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Konety BR, Shore ND, Sant GR. Clinical use of nadofaragene firadenovec-vncg. Ther Adv Urol 2024; 16:17562872241280005. [PMID: 39315392 PMCID: PMC11418227 DOI: 10.1177/17562872241280005] [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: 02/08/2024] [Accepted: 07/10/2024] [Indexed: 09/25/2024] Open
Abstract
Non-muscle-invasive bladder cancer (NMIBC), which is restricted to the mucosa (stage Ta, carcinoma in situ (CIS)) or submucosa (stage T1), comprises 75% of bladder cancer diagnoses. Intravesical bacillus Calmette-Guérin (BCG) therapy is the standard-of-care initial treatment for high-risk NMIBC; however, a significant proportion of patients have BCG-unresponsive disease. While radical cystectomy is a definitive treatment in this setting, not all patients are willing or able to undergo this complex procedure associated with morbidity, mortality, and decreased quality of life. Bladder-preserving options for patients with BCG-unresponsive NMIBC represent an unmet need in this patient population. Nadofaragene firadenovec-vncg (Adstiladrin) is a nonreplicating adenoviral vector-based gene therapy indicated for the treatment of adult patients with high-risk BCG-unresponsive NMIBC with CIS with or without papillary tumors. The antitumor efficacy of nadofaragene firadenovec is driven by its local delivery of copies of the gene encoding for interferon alpha-2b (IFNα-2b) to urothelial cells. In the phase III CS-003 study, over half of participants with CIS exhibited a complete response by month 3 after instillation, with minimal serious adverse events. The favorable efficacy and safety profile, clinical utility, novel mechanism of action, and every 3-month dosing schedule give nadofaragene firadenovec a unique role in the treatment of high-risk BCG-unresponsive NMIBC. This review provides a practical approach to the effective clinical use of nadofaragene firadenovec regarding pre-instillation visit arrangements, storage, handling, instillation procedures, and post-instillation procedures. Implementation of these recommendations will ensure efficient real-world use of nadofaragene firadenovec and the development of useful training materials and relevant standard operating procedures to help support a clinic's treatment for patients with BCG-unresponsive NMIBC with CIS. Video Abstract https://vimeo.com/user17898099/review/953723559/e18af7ec43.
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Affiliation(s)
| | - Neal D Shore
- Carolina Urologic Research Center, 823 82nd Parkway, Myrtle Beach, SC 29572, USA
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2
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Howard JM, Cook GS, Tverye A, Nandy K, Margulis V, Woldu SL, Lotan Y. Outcomes of Patients with Bacillus Calmette-Guérin (BCG)-Unresponsive Non-Muscle Invasive Bladder Cancer as Defined by the U.S. Food and Drug Administration. Bladder Cancer 2022; 8:303-314. [PMID: 38993682 PMCID: PMC11181681 DOI: 10.3233/blc-211657] [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: 12/20/2021] [Accepted: 05/31/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Limited data are available on the outcomes of patients with non-muscle invasive bladder cancer (NMIBC) unresponsive to intravesical bacillus Calmette-Guérin (BCG), as defined by the United States Food and Drug Administration. OBJECTIVE To define the outcomes of patients with BCG-unresponsive NMIBC. METHODS This was a retrospective, single-institution observational cohort study. Records of patients managed at our institution for BCG-unresponsive NMIBC between 2005 and 2020 were reviewed and clinical outcomes evaluated. RESULTS The study included 149 patients. Management was with initial radical cystectomy in 60 patients (40%) and initial bladder-sparing therapy (BST) in 89 patients (60%). Overall survival was greater among patients undergoing RC than BST (HR 1.83, 95% CI 1.04-3.22, p = 0.036), potentially due to patient selection, as no significant difference was noted for metastasis-free or cancer-specific survival. Patients opting for initial BST had high rates of treatment failure, with estimated 5-year cystectomy-free survival of only 42%. Patients who received additional lines of BST after a subsequent failure were at increased risk of having ≥pT3 or pN+ disease at cystectomy (42% for ≥2 lines BST, versus 18% for 1 line BST and 15% for initial cystectomy, p = 0.038). CONCLUSION Among patients who underwent initial BST for BCG-unresponsive NMIBC, rates of treatment failure were very high. Patients who underwent delayed cystectomy after ≥2 lines of BST had elevated rates of extravesical disease. Our observations emphasize the importance of recent and ongoing clinical trials in this clinical space.
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Affiliation(s)
- Jeffrey M Howard
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Urology, Maine Medical Center, Portland, ME, USA
| | - Grayden S Cook
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Urology, Brigham and Women's Hospital / Harvard Medical School, Boston, MA, USA
| | - Aaron Tverye
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Karabi Nandy
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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3
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Yergin CG, Pafford R, Pirris J, Rao D, Rahmathulla G. Spinal Tuberculosis Secondary to Intravesical Bacille Calmette-Guerin Treatment for Bladder Cancer. Cureus 2021; 13:e17446. [PMID: 34589352 PMCID: PMC8460556 DOI: 10.7759/cureus.17446] [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: 07/25/2021] [Accepted: 08/23/2021] [Indexed: 11/05/2022] Open
Abstract
Intravesical administration of bacille Calmette-Guérin (BCG) is an important component of the gold standard in treating non-muscle invasive bladder cancer (NMIBC). However, complications of this treatment include infections caused by the dissemination of Mycobacterium bovis. We present a case of a 62-year-old man who had been treated with intravesical BCG for bladder cancer and developed an M. bovis infection of his vertebral column. About four months after completing the BCG treatment, he developed an acute onset of severe upper thoracic radicular back pain, with radiation anteriorly to his sternum. Examination revealed the presence of early myelopathy. After other causes were ruled out, he was diagnosed with the infection four months later. He was investigated for the pain, with resulting imaging identifying an erosive ventral epidural mass at the T4-T5 levels causing cord compression. The patient underwent a transthoracic procedure to evacuate the paraspinal mass lesion and obtain a diagnostic biopsy, followed by a posterolateral decompression of the lesion and posterior instrumented stabilization. Pathology resulted in the identification of a granuloma with a single acid-fast bacillus (AFB) from the paraspinal abscess, thus being diagnostic of a mycobacterial granuloma with paraspinal involvement. We subsequently performed an extensive review of current literature, looking at articles on spinal osteomyelitis following intravesical BCG treatment of bladder cancer. We identified 26 documented cases in English literature. We present our case report with a good outcome at 24 months, resolving with appropriate chemotherapy. Additionally, we completed a systematic review of the literature and discuss this infrequent iatrogenic pathology. Our report reveals the good response to targeted therapy in the case of osteomyelitis at other skeletal sites and that practitioners caring for these patients maintain a high degree of suspicion in the workup of these patients. Early identification and treatment can appropriately treat osteomyelitis with good long-term outcomes.
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Affiliation(s)
- Celeste G Yergin
- Neurological Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Ryan Pafford
- Neurological Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - John Pirris
- Cardiothoracic Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Dinesh Rao
- Neuroradiology, University of Florida Health, Jacksonville, USA
| | - Gazanfar Rahmathulla
- Neurological Surgery, University of Florida College of Medicine, Jacksonville, USA
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4
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Muto S, Lu Y, Ide H, Yamaguchi R, Saito K, Kitamura K, Noma Y, Koyasu H, Hirano H, Ashizawa T, Isotani S, Nagata M, Horie S. The Use of Urine Mycobacterium tuberculosis Complex Polymerase Chain Reaction as a Predictive Factor for Recurrence and Progression After Intravesical Bacillus Calmette-Guérin Therapy in Patients with Non-muscle‑invasive Bladder Cancer. EUR UROL SUPPL 2021; 27:10-18. [PMID: 34337512 PMCID: PMC8317891 DOI: 10.1016/j.euros.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Intravesical bacillus Calmette-Guérin (BCG) instillation is a standard treatment for non-muscle-invasive bladder cancer (NMIBC); however, not all patients benefit from BCG therapy. Currently, no surrogate marker exists to predict BCG efficacy, and thereby, identify patients who will benefit from this treatment. OBJECTIVE To evaluate the utility of urine Mycobacterium tuberculosis complex polymerase chain reaction (MTC-PCR) assay as a predictive marker for recurrence and progression following BCG therapy. DESIGN SETTING AND PARTICIPANTS A prospective analysis was carried out for of intermediate- or high-risk NMIBC patients who received BCG instillation for the first time. Urine samples, for MTC-PCR assay, were collected at baseline and annually for up to 10 yr after the last BCG instillation, including induction and maintenance therapy. The first postoperative sample for MTC-PCR was taken at 1 yr from the last instillation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A survival analysis was performed using the Kaplan-Meier method, and risk factors for recurrence and progression after BCG treatment were assessed using Cox regression analysis. RESULTS AND LIMITATIONS During follow-up (median: 57 mo), 468/521 samples (89.8%) were MTC-PCR positive, and 108/123 patients (87.8%) exhibited MTC-PCR positivity at least once. Five-year recurrence- and progression-free survival in patients who were not MTC-PCR positive was significantly lower than in patients who were MTC-PCR positive at least once (p < 0.001). Using multivariable Cox regression analysis, MTC-PCR positivity at least once was a significant prognostic factor for recurrence (hazard ratio [HR]: 36.782, p < 0.001) and progression (HR: 47.209, p < 0.001). CONCLUSIONS Patients who were not MTC-PCR positive, even once after BCG therapy, were extremely likely to exhibit recurrence and progression. Urine MTC-PCR may be an extremely useful, noninvasive surrogate marker to predict recurrence and progression following BCG therapy. PATIENT SUMMARY Urine Mycobacterium tuberculosis complex polymerase chain reaction may be a novel biomarker capable of identifying patients at risk of recurrence and progression after bacillus Calmette-Guérin (BCG) immunotherapy.
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Affiliation(s)
- Satoru Muto
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Advanced Informatics for Genetic Disease, Juntendo University School of Medicine, Tokyo, Japan
| | - Yan Lu
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Urology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Raizo Yamaguchi
- Department of Urology, Kobe Minimally Invasive Cancer Center, Kobe, Japan
| | - Keisuke Saito
- Department of Urology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Kousuke Kitamura
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Noma
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroki Koyasu
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hisashi Hirano
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Ashizawa
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Masayoshi Nagata
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Advanced Informatics for Genetic Disease, Juntendo University School of Medicine, Tokyo, Japan
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Bansal D, Reimers MA, Knoche EM, Pachynski RK. Immunotherapy and Immunotherapy Combinations in Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2021; 13:cancers13020334. [PMID: 33477569 PMCID: PMC7831137 DOI: 10.3390/cancers13020334] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/01/2021] [Accepted: 01/14/2021] [Indexed: 12/21/2022] Open
Abstract
Although most prostate cancers are localized, and the majority are curable, recurrences occur in approximately 35% of men. Among patients with prostate-specific antigen (PSA) recurrence and PSA doubling time (PSADT) less than 15 months after radical prostatectomy, prostate cancer accounted for approximately 90% of the deaths by 15 years after recurrence. An immunosuppressive tumor microenvironment (TME) and impaired cellular immunity are likely largely responsible for the limited utility of checkpoint inhibitors (CPIs) in advanced prostate cancer compared with other tumor types. Thus, for immunologically "cold" malignancies such as prostate cancer, clinical trial development has pivoted towards novel approaches to enhance immune responses. Numerous clinical trials are currently evaluating combination immunomodulatory strategies incorporating vaccine-based therapies, checkpoint inhibitors, and chimeric antigen receptor (CAR) T cells. Other trials evaluate the efficacy and safety of these immunomodulatory agents' combinations with standard approaches such as androgen deprivation therapy (ADT), taxane-based chemotherapy, radiotherapy, and targeted therapies such as tyrosine kinase inhibitors (TKI) and poly ADP ribose polymerase (PARP) inhibitors. Here, we will review promising immunotherapies in development and ongoing trials for metastatic castration-resistant prostate cancer (mCRPC). These novel trials will build on past experiences and promise to usher a new era to treat patients with mCRPC.
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Minoli M, Kiener M, Thalmann GN, Kruithof-de Julio M, Seiler R. Evolution of Urothelial Bladder Cancer in the Context of Molecular Classifications. Int J Mol Sci 2020; 21:E5670. [PMID: 32784716 PMCID: PMC7461199 DOI: 10.3390/ijms21165670] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
Bladder cancer is a heterogeneous disease that is not depicted by current classification systems. It was originally classified into non-muscle invasive and muscle invasive. However, clinically and genetically variable tumors are summarized within both classes. A definition of three groups may better account for the divergence in prognosis and probably also choice of treatment. The first group represents mostly non-invasive tumors that reoccur but do not progress. Contrarily, the second group represent non-muscle invasive tumors that likely progress to the third group, the muscle invasive tumors. High throughput tumor profiling improved our understanding of the biology of bladder cancer. It allows the identification of molecular subtypes, at least three for non-muscle invasive bladder cancer (Class I, Class II and Class III) and six for muscle-invasive bladder cancer (luminal papillary, luminal non-specified, luminal unstable, stroma-rich, basal/squamous and neuroendocrine-like) with distinct clinical and molecular phenotypes. Molecular subtypes can be potentially used to predict the response to treatment (e.g., neoadjuvant chemotherapy and immune checkpoint inhibitors). Moreover, they may allow to characterize the evolution of bladder cancer through different pathways. However, to move towards precision medicine, the understanding of the biological meaning of these molecular subtypes and differences in the composition of cell subpopulations will be mandatory.
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Affiliation(s)
- Martina Minoli
- Department of BioMedical Research, Urology Research Laboratory, University of Bern, 3008 Bern, Switzerland; (M.M.); (M.K.); (G.N.T.); (M.K.-d.J.)
| | - Mirjam Kiener
- Department of BioMedical Research, Urology Research Laboratory, University of Bern, 3008 Bern, Switzerland; (M.M.); (M.K.); (G.N.T.); (M.K.-d.J.)
| | - George N. Thalmann
- Department of BioMedical Research, Urology Research Laboratory, University of Bern, 3008 Bern, Switzerland; (M.M.); (M.K.); (G.N.T.); (M.K.-d.J.)
- Department of Urology, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Marianna Kruithof-de Julio
- Department of BioMedical Research, Urology Research Laboratory, University of Bern, 3008 Bern, Switzerland; (M.M.); (M.K.); (G.N.T.); (M.K.-d.J.)
- Department of Urology, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Roland Seiler
- Department of BioMedical Research, Urology Research Laboratory, University of Bern, 3008 Bern, Switzerland; (M.M.); (M.K.); (G.N.T.); (M.K.-d.J.)
- Department of Urology, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
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7
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Becker REN, Kates MR, Bivalacqua TJ. Identification of Candidates for Salvage Therapy: The Past, Present, and Future of Defining Bacillus Calmette-Guérin Failure. Urol Clin North Am 2019; 47:15-21. [PMID: 31757296 DOI: 10.1016/j.ucl.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disease progression and recurrence are common among patients on Bacillus Calmette-Guérin (BCG) therapy, and options for bladder-preserving subsequent therapy remain limited. Ongoing efforts to develop better second-line bladder-sparing therapies rely on clinical trials of patients deemed to have failed management with BCG. This article describes historical definitions of BCG failure, as well as recent efforts to better delineate and refine the clinical criteria for identifying individual patients who will not benefit from further intravesical BCG therapy. It also reviews guidance from the most recent expert consensus panels and professional association guidelines regarding which patients should not receive additional BCG therapy.
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Affiliation(s)
- Russell E N Becker
- The James Buchanan Brady Urological Institute and Greenberg Bladder Cancer Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Max R Kates
- The James Buchanan Brady Urological Institute and Greenberg Bladder Cancer Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Greenberg Bladder Cancer Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Cassell A, Yunusa B, Jalloh M, Mbodji MM, Diallo A, Ndoye M, Diallo Y, Labou I, Niang L, Gueye SM. Non-Muscle Invasive Bladder Cancer: A Review of the Current Trend in Africa. World J Oncol 2019; 10:123-131. [PMID: 31312279 PMCID: PMC6615913 DOI: 10.14740/wjon1210] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/21/2019] [Indexed: 01/02/2023] Open
Abstract
Bladder cancer is the fourth most common cancer in men and the 11th most common cancer in woman accounting for 6.6% of all cancer cases. Approximately 70-75% bladder cancers are non-muscle invasive bladder cancer (NMIBC). A few African studies have provided considerable rates of NMIBC as compared to western settings 70% to 85%. Critical step in the management of NMIBC is to prevent tumor recurrence which include transurethral resection of the bladder tumor (TURBT) for staging and histological diagnosis. A second TURBT for high grade tumor, T1 tumors and intravesical adjuvant chemotherapy and immunotherapy are essential to reduce recurrence rate. Nevertheless, variant histology, multiple, progressive and recurrent high-grade tumors are best treated with early radical cystectomy. The African literature is scanty on the management of NMIBC. Most of the histological types are squamous cell bladder cancer and may not conform to transurethral resection only but rather radical cystectomy. Most of these patients are not suitable for any form of treatment as they present with advanced disease. However, there is an increasing incidence of urothelial cancer in Africa over the years due to urbanization. It is best that major investment is made in uro-oncological care to address the growing challenge of these subtypes.
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Affiliation(s)
- Ayun Cassell
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Bashir Yunusa
- Department of Surgery, Liberia College of Physicians and Surgeons, Monrovia, Liberia
| | - Mohamed Jalloh
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Mouhamadou M Mbodji
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Abdourahmane Diallo
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Madina Ndoye
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | | | - Issa Labou
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Lamine Niang
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Serigne M Gueye
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
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Doyle E, Crew J, Mostafid H, Tuthill M, Cerundolo V, Gerristen W, Protheroe A. Urothelial cancer: a narrative review of the role of novel immunotherapeutic agents with particular reference to the management of non-muscle-invasive disease. BJU Int 2019; 123:947-958. [PMID: 30548196 DOI: 10.1111/bju.14643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM This narrative review describes current guidelines for treating NMIBC, provides an overview of the principle behind immune checkpoint inhibition, and summarizes current evidence for checkpoint inhibitors in urothelial malignancy. Further, we discuss potential strategies for immune checkpoint inhibition in the management of NMIBC. BACKGROUND Adjuvant intravesical BCG immunotherapy has been the mainstay of treatment for high-risk non-muscle-invasive bladder cancer (NMIBC) for decades but is associated with both a significant side effect profile and failure rate. Recently, a substantial body of trial data has been published demonstrating the successful use of systemic immunotherapy in the treatment of advanced urothelial malignancy and, in particular, a class of drugs known as 'immune checkpoint inhibitors'. This has led to the approval of a number of these drugs by the UK National Institute of Health and Care Excellence and the US Food and Drug Administration, and ongoing trials are examining use in the management of NMIBC. METHODS To identify relevant published data, using the PubMed/ Medline search engine, an online search of the Pubmed/ Medline archives was conducted using the terms bladder cancer' in combination with 'checkpoint inhibitors', and limited to articles in English published between 1966 and September 2017.To identify ongoing trials of interest but not yet published, a further search of the clinical trials.gov search engine was conducted using the term 'non-muscle-invasive bladder cancer'. CONCLUSION There has been little advance in available adjuvant therapy for NMIBC treated with TURBT. Current intravesical therapies are associated with a high recurrence rate and significant side effect profile. The impending publication of the wealth of ongoing trials, both into the delivery and efficacy of checkpoint inhibition will direct the future treatment of NMIBC.
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Affiliation(s)
- Emma Doyle
- Department of Oncology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jeremy Crew
- Department of Urology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital Foundation Trust, Guildford, UK
| | - Mark Tuthill
- Department of Oncology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Vincenzo Cerundolo
- MRC Human Immunology Unit, Radcliffe Department of Medicine, Weatherall Institute of Molecular Medicine, Oxford, UK
| | - Winald Gerristen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegan, The Netherlands
| | - Andrew Protheroe
- Department of Oncology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Autenrieth ME, Seidl C, Bruchertseifer F, Horn T, Kurtz F, Feuerecker B, D’Alessandria C, Pfob C, Nekolla S, Apostolidis C, Mirzadeh S, Gschwend JE, Schwaiger M, Scheidhauer K, Morgenstern A. Treatment of carcinoma in situ of the urinary bladder with an alpha-emitter immunoconjugate targeting the epidermal growth factor receptor: a pilot study. Eur J Nucl Med Mol Imaging 2018; 45:1364-1371. [DOI: 10.1007/s00259-018-4003-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/23/2018] [Indexed: 02/03/2023]
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11
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Mehta K, Patel K, Parikh RA. Immunotherapy in genitourinary malignancies. J Hematol Oncol 2017; 10:95. [PMID: 28434403 PMCID: PMC5402074 DOI: 10.1186/s13045-017-0457-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/29/2017] [Indexed: 01/05/2023] Open
Abstract
Treatment of cancer patients involves a multidisciplinary approach including surgery, radiotherapy, and chemotherapy. Traditionally, patients with metastatic disease are treated with combination chemotherapies or targeted agents. These cytotoxic agents have good response rates and achieve palliation; however, complete responses are rarely seen. The field of cancer immunology has made rapid advances in the past 20 years. Recently, a number of agents and vaccines, which modulate the immune system to allow it to detect and target cancer cells, are being developed. The benefit of these agents is twofold, it enhances the ability the body’s own immune system to fight cancer, thus has a lower incidence of side effects compared to conventional cytotoxic chemotherapy. Secondly, a small but substantial number of patients with metastatic disease are cured by immunotherapy or achieve durable responses lasting for a number of years. In this article, we review the FDA-approved immunotherapy agents in the field of genitourinary malignancies. We also summarize new immunotherapy agents being evaluated in clinical studies either as single agents or as a combination.
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Affiliation(s)
- Kathan Mehta
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Keyur Patel
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rahul A Parikh
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA. .,Division of Hematology/Oncology, Department of Medicine, UPMC Cancer Pavilion, 5th Floor, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA.
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12
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Packiam VT, Johnson SC, Steinberg GD. Non-muscle-invasive bladder cancer: Intravesical treatments beyond Bacille Calmette-Guérin. Cancer 2016; 123:390-400. [PMID: 28112819 DOI: 10.1002/cncr.30392] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/15/2022]
Abstract
An unmet need exists for patients with high-risk non-muscle-invasive bladder cancer for whom bacille Calmette-Guérin (BCG) has failed and who seek further bladder-sparing approaches. This shortcoming poses difficult management dilemmas. This review explores previously investigated first-line intravesical therapies and discusses emerging second-line treatments for the heterogeneous group of patients for whom BCG has failed. The myriad of recently published and ongoing trials assessing novel salvage intravesical treatments offer promise to patients who both seek an effective cure and want to avoid radical surgery. However, these trials must carefully be contextualized by specific patient, tumor, and recurrence characteristics. As data continue to accumulate, there will potentially be a role for these agents as second-line or even first-line intravesical therapies. Cancer 2017;123:390-400. © 2016 American Cancer Society.
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Affiliation(s)
- Vignesh T Packiam
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Scott C Johnson
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Gary D Steinberg
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
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Lerner SP, Bajorin DF, Dinney CP, Efstathiou JA, Groshen S, Hahn NM, Hansel D, Kwiatkowski D, O’Donnell M, Rosenberg J, Svatek R, Abrams JS, Al-Ahmadie H, Apolo AB, Bellmunt J, Callahan M, Cha EK, Drake C, Jarow J, Kamat A, Kim W, Knowles M, Mann B, Marchionni L, McConkey D, McShane L, Ramirez N, Sharabi A, Sharpe AH, Solit D, Tangen CM, Amiri AT, Van Allen E, West PJ, Witjes JA, Quale DZ. Summary and Recommendations from the National Cancer Institute's Clinical Trials Planning Meeting on Novel Therapeutics for Non-Muscle Invasive Bladder Cancer. Bladder Cancer 2016; 2:165-202. [PMID: 27376138 PMCID: PMC4927845 DOI: 10.3233/blc-160053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The NCI Bladder Cancer Task Force convened a Clinical Trials Planning Meeting (CTPM) Workshop focused on Novel Therapeutics for Non-Muscle Invasive Bladder Cancer (NMIBC). Meeting attendees included a broad and multi-disciplinary group of clinical and research stakeholders and included leaders from NCI, FDA, National Clinical Trials Network (NCTN), advocacy and the pharmaceutical and biotech industry. The meeting goals and objectives were to: 1) create a collaborative environment in which the greater bladder research community can pursue future optimally designed novel clinical trials focused on the theme of molecular targeted and immune-based therapies in NMIBC; 2) frame the clinical and translational questions that are of highest priority; and 3) develop two clinical trial designs focusing on immunotherapy and molecular targeted therapy. Despite successful development and implementation of large Phase II and Phase III trials in bladder and upper urinary tract cancers, there are no active and accruing trials in the NMIBC space within the NCTN. Disappointingly, there has been only one new FDA approved drug (Valrubicin) in any bladder cancer disease state since 1998. Although genomic-based data for bladder cancer are increasingly available, translating these discoveries into practice changing treatment is still to come. Recently, major efforts in defining the genomic characteristics of NMIBC have been achieved. Aligned with these data is the growing number of targeted therapy agents approved and/or in development in other organ site cancers and the multiple similarities of bladder cancer with molecular subtypes in these other cancers. Additionally, although bladder cancer is one of the more immunogenic tumors, some tumors have the ability to attenuate or eliminate host immune responses. Two trial concepts emerged from the meeting including a window of opportunity trial (Phase 0) testing an FGFR3 inhibitor and a second multi-arm multi-stage trial testing combinations of BCG or radiotherapy and immunomodulatory agents in patients who recur after induction BCG (BCG failure).
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Affiliation(s)
| | - Dean F. Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Colin P. Dinney
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Susan Groshen
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Noah M. Hahn
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Donna Hansel
- University of California, La Jolla, San Diego, CA, USA
| | - David Kwiatkowski
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jonathan Rosenberg
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Robert Svatek
- UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Jeffrey S. Abrams
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Margaret Callahan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Eugene K. Cha
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles Drake
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jonathan Jarow
- Office of Hematology and Oncology Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Ashish Kamat
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Kim
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Margaret Knowles
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Bhupinder Mann
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Luigi Marchionni
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - David McConkey
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisa McShane
- Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Nilsa Ramirez
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Andrew Sharabi
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Arlene H. Sharpe
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - David Solit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Catherine M. Tangen
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Eliezer Van Allen
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | | | - J. A. Witjes
- Department of Urology, Radboud UMC, Nijmegen, The Netherlands
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