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Liu MA, Li JW, Runcie K. Management of Oligometastatic and Locally Recurrent Urothelial Carcinoma. Curr Oncol Rep 2024; 26:496-503. [PMID: 38602581 DOI: 10.1007/s11912-024-01523-8] [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] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE OF REVIEW To summarize and evaluate the literature on treatment approaches for oligometastatic and locally recurrent urothelial cancer. RECENT FINDINGS There is no clear definition for oligometastatic urothelial cancers due to limited data. Studies focusing on oligometastatic and locally recurrent urothelial cancer have been primarily retrospective. Treatment options include local therapy with surgery or radiation, and generalized systemic therapy such as chemotherapy or immunotherapy. Oligometastatic and locally recurrent urothelial cancers remain challenging to manage, and treatment requires an interdisciplinary approach. Systemic therapy is nearly always a component of current care in the form of chemotherapy, but the role of immunotherapy has not been explored. Consideration of surgical and radiation options may improve outcomes, and no studies have compared directly between the two localized treatment options. The development of new prognostic and predictive biomarkers may also enhance the treatment landscape in the future.
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Affiliation(s)
- Michael A Liu
- Division of Hematology and Oncology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Jennifer W Li
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Karie Runcie
- Division of Hematology and Oncology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
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2
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Calleris G, von Deimling M, Kesch C, Soria F, Gontero P, Ploussard G, Laukhtina E, Pradere B. Definitions, outcomes and perspectives for oligometastatic bladder cancer: towards a standardized terminology. Curr Opin Urol 2024; 34:217-224. [PMID: 38426242 DOI: 10.1097/mou.0000000000001170] [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: 03/02/2024]
Abstract
PURPOSE OF REVIEW Oligometastatic (om) cancer is considered as a transitional state in between locally confined disease and widespread metastases, accessible to a multimodal treatment, combining systemic and local therapy. In urothelial bladder cancer (BCa), the definitions and the approaches to this condition are poorly standardised and mainly based on retrospective data. We aim to portray the framework for uro-oncologic terminology in omBCa and go through the latest evidence and the future perspectives. RECENT FINDINGS Retrospective and registry data support the potential benefits of multimodality treatment for carefully selected omBCa patients, especially following a good response to systemic treatment. In 2023, a Delphi consensus has defined omBCa, allowing maximum three metastatic lesions, theoretically amenable to radical local treatment. In de-novo omBCa, surgical treatment of primary tumour might improve overall survival (OS), according to a matched registry analysis; also, consolidative radiotherapy was associated with better OS in two recent cohorts. Furthermore, metastasis-directed therapy (MDT) has shown high local control rates and promising OS (14.9-51 months) in a meta-analysis; benefits might be more pronounced for single-site omBCa and nodal or lung lesions. SUMMARY From a clinical perspective, in de-novo omBCa, the local treatment of primary and metastatic sites might improve disease control and survival, in selected patients; in the oligorecurrent setting, MDT achieves good local symptom control with limited side effects; in selected cases, it could convey a survival benefit, too. From a research perspective, well designed prospective evidence is eagerly awaited, based on recently adopted shared definitions for omBCa.
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Affiliation(s)
- Giorgio Calleris
- Department of Urology UROSUD, La Croix du Sud Hospital, Quint-Fonsegrives, France
- Polytechnic and University of Turin, Turin, Italy
| | - Markus von Deimling
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Claudia Kesch
- Department of Urology UROSUD, La Croix du Sud Hospital, Quint-Fonsegrives, France
- Department of Urology and West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Guillaume Ploussard
- Department of Urology UROSUD, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Benjamin Pradere
- Department of Urology UROSUD, La Croix du Sud Hospital, Quint-Fonsegrives, France
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3
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Sargos P, Le Guevelou J, Khalifa J, Albiges L, Azria D, de Crevoisier R, Supiot S, Créhange G, Roubaud G, Chapet O, Pasquier D, Blanchard P, Latorzeff I. The role of radiation therapy for de novo metastatic bladder and renal cancers. Cancer Radiother 2024; 28:56-65. [PMID: 37286452 DOI: 10.1016/j.canrad.2023.02.004] [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: 01/09/2023] [Accepted: 02/21/2023] [Indexed: 06/09/2023]
Abstract
Metastatic bladder and renal cancers account respectively for 2.1% and 1.8% of cancer deaths worldwide. The advent of immune checkpoint inhibitors has revolutionized the management of metastatic disease, by demonstrating considerable improvements in overall survival. However, despite initial sensitivity to immune checkpoint inhibitors for most patients, both bladder and renal cancer are associated with short progression-free survival and overall survival, raising the need for further strategies to improve their efficacy. Combining systemic therapies with local approaches is a longstanding concept in urological oncology, in clinical settings including both oligometastatic and polymetastatic disease. Radiation therapy has been increasingly studied with either cytoreductive, consolidative, ablative or immune boosting purposes, but the long-term impact of this strategy remains unclear. This review intends to address the impact of radiation therapy with either curative or palliative intent, for synchronous de novo metastatic bladder and renal cancers.
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Affiliation(s)
- P Sargos
- Department of Radiation Oncology, institut Bergonié, Bordeaux, France.
| | - J Le Guevelou
- Faculty of Medicine, Geneva, Switzerland; Department of Radiation Oncology, centre Eugène-Marquis, Rennes, France
| | - J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud, Institut universitaire du cancer de Toulouse - Oncopole, Toulouse, France
| | - L Albiges
- Department of Cancer Medicine, institut Gustave-Roussy, Villejuif, France
| | - D Azria
- Department of Radiation Oncology, Institut du cancer de Montpellier (ICM), IRCM U1194 Inserm, université de Montpellier, Montpellier, France
| | - R de Crevoisier
- Department of Radiation Oncology, centre Eugène-Marquis, Rennes, France
| | - S Supiot
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, Saint-Herblain, France; CRCINA CNRS, Nantes, France; Inserm, Nantes, France; Université de Nantes et d'Angers, Nantes, France
| | - G Créhange
- Department of Radiation Oncology, institut Curie, Saint-Cloud, France
| | - G Roubaud
- Department of Medical Oncology, institut Bergonié, Bordeaux, France
| | - O Chapet
- Department of Oncology Department, centre hospitalier Lyon Sud, Pierre-Bénite, France
| | - D Pasquier
- Department of Radiation Oncology, centre Oscar-Lambret, Lille, France; Cristal UMR 9189, université de Lille, Lille, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy Cancer Campus, université Paris-Saclay, Oncostat U1018 Inserm, Villejuif, France
| | - I Latorzeff
- Department of Radiation Oncology, clinique Pasteur, Toulouse, France
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4
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Ashley S, Choudhury A, Hoskin P, Song Y, Maitre P. Radiotherapy in metastatic bladder cancer. World J Urol 2024; 42:47. [PMID: 38244091 PMCID: PMC10799782 DOI: 10.1007/s00345-023-04744-x] [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: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE To review available and emerging evidence of radiotherapy for symptom management and disease control in metastatic bladder cancer. METHODS A literature search and subsequent cross-referencing were carried out for articles in the PubMed and Scopus databases using terms 'radiotherapy' OR 'palliative radiation therapy' with 'metastatic bladder cancer' OR 'advanced bladder cancer' between 1990 and 2023, excluding articles with no English translation. RESULTS Palliative radiotherapy is an effective and accessible treatment for the alleviation of haematuria and pain due to the primary and metastatic disease. With growing recognition of oligometastatic disease state at diagnosis, response, or progression, radiotherapy can consolidate response by ablating residual or resistant lesions. Experience with other primary cancers supports positive impact of radiotherapy on disease control, quality of life, and survival in oligometastatic stage, without significant adverse effects. Alongside immune checkpoint inhibitors, fibroblast growth receptor inhibitors, and antibody-drug conjugates, the immunomodulatory potential of radiotherapy is being explored in combination with these systemic therapies for metastatic bladder cancer. CONCLUSION Radiotherapy is an effective, safe, and accessible treatment modality for palliation as well as disease control in various clinical settings of metastatic bladder cancer. Its role in oligometastatic stage in combination with systemic therapy is expected to expand with emerging evidence.
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Affiliation(s)
- Sophie Ashley
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Peter Hoskin
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - YeePei Song
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Priyamvada Maitre
- The Christie NHS Foundation Trust, Manchester, United Kingdom.
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Ernest Borges Road, Parel, Mumbai, India.
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5
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Nadal R, Valderrama BP, Bellmunt J. Progress in systemic therapy for advanced-stage urothelial carcinoma. Nat Rev Clin Oncol 2024; 21:8-27. [PMID: 37945764 DOI: 10.1038/s41571-023-00826-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
Despite recent advances, advanced-stage urothelial carcinoma (aUC) remains incurable, with 5-year survival rates of approximately 10%. Platinum-based chemotherapy has a major role as first-line therapy for most patients with aUC. The approval of the anti-PD-L1 antibody avelumab as maintenance therapy for patients without initial disease progression on platinum-based chemotherapy is an important development that has improved the survival outcomes of patients with this disease. Otherwise, the use of first-line immune-checkpoint inhibitors (ICIs) targeting PD-1 or PD-L1 has been restricted to patients who are ineligible for platinum-containing chemotherapy regimens. Other important developments include the FDA-accelerated approval of first-line enfortumab vedotin plus pembrolizumab for patients ineligible to receive cisplatin and the availability of FGFR inhibitors, enfortumab vedotin and sacituzumab govitecan for subsequent lines of therapy. Several research questions remain unaddressed including the lack of adequate biomarkers, how to assign priority to the different treatment options for individual patients and which agents can be effective as monotherapies. The future is promising with the emergence of modalities such as antibody-drug conjugate-like drugs, next-generation ICIs, bispecific antibodies and cellular therapies. In this Review, we summarize the evolution of systemic therapy for patients with aUC and provide insights into the unmet needs.
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Affiliation(s)
- Rosa Nadal
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Begoña P Valderrama
- Hospital Virgen del Rocio, University Hospital Virgen del Rocío, Seville, Spain
| | - Joaquim Bellmunt
- Dana-Farber Cancer Institute/Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA.
- Hospital del Mar Research Inst Lab (IMIM), Barcelona, Spain.
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Santini D, Banna GL, Buti S, Isella L, Stellato M, Roberto M, Iacovelli R. Navigating the Rapidly Evolving Advanced Urothelial Carcinoma Treatment Landscape: Insights from Italian Experts. Curr Oncol Rep 2023; 25:1345-1362. [PMID: 37855848 PMCID: PMC10640402 DOI: 10.1007/s11912-023-01461-x] [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] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE OF REVIEW To discuss recent advances in the treatment of advanced urothelial carcinoma (UC) and how best to incorporate new therapies into clinical practice. RECENT FINDINGS There have been several recent practice-changing phase 2 and 3 trials of immune checkpoint inhibitors (ICIs), antibody-drug conjugates (ADCs), and targeted agents in advanced UC. Based on data from these trials, ICIs can be used as first-line maintenance therapy in patients who do not progress on platinum-based chemotherapy, second-line therapy for those with progression, and first-line therapy in cisplatin-ineligible patients with PD-L1 expression; ADCs and targeted agents provide later-line treatment options. Despite substantial progress in the treatment of advanced UC, there are still many uncertainties, including the optimal treatment sequence for novel agents, and reliable predictive biomarkers to aid in treatment selection. There is also an unmet need for effective treatment options in patients unfit for any platinum-based chemotherapy.
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Affiliation(s)
- Daniele Santini
- Medical Oncology A, University of Rome, Policlinico Umberto I, "La Sapienza, Rome, Italy
| | - Giuseppe Luigi Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, PO6 3LY, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, PO1 2UP, UK
| | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy.
- Oncology Unit, University Hospital of Parma, Viale A. Gramsci 14, 43126, Parma, Italy.
| | - Luca Isella
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Marco Stellato
- Medical Oncology Department, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Michela Roberto
- UOC Oncology A, Department of Radiological, Oncological and Anatomo-Pathological Science, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Roberto Iacovelli
- UOC Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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7
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Bamias A, Stenzl A, Brown SL, Albiges L, Babjuk M, Birtle A, Briganti A, Burger M, Choudhury A, Colecchia M, De Santis M, Fanti S, Fonteyne V, Gallucci M, Rivas JG, Huddart R, Junker K, Kroeze S, Loriot Y, Merseburger A, Montironi R, Necchi A, Oing C, Oldenburg J, Ost P, Pinkawa M, Ribal MJ, Rouprêt M, Thoeny H, Zilli T, Hoskin P. Definition and Diagnosis of Oligometastatic Bladder Cancer: A Delphi Consensus Study Endorsed by the European Association of Urology, European Society for Radiotherapy and Oncology, and European Society of Medical Oncology Genitourinary Faculty. Eur Urol 2023; 84:381-389. [PMID: 37217391 DOI: 10.1016/j.eururo.2023.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/15/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND In contrast to other cancers, the concept of oligometastatic disease (OMD) has not been investigated in bladder cancer (BC). OBJECTIVE To develop an acceptable definition, classification, and staging recommendations for oligometastatic BC (OMBC) spanning the issues of patient selection and the roles of systemic therapy and ablative local therapy. DESIGN, SETTING, AND PARTICIPANTS A European consensus group of 29 experts, led by the European Association of Urology (EAU), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Medical Oncology (ESMO), and including members from all other relevant European societies, was established. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A modified Delphi method was used. A systematic review was used to build consensus questions. Consensus statements were extracted from two consecutive surveys. The statements were formulated during two consensus meetings. Agreement levels were measured to determine if consensus was achieved (≥75% agreement). RESULTS AND LIMITATIONS The first survey included 14 questions and the second survey had 12. Owing to a considerable lack of evidence, which was the major limitation, definition was limited in the context of de novo OMBC, which was further classified as synchronous OMD, oligorecurrence, and oligoprogression. A maximum of three metastatic sites, all resectable or amenable to stereotactic therapy, was proposed as the definition of OMBC. Pelvic lymph nodes represented the only "organ" not included in the definition of OMBC. For staging, no consensus on the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography was reached. A favourable response to systemic treatment was proposed as the criterion for selection of patients for metastasis-directed therapy. CONCLUSIONS A consensus statement on the definition and staging of OMBC has been formulated. This statement will help to standardise inclusion criteria in future trials, potentiate research on aspects of OMBC for which consensus was not achieved, and hopefully will lead to the development of guidelines on optimal management of OMBC. PATIENT SUMMARY As an intermediate state between localised cancer and disease with extensive metastasis, oligometastatic bladder cancer (OMBC) might benefit from a combination of systemic treatment and local therapy. We report the first consensus statements on OMBC drawn up by an international expert group. These statements can provide a basis for standardisation of future research, which will lead to high-quality evidence in the field.
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Affiliation(s)
- Aristotelis Bamias
- National & Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Greece.
| | - Arnulf Stenzl
- University of Tübingen Medical Center, Tübingen, Germany
| | | | | | - Marko Babjuk
- 2nd Faculty of Medicine, Hospital Motol, Charles University, Praha, Czechia
| | - Alison Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alberto Briganti
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Maurizio Colecchia
- Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Maria De Santis
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Stefano Fanti
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Juan Gómez Rivas
- Department of Urology. Hospital Clinico San Carlos. Madrid, Spain
| | | | - Kerstin Junker
- Klinik für Urologie und Kinderurologie, Abteilung für Klinisch-Experimentelle Forschung, Homburg, Germany
| | | | | | - Axel Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Rodolfo Montironi
- Molecular Medicine and Cell Therapy Foundation, Polytechnic University of the Marche Region, Ancona, Italy
| | - Andrea Necchi
- Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Christoph Oing
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Piet Ost
- Department of Radiation Oncology, Iridium Network, Wilrijk, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Maria J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Morgan Rouprêt
- Sorbonne University GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Paris, France
| | - Harriet Thoeny
- Department of Radiology, HFR Fribourg-Hôpital Cantonal, University of Fribourg, Villars-sur-Glâne, Switzerland
| | - Thomas Zilli
- Clinica di Radio-Oncologia, Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Labaki C, Saad E, Choueiri TK, Bellmunt J. Oligometastatic Bladder Cancer: Defining a Novel Entity. Eur Urol 2023; 84:390-392. [PMID: 37414704 DOI: 10.1016/j.eururo.2023.06.003] [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: 05/23/2023] [Accepted: 06/10/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Eddy Saad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joaquim Bellmunt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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9
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Bamias A, Stenzl A, Zagouri F, Andrikopoulou A, Hoskin P. Defining Oligometastatic Bladder Cancer: A Systematic Review. EUR UROL SUPPL 2023; 55:28-37. [PMID: 37662704 PMCID: PMC10468799 DOI: 10.1016/j.euros.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Context Unlike other cancers, the concept of oligometastatic disease (OMD) in bladder cancer (BC) has not been systematically investigated. There is therefore a need to develop universally accepted definitions and guidelines for the management of oligometastatic BC (OMBC). Objective To conduct a systematic review to assist a European consensus group in producing a definition of OMBC and to provide recommendations on staging and local therapies. Evidence acquisition The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Abstracts for articles focused on BC that addressed the issue of OMBC and provided a definition of oligometastatic status were selected. We collected data on the number of metastases, the number of metastases per organ, the number of organs involved, and metastatic sites that were excluded. Evidence synthesis Sixteen eligible articles were retrieved (9 retrospective series involving 330 patients, 4 reviews, 1 consensus statement, 1 guideline paper, and 1 ongoing prospective phase 2 trial). A maximum of three to five metastatic lesions were compatible with the definition of OMBC. The number of organs involved and lesion size were not universally included in the OMBC definitions. OMD categories studied included synchronous OMBC, oligorecurrence, and oligoprogression. 18F-Fluorodeoxyglucose positron emission tomography combined with computed tomography was used in addition to conventional imaging for OMD detection. Surgery and radiotherapy were both used. Systemic chemotherapy was also used in all studies. Conclusions There is little information on OMBC in the literature. Our systematic review revealed that only three to five metastatic sites amenable to surgery or radiotherapy that respond to systemic therapy is the setting most frequently chosen for a combination of systemic treatment and metastases-directed therapy. This setting could represent a basis for future prospective studies on OMBC. Patient summary Oligometastatic bladder cancer is a disease state in which favorable outcomes can be expected after a treatment combination of systemic therapy, plus surgery and/or radiotherapy for sites of bladder cancer metastasis. Our systematic review showed a lack of meaningful evidence to define this disease state. There is an urgent need to develop organized research in this field.
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Affiliation(s)
- Aristotelis Bamias
- Second Propaedeutic Department of Internal Medicine, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
- Hellenic GU Cancer Group, Athens, Greece
| | - Arnulf Stenzl
- Department of Urology, University Medical Centre, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Flora Zagouri
- Hellenic GU Cancer Group, Athens, Greece
- Department of Clinical Therapeutics, National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Angeliki Andrikopoulou
- Department of Clinical Therapeutics, National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Peter Hoskin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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10
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Aboudaram A, Chaltiel L, Pouessel D, Graff-Cailleaud P, Benziane-Ouaritini N, Sargos P, Schick U, Créhange G, Cohen-Jonathan Moyal E, Chevreau C, Khalifa J. Consolidative Radiotherapy for Metastatic Urothelial Bladder Cancer Patients with No Progression and with No More than Five Residual Metastatic Lesions Following First-Line Systemic Therapy: A Retrospective Analysis. Cancers (Basel) 2023; 15:cancers15041161. [PMID: 36831503 PMCID: PMC9954747 DOI: 10.3390/cancers15041161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Local consolidative radiotherapy in the treatment of metastatic malignancies has shown promising results in several types of tumors. The objective of this study was to assess consolidative radiotherapy to the bladder and to residual metastases in metastatic urothelial bladder cancer with no progression following first-line systemic therapy. MATERIALS/METHODS Patients who received first-line therapy for the treatment of metastatic urothelial bladder cancer (mUBC) and who were progression-free following treatment with no more than five residual metastases were retrospectively identified through the database of four Comprehensive Cancer Centers, between January 2005 and December 2018. Among them, patients who received subsequent definitive radiotherapy (of EQD2Gy > 45Gy) to the bladder and residual metastases were included in the consolidative group (irradiated (IR) group), and the other patients were included in the observation group (NIR group). Progression-free survival (PFS) and overall survival (OS) were determined from the start of the first-line chemotherapy using the Kaplan-Meier method. To prevent immortal time bias, a Cox model with time-dependent covariates and 6-month landmark analyses were performed to examine OS and PFS. RESULTS A total of 91 patients with at least stable disease following first-line therapy and with no more than five residual metastases were analyzed: 51 in the IR group and 40 in the NIR group. Metachronous metastatic disease was more frequent in the NIR group (19% vs. 5%, p = 0.02); the median number of metastases in the IR group vs. in the NIR group was 2 (1-9) vs. 3 (1-5) (p = 0.04) at metastatic presentation, and 1 (0-5) vs. 2 (0-5) (p = 0.18) after completion of chemotherapy (residual lesions), respectively. Two grade 3 toxicities (3.9%) and no grade 4 toxicity were reported in the IR group related to radiotherapy. With a median follow up of 85.9 months (95% IC (36.7; 101.6)), median OS and PFS were 21.7 months (95% IC (17.1; 29.7)) and 11.1 months (95% IC (9.9; 14.1)) for the whole cohort, respectively. In multivariable analysis, consolidative radiotherapy conferred a benefit in both PFS (HR = 0.49, p = 0.007) and OS (HR = 0.47, p = 0.015) in the whole population; in the landmark analysis at 6 months, radiotherapy was associated with improved OS (HR = 0.48, p = 0.026), with a trend for PFS (HR = 0.57, p = 0.082). CONCLUSION Consolidative radiotherapy for mUBC patients who have not progressed after first-line therapy and with limited residual disease seems to confer both OS and PFS benefits. The role of consolidative radiotherapy in the context of avelumab maintenance should be addressed prospectively.
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Affiliation(s)
- Amélie Aboudaram
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31000 Toulouse, France
| | - Léonor Chaltiel
- Department of Biostatistics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31059 Toulouse, France
| | - Damien Pouessel
- Department of Medical Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31059 Toulouse, France
| | | | | | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, 33000 Bordeaux, France
| | - Ulrike Schick
- Department of Radiation Oncology, CHU Brest, 29200 Brest, France
| | - Gilles Créhange
- Department of Radiation Oncology, Institut Curie, 75248 Paris, France
| | - Elizabeth Cohen-Jonathan Moyal
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31000 Toulouse, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31059 Toulouse, France
| | - Jonathan Khalifa
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31000 Toulouse, France
- Correspondence: ; Tel.: +33-5-31-15-54-01
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11
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Miyazaki S, Ueda T, Tamai R, Ueno A, Nakamura T. Metastatic small-cell carcinoma of the bladder that maintains a complete response to chemoradiation therapy. IJU Case Rep 2022; 6:81-84. [PMID: 36605689 PMCID: PMC9807349 DOI: 10.1002/iju5.12547] [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: 09/10/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction Small-cell carcinoma of the urinary bladder has a poor prognosis, and no standard treatment has been established. We encountered a case of a patient with metastasis in which complete response and long-term survival were obtained by treating the primary lesion with a combination of irinotecan, carboplatin chemotherapy, and radiation therapy. Case presentation An 83-year-old man was diagnosed with a bladder tumor with liver metastasis. Small-cell carcinoma was diagnosed via transurethral resection. Second-line chemotherapy with irinotecan and carboplatin and irradiation of the primary lesion were significantly effective. The imaging evaluation showed a complete response. The therapeutic effect was maintained for 1 year, even after the discontinuation of chemotherapy. Conclusion Irinotecan and carboplatin should be considered for the treatment of small-cell carcinoma of the bladder. Irradiation of the primary lesion may also be useful if the extent of metastasis is low.
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Affiliation(s)
- Shinya Miyazaki
- Department of UrologySaiseikai Suita HospitalSuitaOsakaJapan
| | - Takashi Ueda
- Department of UrologyKyoto Prefectural University of MedicineKyoto CityJapan
| | - Ryosuke Tamai
- Department of UrologySaiseikai Suita HospitalSuitaOsakaJapan
| | - Akihisa Ueno
- Department of UrologySaiseikai Suita HospitalSuitaOsakaJapan
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12
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Longo N, Celentano G, Napolitano L, La Rocca R, Capece M, Califano G, Collà Ruvolo C, Mangiapia F, Fusco F, Morra S, Turco C, Di Bello F, Fusco GM, Cirillo L, Cacciapuoti C, Spirito L, Calogero A, Sica A, Sagnelli C, Creta M. Metastasis-Directed Radiation Therapy with Consolidative Intent for Oligometastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14102373. [PMID: 35625979 PMCID: PMC9139743 DOI: 10.3390/cancers14102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Patients with oligometastatic urothelial carcinoma represent a challenging subset of subjects to manage. Herein we summarized evidence about the role of metastasis-directed radiation therapy in this clinical setting. Available preliminary evidence supports the role of metastasis-directed radiation therapy as a safe and efficacious option as it has the potential to facilitate local disease control and overall survival. However, in the absence of data from high-quality trials, definitive recommendations cannot be provided, and patients should be counseled on an individual basis. Abstract The management of patients with oligometastatic urothelial carcinoma (UC) represents an evolving field in uro-oncology, and the role of metastasis-directed therapies, including metastasectomy and metastasis-directed radiation therapy (MDRT), is gaining increasing attention. Herein, we summarize available evidence about the role of MDRT with consolidative intent in oligometastatic UC patients. A systematic review was performed in December 2021. Six studies involving 158 patients were identified. Most patients (n = 120, 90.2%) had a history of bladder cancer and the most frequent sites of metastases were lymph nodes (n= 61, 52.1%) followed by the lungs (n = 34, 29%). Overall, 144 metastases were treated with MDRT. Median follow-up ranged from 17.2 to 25 months. Local control rates ranged from 57% to 100%. Median Overall Survival (OS) ranged from 14.9 to 51.0 months and median progression-free survival ranged from 2.9 to 10.1 months. Rates of OS at one and two years ranged from 78.9% to 96% and from 26% to 63%, respectively. Treatment-related toxicity was recorded in few patients and in most cases a low-grade toxicity was evident. MDRT with consolidative intent represents a potential treatment option for selected patients with oligometastatic UC.
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Affiliation(s)
- Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Giuseppe Celentano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
- Correspondence: ; Tel.: +39-0817462611
| | - Roberto La Rocca
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Marco Capece
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Gianluigi Califano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Francesco Mangiapia
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Ferdinando Fusco
- Department of Woman, Child and General, Specialized Surgery, Urology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.F.); (L.S.)
| | - Simone Morra
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Carmine Turco
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Francesco Di Bello
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Giovanni Maria Fusco
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Luigi Cirillo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Crescenzo Cacciapuoti
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Lorenzo Spirito
- Department of Woman, Child and General, Specialized Surgery, Urology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.F.); (L.S.)
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Va Pansini, 5, 80131 Naples, Italy;
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie n. 1, 80138 Naples, Italy;
| | - Massimiliano Creta
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
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13
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Management of Patients with Metastatic Bladder Cancer in the Real-World Setting from the Multidisciplinary Team: Current Opinion of the SOGUG Multidisciplinary Working Group. Cancers (Basel) 2022; 14:cancers14051130. [PMID: 35267437 PMCID: PMC8909046 DOI: 10.3390/cancers14051130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary This report presents clinically relevant advances in the management of metastatic bladder cancer, which have been the focus of discussion of expert members of the Spanish Oncology Genitourinary (SOGUG) Multidisciplinary Working Group in the framework of the Genitourinary Alliance project (12GU) designed as a space for the integration of novel information in the care of bladder cancer patients. The present study is focused on different aspects regarding integration of immunotherapy especially in the patient unfit for platinum-based chemotherapy, PD-L1 assays and samples to be evaluated, role of imaging techniques in preoperative staging or re-staging, definition and treatment approach of oligometastatic disease, and rescue strategies in responders. Involvement of a dedicated multidisciplinary team in the care of patients with mBC is crucial to improve outcome. Abstract Based on the discussion of current state of research of relevant topics of metastatic bladder cancer (mBC) among a group of experts of a Spanish Oncology Genitourinary (SOGUG) Working Group, a set of recommendations were proposed to overcome the challenges posed by the management of mBC in clinical practice. First-line options in unfit patients for cisplatin are chemotherapy with carboplatin and immunotherapy in PD-L1 positive patients. FDG-PET/CT may be a useful imaging technique in the initial staging or re-staging. In patients with oligometastatic disease, it is important to consider not only the number of metastatic lesions, but also the tumor biology and the clinical course. The combination of stereotactic body radiotherapy and immunotherapy with anti-PD-L1 monoclonal antibodies is under investigation and could improve the results of systemic treatment in patient with oligometastatic disease. Rescue treatment with curative intent could be considered in patients with oligometastatic disease after complete response on FDG-PET/CT. Metastatic disease should be evaluated using the same imaging modality over the course of the disease from diagnosis until rescue treatment. For improving the outcome of patients with mBC, the involvement of a dedicated multidisciplinary team, including urologists, pathologists, oncologists, radiologists and other specialists is of outmost importance in the daily care of these patients.
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14
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Shigeta K, Matsumoto K, Oya M. Reply to Fredrik Liedberg, Johan Abrahamsson, and Johannes Bobjer's Letter to the Editor re: Keisuke Shigeta, Kazuhiro Matsumoto, Koichiro Ogihara, et al. Does Neoadjuvant Chemotherapy have Therapeutic Benefit for Node-positive Upper Tract Urothelial Carcinoma? Results of a Multi-center Cohort Study. Urol Oncol. In press. https://doi.org/10.1016/j.urolonc.2021.07.029: A Plea for Uniform Terminology for Patients with Urothelial Carcinoma Treated with Chemotherapy Before Consolidative Surgery with Curative Intent: Induction Versus Neoadjuvant Chemotherapy: Need for Debate on the Optimized Treatment Strategy for Node-positive Upper Tract Urothelial Carcinoma. Eur Urol 2021; 81:e20-e21. [PMID: 34716047 DOI: 10.1016/j.eururo.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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15
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Stecca C, Abdeljalil O, Sridhar SS. Metastatic Urothelial Cancer: a rapidly changing treatment landscape. Ther Adv Med Oncol 2021; 13:17588359211047352. [PMID: 34616491 PMCID: PMC8488509 DOI: 10.1177/17588359211047352] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/01/2021] [Indexed: 12/20/2022] Open
Abstract
Despite significant progress, metastatic urothelial cancer remains an incurable condition with a limited life expectancy. Platinum-based chemotherapy is still the mainstay of treatment for metastatic disease, but immunotherapy, antibody drug conjugates, and targeted agents have shown encouraging results in several recent practice changing trials. In this review, we discuss the standard of care, recent therapeutic advances, ongoing clinical trials, and future perspectives in metastatic urothelial carcinoma.
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Affiliation(s)
- Carlos Stecca
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Osama Abdeljalil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Srikala S. Sridhar
- Professor, University of Toronto, Medical Oncologist, Princess Margaret Cancer Center, Chair, GU Medical Oncologists of Canada, 7-625 -700 University Avenue, Toronto, ON M5G 2M9, Canada
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16
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Miranda AF, Howard JM, McLaughlin M, Meng X, Clinton T, Şanli Ö, Garant A, Bagrodia A, Margulis V, Lotan Y, Hannan R, Desai N, Woldu SL. Metastasis-directed radiation therapy after radical cystectomy for bladder cancer. Urol Oncol 2021; 39:790.e1-790.e7. [PMID: 34215505 DOI: 10.1016/j.urolonc.2021.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Metastasis-directed radiation therapy (MDRT) may improve oncologic and quality of life outcomes in patients with metastatic cancer, but data on its use in metastatic bladder cancer is severely limited. We sought to review our institutional experience with MDRT in patients with metastatic bladder cancer following radical cystectomy. MATERIALS AND METHODS We reviewed records of patients who underwent radical cystectomy and subsequent MDRT at our institution between 2009 and 2020. Baseline demographic and clinical/pathologic factors were collected, as were details of treatment including systemic therapy and MDRT. Cases were categorized by treatment intent as consolidative (intended to prolong survival) and palliative (intended only to relieve symptoms). Response to treatment, survival, and toxicity outcomes were reviewed. RESULTS A total of 52 patients underwent MDRT following radical cystectomy. MDRT was categorized as consolidative in 40% of cases and palliative in 60%. Toxicity (CTCAE Grade ≥ 2) was reported in 15% of patients, none of which exceeded Grade 3. Most patients undergoing consolidative MDRT were treated with SBRT techniques (76%) and a majority (67%) received concurrent treatment with an immuno-oncology agent. Among patients treated with consolidative intent, 2-year progression-free and overall survival were 19% and 60%, respectively. CONCLUSION MDRT is safe and well-tolerated by a majority of patients. A majority of patients treated with consolidative intent survived ≥ 2 years from treatment.
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Affiliation(s)
- Andre F Miranda
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey M Howard
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mark McLaughlin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Timothy Clinton
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Öner Şanli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Fatih, Turkey
| | - Aurelie Garant
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Neil Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Berghen C, Joniau S, Vulsteke C, Albersen M, Devos G, Rans K, Haustermans K, De Meerleer G. Metastasis-directed therapy for oligometastatic urological tumours: still no second-hand news. Ecancermedicalscience 2020; 14:1036. [PMID: 32565889 PMCID: PMC7289610 DOI: 10.3332/ecancer.2020.1036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 12/31/2022] Open
Abstract
For patients presenting with limited metastatic disease burden, known as the oligometastatic state of disease, a more aggressive treatment approach targeting the new or progressive metastatic lesions might improve patient outcome, with no or only limited toxicity to be expected from the treatment. This review provides an overview of the existing evidence and on-going trials on oligometastatic disease and metastasis-directed therapy in the field of renal, bladder and prostate cancer.
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Affiliation(s)
- Charlien Berghen
- Department of Radiation Oncology, Leuven University Hospital, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, Leuven University Hospital, Leuven, Belgium
| | - Christof Vulsteke
- Department of Oncology, Ghent Maria Middelares Hospital, Ghent, Belgium.,Department of Molecular Imaging, Pathology, Radiotherapy and Oncology (MIPRO), Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - Maarten Albersen
- Department of Urology, Leuven University Hospital, Leuven, Belgium
| | - Gaëtan Devos
- Department of Urology, Leuven University Hospital, Leuven, Belgium
| | - Kato Rans
- Department of Radiation Oncology, Leuven University Hospital, Leuven, Belgium
| | - Karin Haustermans
- Department of Radiation Oncology, Leuven University Hospital, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, Leuven University Hospital, Leuven, Belgium
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18
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Zhou H, Lu T, Guo Q, Chen Y, Chen M, Chen Y, Lin Y, Chen C, Ma L, Xu Y, Lin S, Pan J. Effects of oral maintenance chemotherapy and predictive value of circulating EBV DNA in metastatic nasopharyngeal carcinoma. Cancer Med 2020; 9:2732-2741. [PMID: 32090498 PMCID: PMC7163084 DOI: 10.1002/cam4.2926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/07/2020] [Accepted: 02/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background/Objectives Oral maintenance chemotherapy can effectively prolong overall survival (OS) in many types of metastatic cancer, but its role in metastatic nasopharyngeal carcinoma (mNPC) is unclear. In this study, the efficacy of oral maintenance chemotherapy in mNPC and the effectiveness of circulating tumor EBV‐DNA for screening patients were evaluated. Methods Between June 2016 and December 2017, 141 patients with mNPC who received platinum‐based systemic chemotherapy were included (median follow‐up time, 21 months). Patients were classified into two groups according to the administration of oral maintenance chemotherapy. Plasma samples were collected before, during, and after treatment for the measurement of circulating EBV DNA. Results The 2‐year OS was higher for patients who received maintenance chemotherapy than for patients without maintenance chemotherapy (78.9% vs 62.7%, P = .016). Patients with undetectable posttreatment EBV‐DNA after 4‐6 cycles of systemic chemotherapy (n = 73) had a higher 2‐year OS than that of patients with detectable EBV‐DNA (n = 68) (82.16% vs 51.45%, P = .001). For patients with undetectable posttreatment EBV‐DNA, OS was better for those with maintenance chemotherapy than for those without (86.7% vs 73%, P = .027). For patients with detectable posttreatment EBV‐DNA, maintenance chemotherapy did not improve outcomes (49.5% vs 55.4%, P = .824). The most common acute events were hematological toxicity, and all were tolerable and curable. Conclusions Oral maintenance chemotherapy with S1 or capecitabine can improve OS in mNPC. Posttreatment EBV‐DNA was not only an independent prognosis factor for mNPC but also can screen out beneficiaries of maintenance chemotherapy.
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Affiliation(s)
- Han Zhou
- Department of Radiation Oncology, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Tianzhu Lu
- Department of Radiation Oncology, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China
| | - Qiaojuan Guo
- Department of Radiation Oncology, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China
| | - Yan Chen
- Laboratory of Biochemistry and Molecular Biology Research, Fujian Cancer Hospital, Fuzhou, China.,Department of Clinical Laboratory, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Mengwei Chen
- Department of Radiation Oncology, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yansong Chen
- Laboratory of Biochemistry and Molecular Biology Research, Fujian Cancer Hospital, Fuzhou, China.,Department of Clinical Laboratory, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yingying Lin
- Laboratory of Biochemistry and Molecular Biology Research, Fujian Cancer Hospital, Fuzhou, China.,Department of Clinical Laboratory, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Chuanben Chen
- Department of Radiation Oncology, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Liqin Ma
- Department of Radiation Oncology, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yun Xu
- Department of Radiation Oncology, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Shaojun Lin
- Department of Radiation Oncology, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital &, Fujian Medical University Cancer Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China
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19
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Leonetti A, D'Abbiero N, Baldari G, Andreani S, Ruffini L, Viansone AA, Buti S. Radiotherapy for the treatment of distant nodes metastases from oligometastatic urothelial cancer: A retrospective case series. Int J Urol 2018; 25:879-886. [DOI: 10.1111/iju.13773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/09/2018] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Giorgio Baldari
- Nuclear Medicine Unit; University Hospital of Parma; Parma Italy
| | | | - Livia Ruffini
- Nuclear Medicine Unit; University Hospital of Parma; Parma Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit; University Hospital of Parma; Parma Italy
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