyte ratio (NLR), a widely assessed biomarker in most common diseases, is typically evaluated before treatment initiation. However, data on NLR in the post-treatment setting is limited. Therefore, we assessed the NLR calculated after neoadjuvant chemotherapy (NAC) initiation in patients with bladder cancer (BC). We hypothesised that changes in blood cells after NAC could be a marker of tumour response and long-term survival. Materials and Methods: Our study included 214 patients who underwent NAC followed by radical cystectomy (RC) in two urological departments, wherein post-NAC NLR was used to categorize patients into the low (NLR ≤ 1.75) and high (NLR > 1.75) groups. Results: Logistic regression analysis indicated that a post-NAC NLR ≥ 1.75 is a good biomarker for pathologic response (odds ratio (OR), 0.045; p <0.001), emphasizing its ability to predict patient survival. The HRs for overall survival and cancer-specific survival were 2.387 (p = 0.048) and 2.342 (p < 0.001), respectively. Conclusions: We believe that post-NAC NLR can be used for patient stratification after NAC. Consequently, the post-NAC NLR may serve as a guide for the decision-making process regarding RC versus bladder-preserving strategies.
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Affiliation(s)
- Krystian Kaczmarek
- Department of General and Oncological Urology, Independent Provincial Public Integrated Hospital, Arkońska 4, 71-455 Szczecin, Poland
| | - Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (B.M.)
| | - Adam Gurwin
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (B.M.)
| | - Wiktor Mateusz Krawczyk
- Department of Urology and Urological Oncology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Karolina Skonieczna-Żydecka
- Department of Biochemical Sciences, Pomeranian Medical University, Władysława Broniewskiego 24, 71-460 Szczecin, Poland;
| | - Artur Lemiński
- Department of General and Oncological Urology, Independent Provincial Public Integrated Hospital, Arkońska 4, 71-455 Szczecin, Poland
- Department of Biochemical Sciences, Pomeranian Medical University, Władysława Broniewskiego 24, 71-460 Szczecin, Poland;
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28
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Ben-David R, Tillu N, Cumarasamy S, Alerasool P, Rich JM, Kaufmann B, Elkun Y, Attalla K, Mehrazin R, Wiklund P, Sfakianos JP. Longitudinal Tumor-informed Circulating Tumor DNA Status Predicts Disease Upstaging and Poor Prognosis for Patients Undergoing Radical Cystectomy. Eur Urol Oncol 2024:S2588-9311(24)00055-5. [PMID: 38521660 DOI: 10.1016/j.euo.2024.03.002] [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: 01/08/2024] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Decision-making on the use of neoadjuvant and adjuvant treatment for patients with bladder cancer undergoing radical cystectomy (RC) currently depends on assessment of clinical and pathological features, which lack sensitivity. Circulating tumor DNA (ctDNA) has emerged as a possible novel prognostic biomarker in the field. Our aim was to assess whether ctDNA status before RC is predictive of pathological and oncological outcomes. We also evaluated the dynamic changes in ctDNA status after RC in relation to recurrence-free survival (RFS). METHODS We analyzed data for patients who underwent RC during 2021-2023 for whom prospective tumor-informed ctDNA analyses were conducted before and after RC. RFS was evaluated using the Kaplan-Meier method. Predictors for disease recurrence were assessed using Cox proportional-hazards models. Pathological outcomes associated with detectable ctDNA before RC were assessed in univariable and multivariable regression analyses. KEY FINDINGS AND LIMITATIONS We included 112 patients in the analysis. Median follow-up was 8 mo (interquartile range 4-13). ctDNA was detected before RC in 59 patients (53%) and was associated with poor RFS (log-rank p < 0.0001). Detectable ctDNA before RC was associated with poor outcomes regardless of clinical stage ( CONCLUSIONS AND CLINICAL IMPLICATIONS Detectable ctDNA before definitive therapy with RC is predictive of nodal involvement, locally advanced disease, and disease recurrence in patients with bladder cancer. ctDNA status holds promise for improving clinical staging and augmenting current decision-making tools. PATIENT SUMMARY We found that for patients with bladder cancer undergoing radical cystectomy, a test to show the presence of tumor DNA in blood before surgery was able to predict the risk of disease relapse and adverse pathology. Use of this assay could help in decision-making by clinicians and patients for optimal personalized treatment of this disease.
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Affiliation(s)
- Reuben Ben-David
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Neeraja Tillu
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shivaram Cumarasamy
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parissa Alerasool
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordan M Rich
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Basil Kaufmann
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yuval Elkun
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kyrollis Attalla
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Mehrazin
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Wiklund
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John P Sfakianos
- Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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29
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Shih CH, Lin YH, Luo HL, Sung WW. Antibody-drug conjugates targeting HER2 for the treatment of urothelial carcinoma: potential therapies for HER2-positive urothelial carcinoma. Front Pharmacol 2024; 15:1326296. [PMID: 38572425 PMCID: PMC10987710 DOI: 10.3389/fphar.2024.1326296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/07/2024] [Indexed: 04/05/2024] Open
Abstract
Urothelial carcinoma (UC) is a common cancer characterized by high morbidity and mortality rates. Despite advancements in treatment, challenges such as recurrence and low response rates persist. Antibody-drug conjugates (ADCs) have emerged as a promising therapeutic approach for various cancers, although their application in UC is currently limited. This review focuses on recent research regarding ADCs designed to treat UC by targeting human epidermal growth factor receptor 2 (HER2), a surface antigen expressed on tumor cells. ADCs comprise three main components: an antibody, a linker, and a cytotoxic payload. The antibody selectively binds to tumor cell surface antigens, facilitating targeted delivery of the cytotoxic drug, while linkers play a crucial role in ensuring stability and controlled release of the payload. Cleavable linkers release the drug within tumor cells, while non-cleavable linkers ensure stability during circulation. The cytotoxic payload exerts its antitumor effect by disrupting cellular pathways. HER2 is commonly overexpressed in UCs, making it a potential therapeutic target. Several ADCs targeting HER2 have been approved for cancer treatment, but their use in UC is still being tested. Numerous HER2 ADCs have demonstrated significant growth inhibition and induction of apoptosis in translational models of HER2-overexpressing bladder cancer. Ongoing clinical trials are assessing the efficacy and safety of ADCs targeting HER2 in UC, with the aim of determining tumor response and the potential of ADCs as a treatment option for UC patients. The development of effective therapies with improved response rates and long-term effectiveness is crucial for advanced and metastatic UC. ADCs targeting HER2 show promise in this regard and merit further investigation for UC treatment.
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Affiliation(s)
- Chia-Hsien Shih
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hua Lin
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Chemistry, Fu Jen Catholic University, New Taipei City, Taiwan
- Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hao-Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Wei Sung
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Saito T, Kanao K, Matsumoto K, Fukumoto K, Igarashi D, Takahashi T, Kaneko G, Shirotake S, Nishimoto K, Mizuno R, Ishida M, Hara S, Oya M, Oyama M. New risk stratification for adjuvant nivolumab for high-risk muscle-invasive urothelial carcinoma. BJUI COMPASS 2024; 5:281-288. [PMID: 38371203 PMCID: PMC10869665 DOI: 10.1002/bco2.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 02/20/2024] Open
Abstract
Objectives We aim to evaluate the risk of recurrence after neoadjuvant chemotherapy followed by radical cystectomy, particularly in ypT2 disease in patients with urothelial carcinoma, because it is not clear if all eligible patients with high-risk muscle-invasive urothelial carcinoma should be treated with adjuvant nivolumab. Materials and Methods We analysed the radiological and clinicopathological features, including cT and ypT stages, of 197 patients who had undergone two to four cycles of cisplatin-based neoadjuvant chemotherapy and radical cystectomy without adjuvant chemotherapy. We stratified the risk of postoperative recurrence by these factors. Results The median observation period was 29.6 (interquartile range, 11.4-71.7) months, and disease recurrence was observed in 58 patients. Multivariate analysis revealed that ypT stage (P = 0.019) and lymphovascular invasion (P = 0.015) were independent risk factors for postoperative recurrence. The ypT2 group (n = 38) had significantly better recurrence-free survival than the ypT3 group (n = 41) (median recurrence-free survival: not reached vs. 13.4 months, respectively, P = 0.005). In ypT2 disease, the cT2 and ypT2 group (n = 15), which was diagnosed as cT2 preoperatively and then diagnosed as ypT2 postoperatively, had significantly better recurrence-free survival than the cT3/4 and ypT2 group (n = 23) (median recurrence-free survival: not reached vs. 63.1 months, respectively, P = 0.034). There was no significant difference in recurrence-free survival between the ypT ≤ 1 (n = 106) and the cT2 and ypT2 groups (median recurrence-free survival: not reached in both, P = 0.962). Conclusion Patients with cT2 and ypT2 stage have a relatively low risk of recurrence and thus have a lower need for adjuvant nivolumab, particularly those with ypT2.
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Affiliation(s)
- Takafumi Saito
- Department of Uro‐OncologySaitama Medical University International Medicine CenterSaitamaJapan
- Department of UrologyKeio University School of MedicineTokyoJapan
- Department of UrologySaiseikai Yokohamashi Tobu HospitalTokyoJapan
| | - Kent Kanao
- Department of Uro‐OncologySaitama Medical University International Medicine CenterSaitamaJapan
| | | | | | - Daisuke Igarashi
- Department of Uro‐OncologySaitama Medical University International Medicine CenterSaitamaJapan
| | - Takayuki Takahashi
- Department of Uro‐OncologySaitama Medical University International Medicine CenterSaitamaJapan
| | - Go Kaneko
- Department of Uro‐OncologySaitama Medical University International Medicine CenterSaitamaJapan
| | - Suguru Shirotake
- Department of Uro‐OncologySaitama Medical University International Medicine CenterSaitamaJapan
| | - Koshiro Nishimoto
- Department of Uro‐OncologySaitama Medical University International Medicine CenterSaitamaJapan
| | - Ryuichi Mizuno
- Department of UrologyKeio University School of MedicineTokyoJapan
| | - Masaru Ishida
- Department of UrologySaiseikai Yokohamashi Tobu HospitalTokyoJapan
| | - Satoshi Hara
- Department of UrologyKawasaki Municipal HospitalKawasakiJapan
| | - Mototsugu Oya
- Department of UrologyKeio University School of MedicineTokyoJapan
| | - Masafumi Oyama
- Department of Uro‐OncologySaitama Medical University International Medicine CenterSaitamaJapan
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Körner SK, Dreyer T, Carus A, Dohn LH, Joensen UN, Lam GW, Jensen NV, Fabrin K, Jensen TK, Pappot H, Agerbæk M, Jensen JB. DaBlaCa-17: nationwide observational study in Denmark on survival before and after implementation of neoadjuvant chemotherapy prior to cystectomy for muscle-invasive bladder cancer. Scand J Urol 2024; 59:39-46. [PMID: 38406925 DOI: 10.2340/sju.v59.24024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To investigate the impact of neoadjuvant chemotherapy implementation with gemcitabine-cisplatin on survival outcomes for patients with muscle-invasive bladder cancer in Denmark. MATERIALS AND METHODS Data were collected on all patients in Denmark undergoing radical cystectomy who were potential candidates for neoadjuvant chemotherapy from 2010 to 2015 (n = 851). A cohort before the implementation of neoadjuvant chemotherapy (Cohort 2010-12) was compared with a cohort after implementation (Cohort 2013-15). Patients in Cohort 2013-15 receiving neoadjuvant chemotherapy (+NAC, n = 213) were compared with patients in Cohort 2013-15 not receiving neoadjuvant chemotherapy (-NAC, n = 139). Pathological results after radical cystectomy and oncological outcomes were compared between the study cohorts. Overall survival, disease-free survival, and disease-specific survival were compared with Kaplan-Meier plots and with univariable and multivariable Cox regression. Kaplan-Meier estimates of overall survival were also performed separately for treating hospital and for pathological stage. RESULTS Pathological T0 (pT0) was more frequent in patients who received neoadjuvant chemotherapy: 34% versus 18% when comparing Cohort 2013-15 with Cohort 2010-12 (p < 0.001), and 46% versus 16% in +NAC compared with -NAC (p < 0.001). Overall survival, disease-free survival, and disease-specific survival at 5 years after cystectomy were not improved in Cohort 2013-15 compared with Cohort 2010-12 with adjusted hazard ratios of 1.11 (95% confidence interval [CI]: 0.87-1.43), 1.02 (95% CI: 0.81-1.29), and 1.06 (95% CI: 0.80-1.41), respectively. CONCLUSIONS This observational study found no improved survival in a national cohort of patients with muscle-invasive bladder cancer undergoing radical cystectomy after implementation of NAC. However, reservations should be made regarding the study design and the true effect of NAC on survival outcomes.
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Affiliation(s)
- Stefanie Korsgaard Körner
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Thomas Dreyer
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Carus
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Line Hammer Dohn
- Department of Oncology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Gitte Wrist Lam
- Department of Urology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | | | - Knud Fabrin
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Urology, Aalborg University Hospital, Aalborg, Denmark
| | - Thor Knak Jensen
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Helle Pappot
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark; Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ozcan L, Polat EC, Baran C, Boylu A, Erkoc M, Otunctemur A. Systemic Inflammatory Index: A Promising Non-Invasive Marker for the Prediction of Response to Neoadjuvant Chemotherapy prior to Cystectomy. Urol Int 2024; 108:226-233. [PMID: 38368856 DOI: 10.1159/000537894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The main challenge to the optimal use of neoadjuvant chemotherapy (NAC) is the difficulty in selecting patients who may or may not benefit from NAC. Our aim in this study was to investigate whether the Systemic Inflammatory Index (SII) predicts response to chemotherapy in patients who receive NAC prior to cystectomy. METHODS We retrospectively analysed the data of patients who underwent NAC followed by cystectomy at our institution between January 2010 and September 2015 and whose 5-year follow-up was completed. All patients who underwent diagnostic biopsy with complete transurethral resection of bladder tumour at our hospital and whose pathology result was muscle-invasive transitional cell carcinoma were included in the study. At least 3 courses of gemcitabine/cisplatin NAC were given to all patients. A pathological response was defined as a reduction in cystectomy to a lower pathological stage after NAC. RESULTS The SII was 320.8 ± 51 in the responders and 388.28 ± 50 in the non-responders. SII optimal cut-off of 350 was determined. The sensitivity and specificity of SII in predicting response were found to be 80% and 83%, respectively. Low SII (<350) was found to be a significant predictor of response compared with the other factors on multivariate analysis. The mean overall survival time was 55.4 months in patients with a low SII value and 40.3 months in the high SII group. CONCLUSION SII, together with known clinicopathological factors and newer genetic and molecular markers, can be used to select patients for NAC.
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Affiliation(s)
- Levent Ozcan
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Emre Can Polat
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Caner Baran
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Ahmet Boylu
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Mustafa Erkoc
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Alper Otunctemur
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
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Proietti F, Flammia RS, Licari LC, Bologna E, Bove AM, Brassetti A, Tuderti G, Mastroianni R, Tufano A, Simone G, Leonardo C. Impacts of Neoadjuvant Chemotherapy on Perioperative Outcomes in Patients with Bladder Cancer Treated with Radical Cystectomy: A Single High-Volume Center Experience. J Pers Med 2024; 14:212. [PMID: 38392645 PMCID: PMC10890459 DOI: 10.3390/jpm14020212] [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: 01/20/2024] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Less than 30% of patients with muscle-invasive bladder cancer (MIBC) receive neoadjuvant chemotherapy (NAC), and reasons for underuse remain unclear. One potential explanation is the concern for the increased risk of perioperative morbidity and mortality. The aim of this study is to investigate the impact of NAC on the risk of detrimental perioperative outcomes in patients with MIBC treated with radical cystectomy (RC). (2) Methods: We identified patients receiving RC for MIBC (T2-4a N0 M0) from 2016 to 2022. Moreover, 1:1 propensity score matching (PSM) was applied between RC alone versus RC plus NAC, and our analysis tested the association between NAC status and peri-operative outcomes. (3) Results: Among the 317 patients treated with RC for identified MIBC, 98 (31%) received NAC. Patients treated with NAC were younger (median yr. 64 vs. 71; p < 0.001), with a lower Charlson Comorbidity Index (3 vs. 4; p > 0.001), and received more frequently continent urinary diversion (61 vs. 32%, p < 0.001). About 43% of patients in each group were treated with robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD). After PSM, no differences were detected for the outcomes considered. (4) Conclusions: NAC is not associated with a higher rate of perioperative complications, including patients who received RARC with ICUD.
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Affiliation(s)
- Flavia Proietti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00128 Rome, Italy
| | - Rocco Simone Flammia
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00128 Rome, Italy
| | - Leslie Claire Licari
- Urology Unit, Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Eugenio Bologna
- Urology Unit, Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00128 Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00128 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00128 Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00128 Rome, Italy
| | - Antonio Tufano
- Urology Unit, Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00128 Rome, Italy
| | - Costantino Leonardo
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00128 Rome, Italy
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Kool R, Dragomir A, Kulkarni GS, Marcq G, Breau RH, Kim M, Busca I, Abdi H, Dawidek M, Uy M, Fervaha G, Cury FL, Alimohamed N, Izawa J, Jeldres C, Rendon R, Shayegan B, Siemens R, Black PC, Kassouf W. Benefit of Neoadjuvant Cisplatin-based Chemotherapy for Invasive Bladder Cancer Patients Treated with Radiation-based Therapy in a Real-world Setting: An Inverse Probability Treatment Weighted Analysis. Eur Urol Oncol 2024:S2588-9311(24)00040-3. [PMID: 38326142 DOI: 10.1016/j.euo.2024.01.014] [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: 06/25/2023] [Revised: 11/29/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) improves survival for patients with muscle-invasive bladder cancer (MIBC) treated with radical cystectomy. Studies on the potential benefit of NAC before radiation-based therapy (RT) are conflicting. OBJECTIVE To evaluate the effect of NAC on patients with MIBC treated with curative-intent RT in a real-world setting. DESIGN, SETTING, AND PARTICIPANTS The study cohort consisted of 785 patients with MIBC (cT2-4aN0-2M0) who underwent RT at academic centers across Canada. Patients were classified into two treatment groups based on the administration of NAC before RT (NAC vs no NAC). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The inverse probability of treatment weighting (IPTW) with absolute standardized differences (ASDs) was used to balance covariates across treatment groups. The impact of NAC on complete response, overall, and cancer-specific survival (CSS) after RT in the weighted cohort was analyzed. RESULTS AND LIMITATIONS After applying the exclusion criteria, 586 patients were included; 102 (17%) received NAC before RT. Patients in the NAC subgroup were younger (mean age 65 vs 77 yr; ASD 1.20); more likely to have Eastern Cooperative Oncology Group performance status 0-1 (87% vs 78%; ASD 0.28), lymphovascular invasion (32% vs 20%; ASD 0.27), higher cT stage (cT3-4 in 29% vs 20%; ASD 0.21), and higher cN stage (cN1-2 in 32% vs 4%; ASD 0.81); and more commonly treated with concurrent chemotherapy (79% vs 67%; ASD 0.28). After IPTW, NAC versus no NAC cohorts were well balanced (ASD <0.20) for all included covariates. NAC was significantly associated with improved CSS (hazard ratio [HR] 0.28; 95% confidence interval [CI] 0.14-0.56; p < 0.001) and overall survival (HR 0.56; 95% CI 0.38-0.84; p = 0.005). This study was limited by potential occult imbalances across treatment groups. CONCLUSIONS If tolerated, NAC might be associated with improved survival and should be considered for eligible patients with MIBC planning to undergo bladder preservation with RT. Prospective trials are warranted. PATIENT SUMMARY In this study, we showed that neoadjuvant chemotherapy might be associated with improved survival in patients with muscle-invasive bladder cancer who elect for curative-intent radiation-based therapy.
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Affiliation(s)
- Ronald Kool
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada; Department of Abdominal Surgery, Division of Urologic Oncology, Erasto Gaertner-Cancer Center, Curitiba, Brazil
| | - Alice Dragomir
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Girish S Kulkarni
- Department of Surgery (Urology), Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gautier Marcq
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada; Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France; CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, University of Lille, Lille, France
| | - Rodney H Breau
- Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kim
- Department of Surgery (Urology), Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ionut Busca
- Department of Radiation Oncology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Hamidreza Abdi
- Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Mark Dawidek
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Michael Uy
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Gagan Fervaha
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Fabio L Cury
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada; Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Nimira Alimohamed
- Division of Medical Oncology, University of Calgary, Calgary, AB, Canada
| | - Jonathan Izawa
- Division of Urology, Western University, London, ON, Canada
| | - Claudio Jeldres
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Bobby Shayegan
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Robert Siemens
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada.
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Yılmaz H, Teke K, Süer E, İzol V, Akgül HM, Selvi İ. Does neo-adjuvant chemotherapy improve the negative effect of lymphovascular invasion in survival after radical cystectomy? Urol Oncol 2024; 42:30.e1-30.e7. [PMID: 37867054 DOI: 10.1016/j.urolonc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/29/2023] [Accepted: 09/16/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE There is a lack of studies in the literature to evaluate the impact of the specific benefit of the use of neo-adjuvant chemotherapy (NAC) on the negative effect of lymphovascular invasion (LVI) on prognosis. We aimed to evaluate the survival differences of patients according to the presence of LVI with and without administration of NAC before radical cystectomy (RC). MATERIALS AND METHODS We retrospectively evaluated data of the patients who underwent RC with pelvic lymphadenectomy and urinary diversion for bladder cancer recorded in the bladder cancer database of the Turkish Uro-oncology Association between 2007 and 2021. Patient demographics, follow-up time and overall survival (OS) were noted. RESULTS A total of 633 subjects included in the analyses. Median follow-up time was 24 months (IQR 12-54). Five years OS of the whole cohort was 55.1%. This was 54.7% and 59.9% in NAC- and NAC+ groups (P = 0.683), respectively. It was also 35.7% and 65.7% in LVI+ and LVI- patients (P < 0.0001), respectively. There was a significant difference between LVI+ and LVI- patients (33.2% vs. 68.2%, P < 0.0001) in NAC- group, but similar 5-year OS was found (53.2% vs. 64.5%, P = 0.552) in NAC+ group. In multivariable analyses, female gender, pN stages, presence of variant histology and LVI were significant independent predictive factors for OS in the whole cohort and in the NAC- group. However, gender association, pN stages and LVI lost significance in NAC+ group. CONCLUSION Presence of LVI significantly reduced OS, and the NAC treatment improved the negative effects of LVI on OS. Our findings encourage the use of NAC before RC.
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Affiliation(s)
- Hasan Yılmaz
- Deparment of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey.
| | - Kerem Teke
- Deparment of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Evren Süer
- Deparment of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Volkan İzol
- Deparment of Urology, Çukurova University School of Medicine, Adana, Turkey
| | - Hacı Murat Akgül
- Deparment of Urology, Tekirdağ Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - İsmail Selvi
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
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Serrano M, Muñoz-Unceta N, Alonso LA, Azueta A, Gutiérrez Baños JL, Ferreira L, Domínguez M, Torres Zurita A, Ballestero R, Cacho D, López-Brea M, Sotelo M, Campos-Juanatey F, Ramos Barseló E, Duran I. Neoadjuvant chemotherapy with dose-dense MVAC in muscle-invasive bladder cancer: a tertiary center experience. Clin Transl Oncol 2024; 26:549-553. [PMID: 37566343 DOI: 10.1007/s12094-023-03277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/04/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy in muscle-invasive bladder cancer (MIBC) patients has proven beneficial in overall survival. However, the optimal regimen is still a matter of debate. MATERIALS AND METHODS In this retrospective analysis, we evaluate the results obtained in 42 patients treated in our center with 4 cycles of neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) followed by radical cystectomy from August 2015 to October 2020. All patients had cT2 or higher non-metastatic MIBC. Clinical and pathological outcomes are reported. RESULTS Of the 42 patients, 90.5% were men (n = 38) and the mean age was 65 years. All of them had ECOG 0-1 at diagnosis and most tumors had an initial clinical stage T2N0 (76%). Thirty-six patients (85.7%) completed 4 cycles of neoadjuvant treatment, and 21.4% required a dose reduction. The most frequent adverse event (AE) was grade 1-2 asthenia (81%), while neutropenia was the most frequent grade 3 or higher AE (38%). Complete pathological response (ypT0, ypN0) was achieved in 50% of patients (n = 21), and down-staging was observed in 57.1% (n = 24). Only one patient presented radiological progressive disease during neoadjuvant treatment (2.4%), and after a mean follow-up time of 31.5 months, 33.3% of patients experienced disease recurrence. CONCLUSIONS Neoadjuvant chemotherapy with 4 cycles of dd-MVAC is an effective regimen with high rates of pathological complete responses and down-staging along with an acceptable toxicity profile. DD-MVAC should be considered as an alternative to cisplatin and gemcitabine in patients with good clinical performance status.
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Affiliation(s)
- Marina Serrano
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Nerea Muñoz-Unceta
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Lucía Andrea Alonso
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Ainara Azueta
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Laura Ferreira
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mario Domínguez
- Urology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Albero Torres Zurita
- Medical Oncology Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Roberto Ballestero
- Urology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Diego Cacho
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Marta López-Brea
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Marta Sotelo
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | | | - Ignacio Duran
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
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Kim SW, Yu H, Kim Y, Nam KH, Chae HK, Nam W, Eom DW, Park JY, Kim SJ. HER2 overexpression predicts pathological T2 stage and improved survival in de novo muscle-invasive bladder cancer after immediate radical cystectomy: a retrospective cohort study. Int J Surg 2024; 110:847-858. [PMID: 37916931 PMCID: PMC10871625 DOI: 10.1097/js9.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Human epidermal growth factor receptor type 2 (HER2) overexpression is a prognostic factor and a therapeutic target for breast cancer; however, anti-HER2 therapies are ineffective in patients with bladder cancer. The authors investigated the effect of HER2 overexpression (HER2 + ) on the prognosis of muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS This retrospective cohort study included patients who underwent initial transurethral resection of bladder tumors between 2005 and 2013 and were registered in the Korea National Health Insurance Database, which provides data on overall survival (OS). Sixty-one patients with clinically nonmetastatic de novo MIBC were included in this study. As a subgroup, 33 patients who underwent immediate radical cystectomy (RC) were analyzed. Univariate and multivariate Cox proportional hazards models were used to identify prognostic factors for survival. A multivariable binary logistic regression model was used to identify the favorable T stage. RESULTS Among the 61 patients with d-MIBC, 14 were HER2 + and 47 HER2 - . Age less than 70 years [hazard ratio (HR): 0.312, CI: 0.16-0.59, P <0.001] and HER2 + status (HR: 0.40, CI: 0.19-0.85, P =0.02) were favorable prognostic factors for OS after adjusting for clinical variables. In the RC subgroup, HER2 + status was a significant predictive factor for the pT2 stage (HR): 36.8, CI: 4.83-797.41, P <0.01). Age less than 70 years (HR: 0.15, CI: 0.05-0.42, P <0.001) and HER2 + status (HR: 0.11, CI: 0.02-0.54, P =0.01) were favorable prognostic factors for OS after adjusting for RC pathological variables. CONCLUSIONS HER2 + status could be a marker for an indolent subset of MIBC and could predict favorable survival regardless of RC status. Moreover, HER2 + status not only consistently predicted a favorable T stage after RC, but also predicted better survival than pathological outcomes.
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Affiliation(s)
- So Won Kim
- Department of Pharmacology
- Bio-Medical Institute of Technology, University of Ulsan, Seoul
| | - Hoon Yu
- Bio-Medical Institute of Technology, University of Ulsan, Seoul
- Department of Nephrology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Younjuong Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine
| | - Kyeng Hyun Nam
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine
| | | | | | | | | | - Sung Jin Kim
- Bio-Medical Institute of Technology, University of Ulsan, Seoul
- Department of Urology
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Cherukula A, Agrawal S, Jajoo SN, Saxena G. Radical Resection for Locally Advanced Colon Cancer With Bladder Involvement Treated in a Tertiary Health Care Centre. Cureus 2024; 16:e54333. [PMID: 38500924 PMCID: PMC10945465 DOI: 10.7759/cureus.54333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Colorectal cancer with involvement of the urinary bladder is infrequent in the nonmetastatic setting. Procedures for advanced colorectal cancers with bladder involvement may include partial or complete bladder resections. Proper therapeutic management principles dictate radical surgery when negative margins can be obtained. High-resolution CT imaging along with endoscopic evaluation of the urinary bladder is frequently required to assess the extent of urinary bladder dissection. Here, we present a case of adenocarcinoma of the sigmoid colon with urinary bladder involvement and its treatment.
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Affiliation(s)
- Anilreddy Cherukula
- Department of General Surgery, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Suraj Agrawal
- Department of Surgery, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Wardha, IND
| | - Suhas N Jajoo
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Garima Saxena
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Chen Y, Liao Y, Yang Y, Zheng X. Letter to the editor: Long-term survival after female pelvic organ-sparing radical cystectomy versus standard radical cystectomy: a multi-institutional propensity score-matched analysis. Int J Surg 2024; 110:1289-1290. [PMID: 38000058 PMCID: PMC10871626 DOI: 10.1097/js9.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Yingjie Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital
| | - Yanling Liao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital
| | - Yuwei Yang
- Department of Anesthesiology and Perioperative Medicine, Fuzhou General Hospital of Nanjing Military Command Area: 900th Hospital of PLA
| | - Xiaochun Zheng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital
- Fujian Emergency Medical Center, Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of "Belt and Road", Fuzhou, People's Republic of China
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40
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Viergever BJ, Raats DAE, Geurts V, Mullenders J, Jonges TN, van der Heijden MS, van Es JH, Kranenburg O, Meijer RP. Urine-derived bladder cancer organoids (urinoids) as a tool for cancer longitudinal response monitoring and therapy adaptation. Br J Cancer 2024; 130:369-379. [PMID: 38102228 PMCID: PMC10844626 DOI: 10.1038/s41416-023-02494-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Bladder cancer is one of the most common cancer types worldwide. Generally, research relies on invasive sampling strategies. METHODS Here, we generate bladder cancer organoids directly from urine (urinoids). In this project, we establish 12 urinoid lines from 22 patients with non-muscle and muscle-invasive bladder tumours, with an efficiency of 55%. RESULTS The histopathological features of the urinoids accurately resemble those of the original bladder tumours. Genetically, there is a high concordance of single nucleotide polymorphisms (92.56%) and insertions & deletions (91.54%) between urinoids and original tumours from patient 4. Furthermore, these urinoids show sensitivity to bladder cancer drugs, similar to their tissue-derived organoid counterparts. Genetic analysis of longitudinally generated tumoroids and urinoids from one patient receiving systemic immunotherapy, identify alterations that may guide the choice for second-line therapy. Successful treatment adaptation was subsequently demonstrated in the urinoid setting. CONCLUSION Therefore, urinoids can advance precision medicine in bladder cancer as a non-invasive platform for tumour pathogenesis, longitudinal drug-response monitoring, and therapy adaptation.
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Affiliation(s)
- Bastiaan J Viergever
- Laboratory Translational Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands
- Department of Oncological Urology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands
| | - Daniëlle A E Raats
- Laboratory Translational Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands
- Utrecht Platform for Organoid Technology, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Veerle Geurts
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT, Utrecht, The Netherlands
| | - Jasper Mullenders
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT, Utrecht, The Netherlands
| | - Trudy N Jonges
- Department of Pathology, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
| | | | - Johan H van Es
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT, Utrecht, The Netherlands
| | - Onno Kranenburg
- Laboratory Translational Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands
- Utrecht Platform for Organoid Technology, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Richard P Meijer
- Laboratory Translational Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands.
- Department of Oncological Urology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands.
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41
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Kustrimovic N, Bilato G, Mortara L, Baci D. The Urinary Microbiome in Health and Disease: Relevance for Bladder Cancer. Int J Mol Sci 2024; 25:1732. [PMID: 38339010 PMCID: PMC10855347 DOI: 10.3390/ijms25031732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Bladder cancer (BC) constitutes one of the most diagnosed types of cancer worldwide. Advancements in and new methodologies for DNA sequencing, leading to high-throughput microbiota testing, have pinpointed discrepancies in urinary microbial fingerprints between healthy individuals and patients with BC. Although several studies suggest an involvement of microbiota dysbiosis in the pathogenesis, progression, and therapeutic response to bladder cancer, an established direct causal relationship remains to be elucidated due to the lack of standardized methodologies associated with such studies. This review compiles an overview of the microbiota of the human urinary tract in healthy and diseased individuals and discusses the evidence to date on microbiome involvement and potential mechanisms by which the microbiota may contribute to the development of BC. We also explore the potential profiling of urinary microbiota as a biomarker for risk stratification, as well as the prediction of the response to intravesical therapies and immunotherapy in BC patients. Further investigation into the urinary microbiome of BC patients is imperative to unravel the complexities of the role played by host-microbe interactions in shaping wellness or disease and yield valuable insights into and strategies for the prevention and personalized treatment of BC.
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Affiliation(s)
- Natasa Kustrimovic
- Center for Translational Research on Autoimmune and Allergic Disease—CAAD, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Giorgia Bilato
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
| | - Lorenzo Mortara
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
| | - Denisa Baci
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
- Molecular Cardiology Laboratory, IRCCS—Policlinico San Donato, 20097 Milan, Italy
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Alfred Witjes J, Max Bruins H, Carrión A, Cathomas R, Compérat E, Efstathiou JA, Fietkau R, Gakis G, Lorch A, Martini A, Mertens LS, Meijer RP, Milowsky MI, Neuzillet Y, Panebianco V, Redlef J, Rink M, Rouanne M, Thalmann GN, Sæbjørnsen S, Veskimäe E, van der Heijden AG. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol 2024; 85:17-31. [PMID: 37858453 DOI: 10.1016/j.eururo.2023.08.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023]
Abstract
CONTEXT We present an overview of the updated 2023 European Association of Urology (EAU) guidelines for muscle-invasive and metastatic bladder cancer (MMIBC). OBJECTIVE To provide practical evidence-based recommendations and consensus statements on the clinical management of MMIBC with a focus on diagnosis and treatment. EVIDENCE ACQUISITION A broad and comprehensive scoping exercise covering all areas of the MMIBC guidelines has been performed annually since 2017. Searches cover the Medline, EMBASE, and Cochrane Libraries databases for yearly guideline updates. A level of evidence and strength of recommendation are assigned. The evidence cutoff date for the 2023 MIBC guidelines was May 4, 2022. EVIDENCE SYNTHESIS Patients should be counselled regarding risk factors for bladder cancer. Pathologists should describe tumour and lymph nodes in detail, including the presence of histological subtypes. The importance of the presence or absence of urothelial carcinoma (UC) in the prostatic urethra is emphasised. Magnetic resonance imaging (MRI) of the bladder is superior to computed tomography (CT) for disease staging, specifically in differentiating T1 from T2 disease, and may lead to a change in treatment approach in patients at high risk of an invasive tumour. Imaging of the upper urinary tract, lymph nodes, and distant metastasis is performed with CT or MRI; the additional value of flurodeoxyglucose positron emission tomography/CT still needs to be determined. Frail and comorbid patients should be evaluated by a multidisciplinary team. Postoperative histology remains the most important prognostic variable, while circulating tumour DNA appears to be an interesting predictive marker. Neoadjuvant systemic therapy remains cisplatin-based. In motivated and selected women and men, sexual organ-preserving cystectomy results in better functional outcomes without compromising oncological outcomes. Robotic and open cystectomy have comparable outcomes and should be combined with (extended) lymph node dissection. The diversion type is an individual choice after taking patient and tumour characteristics into account. Radical cystectomy remains a highly complex procedure with considerable morbidity and risk of mortality, although lower rates are observed for higher hospital volumes (>20 cases/yr). With proper patient selection, trimodal therapy (chemoradiation) has comparable outcomes to radical cystectomy. Adjuvant chemotherapy after surgery improves disease-specific survival and overall survival (OS) in patients with high-risk disease who did not receive neoadjuvant treatment, and is strongly recommended. There is a weak recommendation for adjuvant nivolumab, as OS data are not yet available. Health-related quality of life should be assessed using validated questionnaires at baseline and after treatment. Surveillance is needed to monitor for recurrent cancer and functional outcomes. Recurrences detected on follow-up seem to have better prognosis than symptomatic recurrences. CONCLUSIONS This summary of the 2023 EAU guidelines provides updated information on the diagnosis and treatment of MMIBC for incorporation into clinical practice. PATIENT SUMMARY The European Association of Urology guidelines panel on muscle-invasive and metastatic bladder cancer has released an updated version of the guideline containing information on diagnosis and treatment of this disease. Recommendations are based on studies published up to May 4, 2022. Surgical removal of the bladder and bladder preservation are discussed, as well as updates on the use of chemotherapy and immunotherapy in localised and metastatic disease.
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Affiliation(s)
- J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Harman Max Bruins
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
| | - Albert Carrión
- Department of Urology, Vall Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Richard Cathomas
- Department of Medical Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Eva Compérat
- Department of Pathology, Medical University Vienna General Hospital, Vienna, Austria
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Rainer Fietkau
- Department of Radiation Therapy, University of Erlangen, Erlangen, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University of Würzburg, Würzburg, Germany
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Alberto Martini
- Department of Urology, Institut Universitaire du Cancer-Toulouse-Oncopole, Toulouse, France; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew I Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - John Redlef
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Michael Rink
- Department of Urology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Mathieu Rouanne
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - George N Thalmann
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Sæbjørn Sæbjørnsen
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Erik Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
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Deb AA, Chitteti P, Naushad N, Asaad W, Leung S, Hartley A, Serag H. Role of Neoadjuvant Chemotherapy on Pathological, Functional, and Survival Outcomes of Upper Tract Urothelial Carcinoma Patients: A Systematic Review and Meta-Analysis. UROLOGY RESEARCH & PRACTICE 2024; 50:13-24. [PMID: 38451126 PMCID: PMC11059980 DOI: 10.5152/tud.2024.23214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024]
Abstract
The role of neoadjuvant chemotherapy (NAC) in upper tract urothelial cancer (UTUC) is not yet confirmed. Therefore, we conducted this review to pool the available evidence in this regard. We analyzed 14117 UTUC patients reported in 21 studies after searching 5 databases. The NAC was administered in 1983 patients and the remaining 12134 controls underwent radical nephroureterectomy (RNU) alone. Efficacy endpoints included pathological, functional, and survival outcomes. Safety was determined by overall and grade 3-4 complications. For dichotomous outcomes, the log odds ratio (logOR) was pooled, and for continuous variables, the crude mean difference was calculated along with its 95% CI. The NAC was associated with 10% complete pathological response (CPR), 42% pathological downstaging, 31% post-NAC advanced disease (pT3-4), 6% positive surgical margin, 18% lymph node metastasis (pN+), 24% lymphovascular invasion, and 29% mortality and recurrence at 5 years. Compared to controls, NAC resulted in increased risk of CPR [logOR=1.67; 95% CI, 0.11-3.23] and downstaging [logOR=1.30; 95% CI, 0.41-2.18] and reduced risk of advanced disease [logOR=-0.81; 95% CI, -1.51--0.11]. Renal function did not improve from baseline; however, it increased significantly after RNU. The NAC was associated with good survival/low mortality in the short term, with a sustained increase over time. Overall and grade 3-4 complications occurred in 25% and 7% of patients, respectively. Our findings support the potential benefits of NAC in enhancing pathological outcomes and possibly improving survival in UTUC patients undergoing RNU. The variability in response and associated complications underscore the importance of careful patient selection and tailored treatment approaches.
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Affiliation(s)
- Abdalla Ali Deb
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Pragnitha Chitteti
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Naufal Naushad
- Department of Urology, North Tees University Hospital, Stockton, UK
| | - Wael Asaad
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Steve Leung
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Alice Hartley
- Department of Urology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Hosam Serag
- Department of Urology, University Hospitals Birmingham, Birmingham, UK
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Conci N, Tassinari E, Tateo V, Rosellini M, Marchetti A, Ricci C, Chessa F, Santoni M, Grande E, Mollica V, Massari F. How Do Molecular Classifications Affect the Neoadjuvant Treatment of Muscle-Invasive Urothelial Carcinoma? Mol Diagn Ther 2024; 28:37-51. [PMID: 37874465 DOI: 10.1007/s40291-023-00679-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/25/2023]
Abstract
Despite the significant improvements in the field of oncological treatments in recent decades, and the advent of targeted therapies and immunotherapy, urothelial carcinoma of the bladder remains a highly heterogeneous and difficult-to-treat neoplasm with a poor prognosis. In this context, owing to the new methods of genomic sequencing, numerous studies have analyzed the genetic features of muscle-invasive bladder cancer, providing a consensus set of molecular classes, to identify malignancies that may respond better to specific treatments (standard chemotherapy, immunotherapy, target therapy, local-regional treatment, or combinations) and improve the survival. The aim of the current review is to provide an overview of the current status of the molecular landscape of muscle-invasive bladder cancer, focusing our attention on therapeutic and prognostic implications in order to select the most effective and tailored therapeutic regimen for the individual patient.
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Affiliation(s)
- Nicole Conci
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elisa Tassinari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Valentina Tateo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Matteo Rosellini
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Andrea Marchetti
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Costantino Ricci
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
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Kuan FC, Li JM, Huang YC, Chang SF, Shi CS. Therapeutic Potential of Regorafenib in Cisplatin-Resistant Bladder Cancer with High Epithelial-Mesenchymal Transition and Stemness Properties. Int J Mol Sci 2023; 24:17610. [PMID: 38139437 PMCID: PMC10743903 DOI: 10.3390/ijms242417610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Bladder cancer is becoming one of the most common malignancies across the world. Although treatment strategy has been continuously improved, which has led to cisplatin-based chemotherapy becoming the standard medication, cancer recurrence and metastasis still occur in a high proportion of patients because of drug resistance. The high efficacy of regorafenib, a broad-spectrum kinase inhibitor, has been evidenced in treating a variety of advanced cancers. Hence, this study investigated whether regorafenib could also effectively antagonize the survival of cisplatin-resistant bladder cancer and elucidate the underlying mechanism. Two types of cisplatin-resistant bladder cancer cells, T24R1 and T24R2, were isolated from T24 cisplatin-sensitive bladder cancer cells. These cells were characterized, and T24R1- and T24R2-xenografted tumor mice were created to examine the therapeutic efficacy of regorafenib. T24R1 and T24R2 cells exhibited higher expression levels of epithelial-mesenchymal transition (EMT) and stemness markers compared to the T24 cells, and regorafenib could simultaneously inhibit the viability and the expression of EMT/stemness markers of both T24R1 and T24R2 cells. Moreover, regorafenib could efficiently arrest the cell cycle, promote apoptosis, and block the transmigration/migration capabilities of both types of cells. Finally, regorafenib could significantly antagonize the growth of T24R1- and T24R2-xenografted tumors in mice. These results demonstrated the therapeutic efficacy of regorafenib in cisplatin-resistant bladder cancers. This study, thus, provides more insights into the mechanism of action of regorafenib and demonstrates its great potential in the future treatment of cisplatin-resistant advanced bladder cancer patients.
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Affiliation(s)
- Feng-Che Kuan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi 61363, Taiwan
| | - Jhy-Ming Li
- Department of Animal Science, National Chiayi University, Chiayi 60004, Taiwan;
| | - Yun-Ching Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi 61363, Taiwan;
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shun-Fu Chang
- Department of Medical Research and Development, Chang Gung Memorial Hospital Chiayi Branch, Chiayi 61363, Taiwan
- Center for General Education, Chiayi Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Chung-Sheng Shi
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi 61363, Taiwan
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Vieira de Sousa T, Guedes de Pinho P, Pinto J. Metabolomic Signatures of Treatment Response in Bladder Cancer. Int J Mol Sci 2023; 24:17543. [PMID: 38139377 PMCID: PMC10743932 DOI: 10.3390/ijms242417543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Bladder cancer (BC) stands as one of the most prevalent urological malignancies, with over 500 thousand newly diagnosed cases annually. Treatment decisions in BC depend on factors like the risk of recurrence, the type of tumor, and the stage of the disease. While standard therapeutic approaches encompass transurethral resection of the bladder tumor, radical cystectomy, and chemo- or immunotherapy, these methods exhibit limited efficacy in mitigating the aggressive and recurrent nature of bladder tumors. To overcome this challenge, it is crucial to develop innovative methods for monitoring and predicting treatment responses among patients with BC. Metabolomics is gaining recognition as a promising approach for discovering biomarkers. It has the potential to reveal metabolic disruptions that precisely reflect how BC patients respond to particular treatments, providing a revolutionary method to improve accuracy in monitoring and predicting outcomes. In this article, we present a comprehensive review of studies employing metabolomics approaches to investigate the metabolic responses associated with different treatment modalities for BC. The review encompasses an exploration of various models, samples, and analytical techniques applied in this context. Special emphasis is placed on the reported changes in metabolite levels derived from these studies, highlighting their potential as biomarkers for personalized medicine in BC.
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Affiliation(s)
- Tiago Vieira de Sousa
- Associate Laboratory i4HB–Institute for Health and Bioeconomy, University of Porto, 4050-313 Porto, Portugal;
- UCIBIO–Applied Molecular Biosciences Unit, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Paula Guedes de Pinho
- Associate Laboratory i4HB–Institute for Health and Bioeconomy, University of Porto, 4050-313 Porto, Portugal;
- UCIBIO–Applied Molecular Biosciences Unit, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Joana Pinto
- Associate Laboratory i4HB–Institute for Health and Bioeconomy, University of Porto, 4050-313 Porto, Portugal;
- UCIBIO–Applied Molecular Biosciences Unit, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
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Peng M, Chu X, Peng Y, Li D, Zhang Z, Wang W, Zhou X, Xiao D, Yang X. Targeted therapies in bladder cancer: signaling pathways, applications, and challenges. MedComm (Beijing) 2023; 4:e455. [PMID: 38107059 PMCID: PMC10724512 DOI: 10.1002/mco2.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023] Open
Abstract
Bladder cancer (BC) is one of the most prevalent malignancies in men. Understanding molecular characteristics via studying signaling pathways has made tremendous breakthroughs in BC therapies. Thus, targeted therapies including immune checkpoint inhibitors (ICIs), antibody-drug conjugates (ADCs), and tyrosine kinase inhibitor (TKI) have markedly improved advanced BC outcomes over the last few years. However, the considerable patients still progress after a period of treatment with current therapeutic regimens. Therefore, it is crucial to guide future drug development to improve BC survival, based on the molecular characteristics of BC and clinical outcomes of existing drugs. In this perspective, we summarize the applications and benefits of these targeted drugs and highlight our understanding of mechanisms of low response rates and immune escape of ICIs, ADCs toxicity, and TKI resistance. We also discuss potential solutions to these problems. In addition, we underscore the future drug development of targeting metabolic reprogramming and cancer stem cells (CSCs) with a deep understanding of their signaling pathways features. We expect that finding biomarkers, developing novo drugs and designing clinical trials with precisely selected patients and rationalized drugs will dramatically improve the quality of life and survival of patients with advanced BC.
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Affiliation(s)
- Mei Peng
- Department of PharmacyXiangya HospitalCentral South UniversityChangshaHunanChina
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Xuetong Chu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Yan Peng
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Duo Li
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Zhirong Zhang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Weifan Wang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Xiaochen Zhou
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Di Xiao
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Xiaoping Yang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
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Calleris G, Rouprêt M, Seisen T, Bendjeddou L, Chevallier T, Masson-Lecomte A, Thibault C, Neuzillet Y, Audenet F, Xylinas E, Houédé N. Design and rationale of a single-arm phase II study of neoadjuvant Durvalumab and Gemcitabine associated with Cisplatin or Carboplatin for upper urinary tract urothelial cancer: the iNDUCT trial (NCT04617756). World J Urol 2023; 41:3413-3420. [PMID: 37698632 DOI: 10.1007/s00345-023-04596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Upper urinary tract urothelial carcinoma (UTUC) is often locally advanced at initial diagnosis and is associated with high recurrence and mortality rates after radical nephroureterectomy (RNU). Adjuvant platinum-based chemotherapy has shown a recurrence-free survival benefit in a randomised phase III trial, while neoadjuvant treatment seems promising in retrospective series. On the contrary, little is known about the role of perioperative immunotherapy and its combination with chemotherapy for UTUC patients, although initial positive results have been published for muscle-invasive bladder cancer. STUDY DESIGN AND ENDPOINTS Against this backdrop, we are running a multi-centre single-arm phase 2 trial of neoadjuvant Durvalumab, a monoclonal antibody targeting programmed cell death ligand 1, combined with Gemcitabine and Cisplatin or Carboplatin for high-risk UTUC patients. The primary outcome is pathological complete response rate at RNU. Secondary endpoints include the partial pathological response rate, safety, as well as disease-free and overall survival. A biomarker analysis is also planned. PATIENTS AND INTERVENTIONS Included patients must have a good performance status and harbour a non-metastatic UTUC, considered at high risk of progression, defined as either biopsy-proven high-grade disease or invasive features at imaging with or, more recently, without high-grade cytology at the multidisciplinary team discretion, as specified in the latest amendment. Enrolled patients receive 3 cycles of neoadjuvant immuno-chemotherapy before RNU, and the standard of care thereafter. The trial is registered as NCT04617756 and is supervised by an independent data monitoring committee.
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Affiliation(s)
- Giorgio Calleris
- GRC 5 Predictive Onco-Urology Research Group and Urology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, 75013, Paris, France
- Department of Surgical Sciences, Urology, University of Turin, Turin, Italy
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Urology Research Group and Urology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, 75013, Paris, France.
| | - Thomas Seisen
- GRC 5 Predictive Onco-Urology Research Group and Urology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, 75013, Paris, France
| | - Lyamin Bendjeddou
- Research and Innovation Department, Nimes University Hospital, 30029, Nimes, France
| | - Thierry Chevallier
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), Nimes University Hospital, 30029, Nimes, France
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, INSERM, Univ. Montpellier, Montpellier, France
| | - Alexandra Masson-Lecomte
- Department of Urology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, 75010, Paris, France
| | - Constance Thibault
- Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris, Hopital Européen Georges Pompidou, Paris, France
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - François Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Evanguelos Xylinas
- Service d'Urologie, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nadine Houédé
- Gard Cancer Institute, Nimes University Hospital, University of Montpellier, 30029, Nimes, France
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Gao Z, Qi N, Qin X, Li Z, Li G, Wang Z, Wang J, Wen R, Li H. The addition of tislelizumab to gemcitabine and cisplatin chemotherapy increases thrombocytopenia in patients with urothelial carcinoma: A single-center study based on propensity score matching. Cancer Med 2023; 12:22071-22080. [PMID: 38093592 PMCID: PMC10757149 DOI: 10.1002/cam4.6807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 12/31/2023] Open
Abstract
PURPOSE Whether the addition of tislelizumab to gemcitabine and cisplatin (GC) chemotherapy increases the incidence of myelosuppression has not been well established. This study identified the risk factors for the development of myelosuppression in patients with urothelial carcinoma (UC) after receiving GC chemotherapy with or without tislelizumab. MATERIALS AND METHODS We enrolled 192 UC patients who received GC with or without tislelizumab at the Affiliated Hospital of Xuzhou Medical University between July 2014 and November 2022. Patient baseline characteristics were included in the statistical analyses after adjusting for previously reported risk factors affecting survival using propensity score matching (1:1). Binary logistic regression analysis was used to identify the risk factors associated with posttreatment myelosuppression. RESULTS A total of 192 patients were enrolled, of whom 96 were treated with tislelizumab plus gemcitabine and cisplatin (T + GC) and 96 with GC alone. The incidence of leukopenia, anemia, and thrombocytopenia of any grade was 50.0%, 70.8%, and 42.7%, respectively, in the T + GC group and 41.7%, 72.9%, and 20.8%, respectively, in the GC group. In multivariate analysis, patients aged over 70 years (OR = 2.486, 95% CI: 1.067-5.792, p = 0.035) and those who received T + GC (OR = 3.119, 95% CI: 1.576-6.173, p = 0.001) were more likely to develop thrombocytopenia. Patients aged over 70 years (OR = 3.213, 95% CI: 1.254-8.237, p = 0.015) were more likely to develop anemia, and patients with renal insufficiency (OR = 2.105, 95% CI: 1.035-4.280, p = 0.040) were more likely to develop leukopenia. Eventually, 99 (51.6%) patients with UC successfully completed all the treatment cycles. CONCLUSIONS This study demonstrates that the addition of tislelizumab to GC chemotherapy led to a considerable increase in the occurrence of thrombocytopenia, whereas no significant changes were observed regarding anemia or leukopenia. It is crucial to fully inform patients at increased risk for myelosuppression of potential risks and closely monitor changes in their blood routines.
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Affiliation(s)
- Zhimin Gao
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Nienie Qi
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Xu Qin
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Zhen Li
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Gang Li
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Zewei Wang
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Junqi Wang
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Rumin Wen
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Hailong Li
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
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50
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Wang Y, Song Y, Qin C, Zhang C, Du Y, Xu T. Three versus four cycles of neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and meta-analysis. Ann Med 2023; 55:2281654. [PMID: 37963224 PMCID: PMC10871138 DOI: 10.1080/07853890.2023.2281654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE The optimal cycle of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) remains controversial. This study aimed to compare the efficacy of three and four cycles of NAC in the treatment of MIBC through a systematic review and meta-analysis of the literature. MATERIALS AND METHODS Relevant studies were systematically collected and reviewed in PubMed, Medline, Embase, Web of Science Databases, and the Cochrane Library. Relative ratios (RRs), Hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to estimate outcome measures. Studies comparing the pathological response and prognosis of three versus four cycles of NAC for MIBC were included. RESULTS Five studies were included in this meta-analysis, including 2190 patients, of whom 1016 underwent three cycles of NAC and 1174 underwent four cycles of NAC. All studies were retrospective cohort studies. We found that 4 cycles of NAC had significantly better cancer-specific survival than 3 cycles (HR = 1.31, 95%CI,1.03-1.67, p = 0.029). There was no significant difference in overall survival between patients who received 3 and 4 cycles of chemotherapy (HR = 1.18, 95%CI = 0.83-1.69, p = 0.345). Similarly, no significant difference was observed in pathological objective response (RR = 0.95, 95%CI= 0.81-1.11, p = 0.515) and complete response rates (RR = 0.87, 95%CI = 0.69-1.11, p = 0.256) in MIBC after 3 or 4 cycles of NAC. CONCLUSIONS Three and four cycles of NAC had similar pathological responses and prognosis for MIBC, although the cancer-specific survival rate of four cycles was better than that of three cycles.
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Affiliation(s)
- Yulong Wang
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Yuxuan Song
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Caipeng Qin
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Chunlong Zhang
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Yiqing Du
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People’s Hospital, Beijing, China
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