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Armanetti P, Locatelli I, Venegoni C, Alchera E, Campanella B, Pederzoli F, Maturi M, Locatelli E, Tortorella S, Curnis F, Corti A, Lucianò R, Onor M, Salonia A, Montorsi F, Moschini M, Popov V, Jose J, Comes Franchini M, Ooi EH, Menichetti L, Alfano M. Gold nanorod-assisted theranostic solution for nonvisible residual disease in bladder cancer. Proc Natl Acad Sci U S A 2024; 121:e2411583121. [PMID: 39236242 DOI: 10.1073/pnas.2411583121] [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: 06/10/2024] [Accepted: 08/06/2024] [Indexed: 09/07/2024] Open
Abstract
Residual nonvisible bladder cancer after proper treatment caused by technological and therapeutic limitations is responsible for tumor relapse and progression. This study aimed to demonstrate the feasibility of a solution for simultaneous detection and treatment of bladder cancer lesions smaller than one millimeter. The α5β1 integrin was identified as a specific marker in 81% of human high-grade nonmuscle invasive bladder cancers and used as a target for the delivery of targeted gold nanorods (GNRs). In a preclinical model of orthotopic bladder cancer expressing the α5β1 integrin, the photoacoustic imaging of targeted GNRs visualized lesions smaller than one millimeter, and their irradiation with continuous laser was used to induce GNR-assisted hyperthermia. Necrosis of the tumor mass, improved survival, and computational modeling were applied to demonstrate the efficacy and safety of this solution. Our study highlights the potential of the GNR-assisted theranostic strategy as a complementary solution in clinical practice to reduce the risk of nonvisible residual bladder cancer after current treatment. Further validation through clinical studies will support the findings of the present study.
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Affiliation(s)
- Paolo Armanetti
- National Council of Research-Institute of Clinical Physiology, Pisa 56124, Italy
| | - Irene Locatelli
- Division of Experimental Oncology, Urological Research Institute (URI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan 20132, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
| | - Chiara Venegoni
- Division of Experimental Oncology, Urological Research Institute (URI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan 20132, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
| | - Elisa Alchera
- Division of Experimental Oncology, Urological Research Institute (URI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan 20132, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
| | - Beatrice Campanella
- National Research Council (CNR), Institute of Chemistry of Organometallic Compounds, Pisa 56124, Italy
| | - Filippo Pederzoli
- Division of Experimental Oncology, Urological Research Institute (URI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan 20132, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
- Università Vita-Salute San Raffaele, Milan 20132, Italy
| | - Mirko Maturi
- Department of Industrial Chemistry, Toso Montanari, University of Bologna, Bologna 40129, Italy
| | - Erica Locatelli
- Department of Industrial Chemistry, Toso Montanari, University of Bologna, Bologna 40129, Italy
| | - Silvia Tortorella
- Department of Industrial Chemistry, Toso Montanari, University of Bologna, Bologna 40129, Italy
| | - Flavio Curnis
- Division of Experimental Oncology, Tumor Biology and Vascular Targeting Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
| | - Angelo Corti
- Division of Experimental Oncology, Tumor Biology and Vascular Targeting Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
| | - Roberta Lucianò
- Department of Pathology, Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
| | - Massimo Onor
- National Research Council (CNR), Institute of Chemistry of Organometallic Compounds, Pisa 56124, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Urological Research Institute (URI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan 20132, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
- Università Vita-Salute San Raffaele, Milan 20132, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Urological Research Institute (URI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan 20132, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
- Università Vita-Salute San Raffaele, Milan 20132, Italy
| | - Marco Moschini
- Division of Experimental Oncology, Urological Research Institute (URI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan 20132, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
| | - Viktor Popov
- Ascend Technologies Ltd, Southampton SO15 2BG, Hampshire, United Kingdom
| | - Jithin Jose
- FUJIFILM Visualsonics Inc., Amsterdam AB 1114, The Netherlands
| | - Mauro Comes Franchini
- Department of Industrial Chemistry, Toso Montanari, University of Bologna, Bologna 40129, Italy
| | - Ean Hin Ooi
- Medical Engineering and Technology Hub, School of Engineering, Monash University Malaysia, Selangor 47500, Malaysia
| | - Luca Menichetti
- National Council of Research-Institute of Clinical Physiology, Pisa 56124, Italy
| | - Massimo Alfano
- Division of Experimental Oncology, Urological Research Institute (URI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan 20132, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan 20132, Italy
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Ben-David R, Galsky MD, Sfakianos JP. Novel bladder-sparing approaches in patients with muscle-invasive bladder cancer. Trends Mol Med 2024; 30:686-697. [PMID: 38692938 DOI: 10.1016/j.molmed.2024.04.004] [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: 01/17/2024] [Revised: 03/02/2024] [Accepted: 04/04/2024] [Indexed: 05/03/2024]
Abstract
The pursuit of surgeons and oncologists in fulfilling the inherent desire of patients to retain their urinary bladder despite having muscle-invasive bladder cancer (MIBC) has sparked years of research and multiple debates, given its aggressive nature and the high risk of fatal metastatic recurrence. Historically, several approaches to bladder-sparing treatment have been explored, ranging from radical transurethral resection to concurrent chemoradiation. A less well-established approach involves a risk-adapted approach with local therapy deferred based on the clinical response to transurethral resection followed by systemic therapy. Each approach is associated with potential risks, benefits, and trade-offs. In this review, we aim to understand, navigate, and suggest future perspectives on bladder-sparing approaches in patients with MIBC.
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Affiliation(s)
- Reuben Ben-David
- Department of Urology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA; Tisch Cancer Institute, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA.
| | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA; Tisch Cancer Institute, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
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3
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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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Wen F, Lin T, Zhang P, Zeng H, Wei Q, Shen Y. Bladder sparing by short-course radiotherapy combined with toripalimab in high-risk/extremely high-risk non-muscle invasive bladder cancer (HOPE-04): study protocol for a single-arm, prospective, phase II trial. BMJ Open 2024; 14:e076663. [PMID: 38262639 PMCID: PMC10806730 DOI: 10.1136/bmjopen-2023-076663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Radical cystectomy remains the standard treatment for intravesical Bacille Calmette-Guerin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) because potential bladder-preserving therapies are not well established. Combination of radiotherapy with programmed death-1 (PD-1) antibody may offer an optional bladder preservation treatment for high-risk/extremely high risk NMIBC. Hence, the current study aims to investigate the safety and efficacy of short-course radiotherapy (5×5 Gy) and toripalimab (PD-1 antibody) as a novel bladder sparing treatment in this population. METHODS AND ANALYSIS HOPE-04 is an open-label, single-arm, phase II study, designed to evaluate the safety and efficacy of short-course radiotherapy and toripalimab in patients with high-risk/extremely high risk NMIBC. Fifty-five patients with pathological and imaging diagnosed NMIBC with or without BCG treatment will be recruited. Radiotherapy of 5×5 Gy will be given to the whole bladder followed by a focal tumour bed boost and concomitant administration of toripalimab of 240 mg intravenous infusion every 21 days for 12 cycles (about 1 year). The primary endpoints are disease-free survival and safety. The secondary endpoint is overall survival. Additional indicators include implementation rate of salvage surgery and quality of life. ETHICS AND DISSEMINATION This trial has been approved by the Ethics Committee of West China Hospital, Sichuan University. Trial findings will be disseminated via peer reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Chinese Ethics Committee of Registering Clinical Trials (ChiCTR2200059970).
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Affiliation(s)
- Feng Wen
- Abdominal Oncology Ward, Division of Radiation Oncology, Cancer Center, West China Hospital Sichuan University, Chengdu, Sichuan, China
| | - Tianhai Lin
- Department of Urology, Institute of Urology, West China Hospital Sichuan University, Chengdu, China
| | - Peng Zhang
- Department of Urology, Institute of Urology, West China Hospital Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital Sichuan University, Chengdu, China
| | - Yali Shen
- Abdominal Oncology Ward, Division of Radiation Oncology, Cancer Center, West China Hospital Sichuan University, Chengdu, Sichuan, China
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Wu Z, Wang D, Zhang Y, Zhang Z, Shen C, Xin Z, Feng Y, Hu H. SPP1 mRNA determination based on molecular beacon for the recurrence prognosis of bladder cancer. Transl Androl Urol 2023; 12:1834-1844. [PMID: 38196702 PMCID: PMC10772645 DOI: 10.21037/tau-23-432] [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: 08/17/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024] Open
Abstract
Background Bladder cancer (BC) has attracted significant attention on account of its recurrence as well as mortality. Tumor recurrence plays a significant role in cancer patients' individual treatment. Secreted phosphoprotein 1 (SPP1) has been recognized as a potential target for treating BC and served as a useful biomarker for prognosis; it is commonly tested by immunohistochemistry (IHC). However, this conventional method has the disadvantage of being time-consuming and costly. This study aimed to develop a molecular beacon (MB) for the detection of SPP1 messenger RNA (mRNA) for the recurrence prognosis of BC. Methods An MB was constructed and applied to image SPP1 mRNA level at both molecular and cellular level. The fluorescence spectra were recorded with a fluorescence spectrophotometer. The effect of SPP1 MB toward the cell viability was performed by Cell Counting Kit-8 (CCK-8) assays. The SPP1 mRNA expression level was measured by quantitative real-time polymerase chain reaction (qRT-PCR). Cancer cells and tissues were analyzed with confocal fluorescence imaging. Correlation, sensitivity, and specificity parameters were calculated. Results It was demonstrated that both cancer cells and BC tissues expressed high signal which reflected the expression of SPP1. In addition, 42 cases were detected by MB and divided into two groups according to the fluorescence intensity. The results further suggested that highly expressed SPP1 could predict early tumor recurrence in BC. Conclusions The SPP1 MB could be applied as an appropriate approach to predict BC recurrence and patients' prognosis.
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Affiliation(s)
- Zhouliang Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Donghuai Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yu Zhang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhe Zhang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chong Shen
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhongcheng Xin
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuhong Feng
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hailong Hu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Akin O, Lema-Dopico A, Paudyal R, Konar AS, Chenevert TL, Malyarenko D, Hadjiiski L, Al-Ahmadie H, Goh AC, Bochner B, Rosenberg J, Schwartz LH, Shukla-Dave A. Multiparametric MRI in Era of Artificial Intelligence for Bladder Cancer Therapies. Cancers (Basel) 2023; 15:5468. [PMID: 38001728 PMCID: PMC10670574 DOI: 10.3390/cancers15225468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
This review focuses on the principles, applications, and performance of mpMRI for bladder imaging. Quantitative imaging biomarkers (QIBs) derived from mpMRI are increasingly used in oncological applications, including tumor staging, prognosis, and assessment of treatment response. To standardize mpMRI acquisition and interpretation, an expert panel developed the Vesical Imaging-Reporting and Data System (VI-RADS). Many studies confirm the standardization and high degree of inter-reader agreement to discriminate muscle invasiveness in bladder cancer, supporting VI-RADS implementation in routine clinical practice. The standard MRI sequences for VI-RADS scoring are anatomical imaging, including T2w images, and physiological imaging with diffusion-weighted MRI (DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI). Physiological QIBs derived from analysis of DW- and DCE-MRI data and radiomic image features extracted from mpMRI images play an important role in bladder cancer. The current development of AI tools for analyzing mpMRI data and their potential impact on bladder imaging are surveyed. AI architectures are often implemented based on convolutional neural networks (CNNs), focusing on narrow/specific tasks. The application of AI can substantially impact bladder imaging clinical workflows; for example, manual tumor segmentation, which demands high time commitment and has inter-reader variability, can be replaced by an autosegmentation tool. The use of mpMRI and AI is projected to drive the field toward the personalized management of bladder cancer patients.
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Affiliation(s)
- Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alfonso Lema-Dopico
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
| | - Ramesh Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
| | | | | | - Dariya Malyarenko
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lubomir Hadjiiski
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alvin C. Goh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Bernard Bochner
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jonathan Rosenberg
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Lawrence H. Schwartz
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
| | - Amita Shukla-Dave
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
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Xu C, Zou W, Wang Y, Liu X, Wang J. Bladder-sparing treatment for muscle-invasive bladder carcinoma using immune checkpoint inhibitors. Crit Rev Oncol Hematol 2023; 191:104137. [PMID: 37717879 DOI: 10.1016/j.critrevonc.2023.104137] [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: 02/22/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023] Open
Abstract
Multimodal bladder preservation therapy is already an alternative for patients with muscle-invasive bladder cancer (MIBC) who are unable or unwilling to undergo radical cystectomy. Various bladder-preserving strategies that employ immune checkpoint inhibitors (ICIs) for MIBC have been investigated. There are three common modes of ICI-based bladder preservation therapy, of which the most studied is ICIs combined with chemoradiotherapy. The bladder-preserving strategy of ICIs combined with radiation has been investigated in patients who poorly tolerate chemotherapy. ICIs combined with chemotherapy have also been explored in patients who responded to neoadjuvant therapy with a clinical complete response. All the above-described strategies have shown promising efficacy and manageable safety profiles. However, the value of programmed death-ligand 1 (PD-L1) expression, tumor mutation burden and gene alterations for predicting the efficacy of immune-based bladder preservation therapy is still controversial. There remain some challenges for immune-based bladder preservation therapy, and large-sample randomized trials are needed.
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Affiliation(s)
- Chao Xu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen Zou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jingjing Wang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China.
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Fu Z, Tian Z, Chen Y, Jia Z, Wang C, Zhang X, Zhang W, Li G, Wei X, Huang Y. Analysis of the efficacy of a single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy. Eur J Med Res 2023; 28:273. [PMID: 37550747 PMCID: PMC10405402 DOI: 10.1186/s40001-023-01250-z] [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: 11/10/2022] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Radical cystectomy and urinary diversion are the standard surgical treatments for patients with muscle-invasive or high-risk, or recurrent non-muscle-invasive bladder cancer. Although this approach significantly prolongs patient survival, it can lead to postoperative complications. This study aims to compare the efficacy and complications of bilateral cutaneous ureterostomy with a single subumbilical stoma to those of cutaneous ureterostomy with two stomas and an ileal conduit as a means of urinary diversion after radical cystectomy. The findings of this study will provide valuable information for healthcare providers in selecting the appropriate urinary diversion method for their patients. METHODS The clinical data for 108 patients who received bilateral cutaneous ureterostomy with a single subumbilical stoma (ureterostomy with a single stoma group), cutaneous ureterostomy with two stomas (ureterostomy with two stomas group), or an ileal conduit (ileal conduit group) after radical cystectomy were retrospectively analysed. The operative time, pathological stage, survival status, perioperative complication rate, rate of successful first extubation, rehospitalization rate at 6 months after surgery,ostomy-related medical costs,and postoperative quality of life were compared between the three groups of patients. RESULTS A significant difference in the operative time was found between the three groups (P = 0.001). No significant differences in pathological stage, survival status, perioperative complication rate, rehospitalization rate at 6 months after surgery, or bladder cancer index (BCI) score were identified among the three groups. The difference in the successful first extubation rate between the three groups of patients was significant (P = 0.001). Significant differences in ostomy-related medical costs were observed among the three groups of patients (P = 0.006). CONCLUSION A single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy may result in shorter surgery time, increased success rates for initial catheter removal, and lower medical expenses. However, to confirm these findings, further prospective randomized clinical trials are necessary.
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Affiliation(s)
- Zhenyu Fu
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Urology, Changshu No. 2 People's Hospital, Changshu, Jiangsu, China
| | - Zhen Tian
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yongchang Chen
- Department of Urology, Changshu No. 2 People's Hospital, Changshu, Jiangsu, China
| | - Zongming Jia
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chengyu Wang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xuefeng Zhang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Weijie Zhang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Gang Li
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xuedong Wei
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Yuhua Huang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Xu C, Zou W, Zhang L, Xu R, Li Y, Feng Y, Zhao R, Wang Y, Liu X, Wang J. Real-world retrospective study of immune checkpoint inhibitors in combination with radiotherapy or chemoradiotherapy as a bladder-sparing treatment strategy for muscle-invasive bladder urothelial cancer. Front Immunol 2023; 14:1162580. [PMID: 37283762 PMCID: PMC10239884 DOI: 10.3389/fimmu.2023.1162580] [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: 02/09/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023] Open
Abstract
Background Recent developments in MIBC treatment suggest good efficacy of bladder sparing treatment combined with immune checkpoint inhibitor. However, there is no standard treatment mode. A retrospective analysis was conducted to reveal the efficacy and safety of PD-1 inhibitor in combination with radiotherapy or chemoradiotherapy. Methods We retrospectively analyzed 25 patients with MIBC T2-T3N0M0 disease who were unfit or unwilling to undergo RC. These patients underwent the maximum TURBT followed by PD-1 inhibitor (Tislelizumab or Toripalimab) in combination with radiotherapy or chemoradiotherapy (gemcitabine plus cisplatin) between April 2020 and May 2022. The primary outcome was clinical complete response (cCR) rate. The secondary outcomes were disease free survival (DFS) and overall survival (OS). Results Revised: Of 25 patients, 22 were T2 (88%), while 3 were T3 (12%). The median age is 65 years (51-80). Twenty-one patients had programmed cell death ligand 1 (PD-L1) combined positive score (CPS) of 1 or more, and 4 patients had CPS<1 or unknown. Sixteen patients received chemoradiotherapy. Tislelizumab and Toripalimab were administered to 19 and 6 patients, respectively. The median number of cycles of immunotherapy was 8. Twenty-three patients (92%) achieved cCR. Following a median of 13 months of follow-up (range, 5-34 months), 1-year DFS and OS rate were 92% and 96%, respectively. In the univariate analysis, T stage significantly influenced OS and ORR, and efficacy evaluation significantly influenced OS, DFS, and ORR. The expression of PD-L1 and chemotherapy had no effect on prognosis. In the multivariate analysis, no independent prognostic factors were found. Grade 3 or 4 adverse events (AE) were reported in 35.7% patients. Conclusions Bladder sparing therapy with PD-1 inhibitor in combination with radiotherapy or chemoradiotherapy is feasible, safe, and highly effective for patients who were unfit or unwilling to undergo RC.
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Affiliation(s)
- Chao Xu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen Zou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Zhang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yeqian Feng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Runtian Zhao
- Department of Oncology, Guilin Hospital of the Second Xiangya Hospital, Central South University, Guilin, China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jingjing Wang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
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Approaches to Clinical Complete Response after Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer: Possibilities and Limitations. Cancers (Basel) 2023; 15:cancers15041323. [PMID: 36831665 PMCID: PMC9953905 DOI: 10.3390/cancers15041323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
In the surgical oncology field, the change from a past radical surgery to an organ preserving surgery is a big trend. In muscle-invasive bladder cancer treatment, neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer (MIBC) patients eligible for cisplatin. There is a growing interest in bladder preserving strategies after NAC because good oncologic outcome has been reported for pathologic complete response (pCR) patients after NAC, and many studies have continued to discuss whether bladder preservation treatment is possible for these patients. However, in actual clinical practice, decision-making should be determined according to clinical staging and there is a gap that cannot be ignored between clinical complete response (cCR) and pCR. Currently, there is a lack in a uniform approach to post-NAC restaging of MIBC and a standardized cCR definition. In this review, we clarify the gap between cCR and pCR at the current situation and focus on emerging strategies in bladder preservation in selected patients with MIBC who achieve cCR following NAC.
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11
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Shi Y, Mathis BJ, He Y, Yang X. The Current Progress and Future Options of Multiple Therapy and Potential Biomarkers for Muscle-Invasive Bladder Cancer. Biomedicines 2023; 11:biomedicines11020539. [PMID: 36831075 PMCID: PMC9953154 DOI: 10.3390/biomedicines11020539] [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: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Bladder cancer is a common disease in men and the elderly. Current treatment paradigms include radical resection of the bladder and lymph nodes or transurethral resection, both supported by chemotherapy and/or radiation. New modalities, such as illumination-based therapies are also being translationally pursued. However, while survival rates have increased due to combined therapies (particularly chemotherapy, radiation, immune checkpoint inhibitors, and surgery), a lack of diagnostic markers leads clinical professionals to rely on frequently invasive and expensive means of monitoring, such as magnetic resonance imaging or bladder cystoscopy. To improve real-time diagnostic capabilities, biomarkers that reflect both the metabolic and metastatic potential of tumor cells are needed. Furthermore, indicators of therapy resistance would allow for rapid changes in treatment to optimize survival outcomes. Fortunately, the presence of nanoscale extracellular vesicles in the blood, urine, and other peripheral fluids allow for proteomic, genomic, and transcriptomic analyses while limiting the invasiveness of frequent sampling. This review provides an overview of the pathogenesis and progression of bladder cancer, standard treatments and outcomes, some novel treatment studies, and the current status of biomarker and therapy development featuring exosome-based analysis and engineering.
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Affiliation(s)
- Ying Shi
- Department of Urology, Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bryan J. Mathis
- International Medical Center, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan
| | - Yayun He
- Department of Urology, The Second Hospital of Wuhan Iron and Steel (Group) Corporation, Wuhan 430082, China
| | - Xiong Yang
- Department of Urology, Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence:
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12
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Greer MD, Schaub SK, Bowen SR, Liao JJ, Russell K, Chen JJ, Weg ES, Meyer J, Alving T, Schade GR, Gore JL, Psutka SP, Montgomery RB, Schweizer M, Yu EY, Grivas P, Wright JL, Zeng J. A Prospective Study of a Resorbable Intravesical Fiducial Marker for Bladder Cancer Radiation Therapy. Adv Radiat Oncol 2022; 7:100858. [PMID: 35387424 PMCID: PMC8977855 DOI: 10.1016/j.adro.2021.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 11/15/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose We conducted a prospective pilot study to evaluate safety and feasibility of TraceIT, a resorbable radiopaque hydrogel, to improve image guidance for bladder cancer radiation therapy (RT). Methods and Materials Patients with muscle invasive bladder cancer receiving definitive RT were eligible. TraceIT was injected intravesically around the tumor bed during maximal transurethral resection of bladder tumor. The primary endpoint was the difference between radiation treatment planning margin on daily cone beam computed tomography based on alignment to TraceIT versus standard-of-care pelvic bone anatomy. The Van Herk margin formula was used to determine the optimal planning target volume margin. TraceIT visibility, recurrence rates, and survival were estimated by Kaplan-Meier method. Toxicity was measured by Common Terminology Criteria for Adverse Events version 4.03. Results The trial was fully accrued and 15 patients were analyzed. TraceIT was injected in 4 sites/patient (range, 4-6). Overall, 94% (95% confidence interval [CI], 90%-98%) of injection sites were radiographically visible at RT initiation versus 71% (95% CI, 62%-81%) at RT completion. The median duration of radiographic visibility for injection sites was 106 days (95% CI, 104-113). Most patients were treated with a standard split-course approach with initial pelvic radiation fields, then midcourse repeat transurethral resection of bladder tumor followed by bladder tumor bed boost fields, and 14/15 received concurrent chemotherapy. Alignment to fiducials could allow for reduced planning target volume margins (0.67 vs 1.56 cm) for the initial phase of RT, but not for the boost (1.01 vs 0.96 cm). This allowed for improved target coverage (D95% 80%-83% to 91%-94%) for 2 patients retrospectively planned with both volumetric-modulated arc therapy and 3-dimensional conformal RT. At median follow-up of 22 months, no acute or late complications attributable to TraceIT placement occurred. No patients required salvage cystectomy. Conclusions TraceIT intravesical fiducial placement is safe and feasible and may facilitate tumor bed delineation and targeting in patients undergoing RT for localized muscle invasive bladder cancer. Improved image guided treatment may facilitate strategies to improve local control and minimize toxicity.
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Affiliation(s)
| | | | - Stephen R. Bowen
- Radiation Oncology and
- Radiology, University of Washington, Seattle, Washington
| | | | | | | | | | | | - Tristan Alving
- Department of Urology, University of Washington, Seattle, Washington
| | - George R. Schade
- Department of Urology, University of Washington, Seattle, Washington
| | - John L. Gore
- Department of Urology, University of Washington, Seattle, Washington
| | - Sarah P. Psutka
- Department of Urology, University of Washington, Seattle, Washington
| | - Robert B. Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington
| | - Michael Schweizer
- Division of Medical Oncology, Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington
| | - Evan Y. Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington
| | | | - Jing Zeng
- Radiation Oncology and
- Corresponding author: Jing Zeng, MD
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Tholomier C, Marcq G, Shinde-Jadhav S, Ayoub M, Huang JM, Kool R, Skowronski R, Brimo F, Mansure JJ, Kassouf W. Optimizing Sequence of PD-L1 Immune-Checkpoint Inhibitors and Radiation Therapy in Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: New bladder preserving strategies are needed for muscle invasive bladder cancer (MIBC). Combined therapy of immune-checkpoint inhibitors and radiation was shown to have synergistic antitumoral effects in preclinical studies. OBJECTIVES: We aim to evaluate whether the sequence of administration of this combined therapy impacts antitumoral response. METHODS: We developed an in-vivo syngeneic MIBC mouse model where murine bladder cancer cells (MB49) were injected subcutaneously in the right flank of C57BL/6 mice. Mice were then randomized to the following treatments: control, anti-programmed cell death ligand 1 (PD-L1) alone, radiation alone (XRT) consisting of 6.25 Gy x2 fractions, concurrent anti-PD-L1 with XRT, neoadjuvant anti-PD-L1 followed by XRT, or XRT followed by adjuvant anti-PD-L1 therapy. Tumor growth, survival, and rate of response were analyzed. RESULTS: Total of 60 mice were randomized. One-way analysis of variance showed statistically significant difference in tumor growth rate across the treatment arms (p = 0.029). Importantly, timing of immunotherapy (neoadjuvant, concurrent, or adjuvant) did not alter either tumor growth or survival (p > 0.05). The rate of response was also similar in each combination arm (p > 0.05). CONCLUSION: Combining anti-PD-L1 immunotherapy and radiation therapy offers optimal antitumoral responses. Timing of immunotherapy (neoadjuvant, concurrent, or adjuvant) does not appear to affect outcomes. Whether the toxicity profile differs across various sequential deliveries of combination therapy requires further evaluation.
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Affiliation(s)
- Côme Tholomier
- Department of Surgery>, Division of Urology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Gautier Marcq
- Department of Surgery>, Division of Urology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Surashri Shinde-Jadhav
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Mina Ayoub
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Jia Min Huang
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Ronald Kool
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Rodrigo Skowronski
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University, McGill University Health Center, Montréal, QC, Canada
| | - Jose Joao Mansure
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Wassim Kassouf
- Department of Surgery>, Division of Urology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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