1
|
Maroof H, Paramore L, Ali A. Theories behind Bacillus Calmette-Guérin failure in high-risk non-muscle-invasive bladder cancer and update on current management. CANCER PATHOGENESIS AND THERAPY 2024; 2:74-80. [PMID: 38601486 PMCID: PMC11002745 DOI: 10.1016/j.cpt.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 04/12/2024]
Abstract
Bladder cancer encapsulates a wide spectrum of disease severities, with non-muscle invasive bladder cancer (NMIBC) representing an entirely different entity from muscle-invasive disease. Bacillus Calmette-Guérin (BCG) is one of the most successful intravesical treatment methods for patients diagnosed. However, a considerable proportion of patients fail to respond to BCG treatment. Given the propensity for recurrence in patients with high-risk bladder cancer, these patients present with surgical dilemmas. There is currently no gold standard for salvage treatment post-BCG failure or unified definition as to what that means. In this review, we discuss the mechanisms of action and pathophysiology of BCG, potential theories behind BCG failure, and the scope of novel treatments for this surgical conundrum.
Collapse
Affiliation(s)
- Hanna Maroof
- Department of Urology, Frimley Park Hospital, Portsmouth Rd, Frimley, Camberley GU16 7UJ, United Kingdom
| | - Louise Paramore
- Department of Urology, Frimley Park Hospital, Portsmouth Rd, Frimley, Camberley GU16 7UJ, United Kingdom
| | - Ahmed Ali
- Department of Urology, Frimley Park Hospital, Portsmouth Rd, Frimley, Camberley GU16 7UJ, United Kingdom
| |
Collapse
|
2
|
Jaromin M, Konecki T, Kutwin P. Revolutionizing Treatment: Breakthrough Approaches for BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2024; 16:1366. [PMID: 38611044 PMCID: PMC11010925 DOI: 10.3390/cancers16071366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Bladder cancer is the 10th most popular cancer in the world, and non-muscle-invasive bladder cancer (NMIBC) is diagnosed in ~80% of all cases. Treatments for NMIBC include transurethral resection of the bladder tumor (TURBT) and intravesical instillations of Bacillus Calmette-Guérin (BCG). Treatment of BCG-unresponsive tumors is scarce and usually leads to Radical Cystectomy. In this paper, we review recent advancements in conservative treatment of BCG-unresponsive tumors. The main focus of the paper is FDA-approved medications: Pembrolizumab and Nadofaragene Firadenovec (Adstiladrin). Other, less researched therapeutic possibilities are also included, namely: N-803 immunotherapy, TAR-200 and TAR-210 intravesical delivery systems and combined Cabazitaxel, Gemcitabine and Cisplatin chemotherapy. Conservative treatment and delaying radical cystectomy would greatly benefit patients' quality of life; it is undoubtedly the future of BCG-unresponsive NMIBC.
Collapse
Affiliation(s)
| | | | - Piotr Kutwin
- 1st Department of Urology, Medical University of Lodz, 93-513 Lodz, Poland; (M.J.); (T.K.)
| |
Collapse
|
3
|
Achard V, Fournier B, D'Haese D, Krzystyniak J, Tombal B, Roupret M, Sargos P, Dirix P. Radiotherapy Combined with a Radiosensitizer for Bacillus Calmette-Guérin-unresponsive Non-muscle-invasive Carcinoma In Situ Bladder Cancer: An Open-label, Single-arm, Multicenter, Phase 2 European Organisation for Research and Treatment of Cancer Trial. Eur Urol Oncol 2024:S2588-9311(24)00084-1. [PMID: 38556413 DOI: 10.1016/j.euo.2024.03.008] [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: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
Radical cystectomy with pelvic lymph node dissection and urinary diversion is the standard of care for patients with bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC). However, many patients are unwilling or unable to undergo such major surgery associated with high morbidity and a negative impact on quality of life. Chemoradiotherapy is an established treatment option for muscle-invasive bladder cancer. However, it has not been investigated adequately in NMIBC until now. The European Organisation for Research and Treatment of Cancer (EORTC) 2235 study (NCT06310369) is designed as a multicenter, prospective, international, phase 2 trial of moderate hypofractionated radiotherapy combined with a radiosensitizer in BCG-unresponsive NMIBC patients with carcinoma in situ (CIS) who are not eligible for or declined to undergo radical cystectomy. Patients who have received nadofaragene firadenovec or TAR-200 are eligible. The primary endpoint is the 6-mo complete response (CR) rate defined by the absence of CIS proven by a control biopsy of the bladder. The secondary endpoints include overall survival, progression-free survival, durability of CR, grade 3-4 adverse events rate, patients' quality of life, and organ preservation rate. PATIENT SUMMARY: Intravesical instillation of bacillus Calmette-Guérin is the standard treatment of non-muscle-invasive, also coined as superficial, bladder cancer. In case the cancer recurs, even superficially, there is no other proven treatment than a radical cystectomy-the surgical removal of the bladder. Although the surgical technique has improved dramatically over the past few years, it remains contraindicated in patients with severe comorbidities. In addition, because it affects the quality of life, patients may reject this option. This study will assess the efficacy of external beam radiotherapy, a robust alternative to surgery in muscle-invasive bladder cancer. Radiotherapy will be administered 5 d a week for 4 wk. It will be associated with a "radiosensitizer," an intravenous or oral drug, during the radiotherapy treatment. The study will measure the proportion of patients remaining recurrence free at 6 mo and thereafter. It will also evaluate the safety of the treatment and its impact on quality of life.
Collapse
Affiliation(s)
- Vérane Achard
- Department of Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Béatrice Fournier
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - David D'Haese
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Joanna Krzystyniak
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Bertrand Tombal
- Institut de Recherche Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Morgan Roupret
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013 PARIS, France
| | - Paul Sargos
- Department of Radiotherapy, Bergonie Institute, Bordeaux, France
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium
| |
Collapse
|
4
|
Messing EM. BCG in Immunocompromised Patients: Is it effective? Is it safe? Bladder Cancer 2024; 10:89-91. [PMID: 38993531 PMCID: PMC11181704 DOI: 10.3233/blc-249001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 07/13/2024]
|
5
|
Durant AM, Lee YS, Mi L, Faraj K, Lyon TD, Singh P, Tyson II MD. Effect of Bacille Calmette-Guérin for Non-Muscle-Invasive Bladder Cancer After Prostate Radiotherapy. Bladder Cancer 2024; 10:35-45. [PMID: 38993532 PMCID: PMC11181702 DOI: 10.3233/blc-230073] [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: 09/12/2023] [Accepted: 12/20/2023] [Indexed: 07/13/2024]
Abstract
BACKGROUND Little is known about the impact of prior prostate radiation therapy (RT) on the Bacille Calmette-Guerin (BCG) immunotherapy response in patients with non-muscle invasive bladder cancer (NMIBC). OBJECTIVE We hypothesized that the damaging radiation effects on the bladder could negatively influence BCG efficacy. METHODS Men with a history of high-risk NMIBC were identified within the Surveillance, Epidemiology, and End Results-Medicare database. All patients completed adequate BCG defined as at least 5 plus 2 treatments completed within 12 months. Patients were stratified into 2 groups: with prior RT for prostate cancer and without prior RT before the diagnosis of NMIBC. The primary endpoint was a 5-year composite for progression defined as disease progression requiring systemic chemotherapy, checkpoint inhibitors, radical or partial cystectomy, or cancer-specific death. RESULTS We identified 3,466 patients with NMIBC, including 145 with prior RT for prostate cancer. Five-year progression occurred in 471 patients (13.6%). Patients with prior RT were older than patients without prior RT (77.0 vs 75.0 years; P < .001). The distribution of T stage was significantly different at diagnosis between the RT and non-RT groups (RT: Ta, 44.8%; Tis, 18.6%; T1, 36.6%; without RT: Ta, 40.9%; Tis, 10.8%; T1, 48.3%; P = .002). No difference in the risk of total progression was observed between patients with and without prior RT (P = .67). Similarly, no difference was observed after multivariable adjustment (hazard ratio, 0.99; 95% CI, 0.61-1.58; P = .95). CONCLUSION For patients with NMIBC who undergo adequate BCG treatment, prior RT for prostate cancer was not associated with worse 5-year progression-free survival.
Collapse
Affiliation(s)
| | - Yeonsoo S. Lee
- Mayo Clinic Alix School of Medicine – Florida campus, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Lanyu Mi
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Kassem Faraj
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Parminder Singh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | |
Collapse
|
6
|
Noel ODV, Hassouneh Z, Svatek RS, Mukherjee N. Innate Lymphoid Cells in Bladder Cancer: From Mechanisms of Action to Immune Therapies. Cancer Immunol Res 2024; 12:149-160. [PMID: 38060011 DOI: 10.1158/2326-6066.cir-23-0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/10/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
Bladder tumors have a high mutational burden and tend to be responsive to immune therapies; however, response rates remain modest. To date, immunotherapy in bladder cancer has largely focused on enhancing T-cell immune responses in the bladder tumor microenvironment. It is anticipated that other immune cells, including innate lymphoid cells (ILC), which play an important role in bladder oncogenesis and tumor suppression, could be targeted to improve response to existing therapies. ILCs are classified into five groups: natural killer cells, ILC1s, ILC2s, ILC3s, and lymphoid tissue inducer cells. ILCs are pleiotropic and play dual and sometimes paradoxical roles in cancer development and progression. Here, a comprehensive discussion of the current knowledge and recent advancements in understanding the role of ILCs in bladder cancer is provided. We discuss the multifaceted roles that ILCs play in bladder immune surveillance, tumor protection, and immunopathology of bladder cancer. This review provides a rationale for targeting ILCs in bladder cancer, which is relevant for other solid tumors.
Collapse
Affiliation(s)
- Onika D V Noel
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas
| | - Zaineb Hassouneh
- Department of Microbiology, Immunology & Molecular Genetics, University of Texas Health San Antonio, San Antonio, Texas
| | - Robert S Svatek
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas
| | - Neelam Mukherjee
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas
| |
Collapse
|
7
|
Miao Z, Li J, Zeng S, Lv Y, Jia S, Ding D, Li W, Liu Q. Endoplasmic Reticulum-Targeting AIE Photosensitizers to Boost Immunogenic Cell Death for Immunotherapy of Bladder Carcinoma. ACS APPLIED MATERIALS & INTERFACES 2024; 16:245-260. [PMID: 38113527 DOI: 10.1021/acsami.3c14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Bladder cancer is characterized by high rates of recurrence and multifocality. Immunogenic cell death (ICD) of cancer cells has emerged as a promising strategy to improve the immunogenicity of tumor cells for enhanced cancer immunotherapy. Although photosensitizer-based photodynamic therapy (PDT) has been validated as capable of inducing ICD in cancer cells, the photosensitizers with a sufficient ICD induction ability are still rare, and there have been few reports on the development of advanced photosensitizers to strongly evoke the ICD of bladder cancer cells for eliciting potent antitumor immune responses and eradicating bladder carcinoma in situ. In this work, we have synthesized a new kind of endoplasmic reticulum (ER)-targeting aggregation-induced emission (AIE) photosensitizer (named DPASCP-Tos), which could effectively anchor to the cellular ER and trigger focused reactive oxygen species (ROS) production within the ER, thereby boosting ICD in bladder cancer cells. Furthermore, we have demonstrated that bladder cancer cells killed by ER-targeted PDT could serve as a therapeutic cancer vaccine to elicit a strong antitumor immunity. Prophylactic vaccination of the bladder cancer cells killed by DPASCP-Tos under light irradiation promoted the maturation of dendritic cells (DCs) and the expansion of tumor antigen-specific CD8+ T cells in vivo and protected mice from subsequent in situ bladder tumor rechallenge and extended animal survival. In summary, the ER-targeted AIEgens developed here significantly amplified the ICD of bladder cells through focused ROS-based ER oxidative stress and transformed bladder cancer cells into the therapeutic vaccine to enhance immunogenicity against orthotopic bladder cancer, providing valuable insights for bladder carcinoma treatment.
Collapse
Affiliation(s)
- Zhizhao Miao
- Tianjin First Central Hospital, Nankai University, Tianjin 300071, China
| | - Jisen Li
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials, Ministry of Education and College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Sheng Zeng
- Department of Urology, Tianjin First Central Hospital, Tianjin 300384, China
| | - Yonghui Lv
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials, Ministry of Education and College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Shaorui Jia
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials, Ministry of Education and College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Dan Ding
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials, Ministry of Education and College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Wen Li
- Tianjin Key Laboratory of Biomedical Materials and Key Laboratory of Biomaterials and Nanotechnology for Cancer Immunotherapy, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Qian Liu
- Tianjin First Central Hospital, Nankai University, Tianjin 300071, China
| |
Collapse
|
8
|
Bourlotos G, Baigent W, Hong M, Plagakis S, Grundy L. BCG induced lower urinary tract symptoms during treatment for NMIBC-Mechanisms and management strategies. Front Neurosci 2024; 17:1327053. [PMID: 38260019 PMCID: PMC10800852 DOI: 10.3389/fnins.2023.1327053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Non-muscle invasive bladder cancer (NMIBC) accounts for ~70-75% of total bladder cancer tumors and requires effective early intervention to avert progression. The cornerstone of high-risk NMIBC treatment involves trans-urethral resection of the tumor followed by intravesical Bacillus Calmette-Guerin (BCG) immunotherapy. However, BCG therapy is commonly accompanied by significant lower urinary tract symptoms (LUTS) including urinary urgency, urinary frequency, dysuria, and pelvic pain which can undermine treatment adherence and clinical outcomes. Despite this burden, the mechanisms underlying the development of BCG-induced LUTS have yet to be characterized. This review provides a unique perspective on the mechanisms thought to be responsible for the development of BCG-induced LUTS by focussing on the sensory nerves responsible for bladder sensory transduction. This review focuses on how the physiological response to BCG, including inflammation, urothelial permeability, and direct interactions between BCG and sensory nerves could drive bladder afferent sensitization leading to the development of LUTS. Additionally, this review provides an up-to-date summary of the latest clinical data exploring interventions to relieve BCG-induced LUTS, including therapeutic targeting of bladder contractions, inflammation, increased bladder permeability, and direct inhibition of bladder sensory signaling. Addressing the clinical burden of BCG-induced LUTS holds significant potential to enhance patient quality of life, treatment compliance, and overall outcomes in NMIBC management. However, the lack of knowledge on the pathophysiological mechanisms that drive BCG-induced LUTS has limited the development of novel and efficacious therapeutic options. Further research is urgently required to unravel the mechanisms that drive BCG-induced LUTS.
Collapse
Affiliation(s)
- Georgia Bourlotos
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - William Baigent
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Matthew Hong
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sophie Plagakis
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Luke Grundy
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| |
Collapse
|
9
|
Durant AM, Choudry MM, Madura G, Mi L, Faraj KS, Tyson MD. Bacillus Calmette-Guerin (BCG) therapy is safe and effective in non-muscle invasive bladder cancer (NMIBC) patients with immunomodulating conditions. Urol Oncol 2024; 42:21.e21-21.e28. [PMID: 37852817 PMCID: PMC10842448 DOI: 10.1016/j.urolonc.2023.09.010] [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: 05/02/2023] [Revised: 08/18/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Bacillus Calmette-Guerin (BCG) is the most effective therapy available to treat high-risk nonmuscle invasive bladder cancer (NMIBC) patients. However, for patients with immunomodulating conditions BCG is a relative contraindication due to efficacy and safety concerns. To our knowledge, no population-level study evaluating the efficacy and safety profile of BCG for immunomodulated patients exists. METHODS NMIBC patients aged 66 years or older were identified in the Surveillance, Epidemiology, and End Results (SEER) - Medicare database from 1975-2013. All patients completed adequate BCG (at least 5 plus 2 treatments completed within 12 months of diagnosis). Two groups were defined: an immunomodulated population identified by immunomodulating conditions such as solid-organ transplantation, HIV, and autoimmune conditions, and an immunocompetent group. The primary endpoint was 5-year progression-free survival defined as progression to systemic chemotherapy, checkpoint inhibitors, radical or partial cystectomy, metastasis, or cancer-specific death. A safety analysis was performed as a secondary outcome. RESULTS In a total of 4,277 patients with NMIBC who completed adequate BCG, 606 (14.2%) were immunomodulated. The immunomodulated group was older at diagnosis (P < 0.001), more likely to be female (P < 0.001), more likely to live in a metropolitan area (P < 0.001), and had higher Charlson comorbidity scores (P < 0.001). There were no differences in progression to chemotherapy (P = 0.17), checkpoint inhibitors (P > 0.99), radical cystectomy (P = 0.40), partial cystectomy (P = 0.93), metastasis (P = 0.19), cancer-specific death (P = 0.18) or 5-year total bladder cancer progression (P = 0.30) between the groups. For the safety analysis, rates of disseminated BCG were similar between immunomodulated and immunocompetent patients (0.7% vs. <1.8%, P = 0.51). On multivariable analysis 5-year total bladder cancer progression (HR 1.07 [CI 0.88-1.30]) was similar between the groups. CONCLUSION Rates of bladder cancer progression and disseminated BCG complications 5-years after BCG therapy were similar regardless of immunomodulation status. These findings suggest that BCG intravesical therapy can be offered to immunomodulated patients with high-risk NMIBC although theoretical infectious complication risks remain.
Collapse
Affiliation(s)
- Adri M Durant
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ.
| | | | - Grace Madura
- Mayo Clinic College of Medicine and Science, Scottsdale, AZ
| | - Lanyu Mi
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, Scottsdale, AZ
| | - Kassem S Faraj
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mark D Tyson
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ
| |
Collapse
|
10
|
Relouw S, Dugbartey GJ, Sener A. Non-Invasive Imaging Modalities in Intravesical Murine Models of Bladder Cancer. Cancers (Basel) 2023; 15:cancers15082381. [PMID: 37190309 DOI: 10.3390/cancers15082381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Bladder cancer (BCa) is the sixth most prevalent cancer in men and seventeenth most prevalent cancer in women worldwide. Current treatment paradigms have limited therapeutic impact, suggesting an urgent need for the investigation of novel therapies. To best emulate the progression of human BCa, a pre-clinical intravesical murine model is required in conjunction with existing non-invasive imaging modalities to detect and evaluate cancer progression. Non-invasive imaging modalities reduce the number of required experimental models while allowing for longitudinal studies of novel therapies to investigate long-term efficacy. In this review, we discuss the individual and multi-modal use of non-invasive imaging modalities; bioluminescence imaging (BLI), micro-ultrasound imaging (MUI), magnetic resonance imaging (MRI), and positron emission tomography (PET) in BCa evaluation. We also provide an update on the potential and the future directions of imaging modalities in relation to intravesical murine models of BCa.
Collapse
Affiliation(s)
- Sydney Relouw
- Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, Western University, London, ON N6A 5A5, Canada
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - George J Dugbartey
- Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, Western University, London, ON N6A 5A5, Canada
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 1181, Ghana
- Department of Surgery, Division of Urology, London Health Sciences Centre, London, ON N6A 5A5, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, ON N6A 5A5, Canada
| | - Alp Sener
- Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, Western University, London, ON N6A 5A5, Canada
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Department of Surgery, Division of Urology, London Health Sciences Centre, London, ON N6A 5A5, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, ON N6A 5A5, Canada
| |
Collapse
|
11
|
Ji N, Long M, Garcia-Vilanova A, Ault R, Moliva JI, Yusoof KA, Mukherjee N, Curiel TJ, Dixon H, Torrelles JB, Svatek RS. Selective delipidation of Mycobacterium bovis BCG retains antitumor efficacy against non-muscle invasive bladder cancer. Cancer Immunol Immunother 2023; 72:125-136. [PMID: 35748904 PMCID: PMC10992592 DOI: 10.1007/s00262-022-03236-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/31/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Repeated instillations of bacillus Calmette et Guérin (BCG) are the gold standard immunotherapeutic treatment for reducing recurrence for patients with high-grade papillary non-muscle invasive bladder cancer (NMIBC) and for eradicating bladder carcinoma-in situ. Unfortunately, some patients are unable to tolerate BCG due to treatment-associated toxicity and bladder removal is sometimes performed for BCG-intolerance. Prior studies suggest that selectively delipidated BCG (dBCG) improves tolerability of intrapulmonary delivery reducing tissue damage and increasing efficacy in preventing Mycobacterium tuberculosis infection in mice. To address the lack of treatment options for NMIBC with BCG-intolerance, we examined if selective delipidation would compromise BCG's antitumor efficacy and at the same time increase tolerability to the treatment. MATERIALS AND METHODS Murine syngeneic MB49 bladder cancer models and in vitro human innate effector cell cytotoxicity assays were used to evaluate efficacy and immune impact of selective delipidation in Tokyo and TICE BCG strains. RESULTS Both dBCG-Tokyo and dBCG-TICE effectively treated subcutaneous MB49 tumors in mice and enhanced tumor-infiltrating CD8+ T and natural killer cells, similar to conventional BCG. However, when compared to conventional BCG, only dBCG-Tokyo retained a significant effect on intratumoral tumor-specific CD8+ and γδ T cells by increasing their frequencies in tumor tissue and their production of antitumoral function-related cytokines, i.e., IFN-γ and granzyme B. Further, dBCG-Tokyo but not dBCG-TICE enhanced the function and cytotoxicity of innate effector cells against human bladder cancer T24 in vitro. CONCLUSIONS These data support clinical investigation of dBCG-Tokyo as a treatment for patients with BCG-intolerant NMIBC.
Collapse
Affiliation(s)
- Niannian Ji
- Experimental Developmental Therapeutics (EDT) Program, Mays Cancer Center at UT Health MD Anderson, San Antonio, TX, USA
- Department of Urology, UT Health San Antonio, San Antonio, TX, USA
| | - Meijun Long
- Department of Urology, UT Health San Antonio, San Antonio, TX, USA
- Breast Cancer Center, the 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Andreu Garcia-Vilanova
- Population Health Program, TB Group, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Russell Ault
- Population Health Program, TB Group, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Juan I Moliva
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kizil A Yusoof
- Population Health Program, TB Group, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Neelam Mukherjee
- Experimental Developmental Therapeutics (EDT) Program, Mays Cancer Center at UT Health MD Anderson, San Antonio, TX, USA
- Department of Urology, UT Health San Antonio, San Antonio, TX, USA
| | - Tyler J Curiel
- Experimental Developmental Therapeutics (EDT) Program, Mays Cancer Center at UT Health MD Anderson, San Antonio, TX, USA
- Division of Hematology/Medical Oncology at the UT Health San Antonio, San Antonio, TX, USA
| | - Hong Dixon
- Chemistry and Chemical Engineering Division, Microencapsulation and Nanomaterials Department, Southwest Research Institute, San Antonio, TX, USA
| | - Jordi B Torrelles
- Population Health Program, TB Group, Texas Biomedical Research Institute, San Antonio, TX, USA.
| | - Robert S Svatek
- Experimental Developmental Therapeutics (EDT) Program, Mays Cancer Center at UT Health MD Anderson, San Antonio, TX, USA.
- Department of Urology, UT Health San Antonio, San Antonio, TX, USA.
| |
Collapse
|
12
|
Yaghoubi A, Movaqar A, Asgharzadeh F, Derakhshan M, Ghazvini K, Hasanian SM, Avan A, Mostafapour A, Khazaei M, Soleimanpour S. Anticancer activity of Pseudomonas aeruginosa derived peptide with iRGD in colon cancer therapy. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2023; 26:768-776. [PMID: 37396945 PMCID: PMC10311979 DOI: 10.22038/ijbms.2023.68331.14913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/01/2023] [Indexed: 07/04/2023]
Abstract
Objectives Colon cancer is well-known as a life-threatening disease. Since the current treatment modalities for this type of cancer are powerful yet face some limitations, finding novel treatments is required to achieve better outcomes with fewer side effects. Here we investigated the therapeutic potential of Azurin-p28 alone or along with iRGD (Ac-CRGDKGPDC-amide) as a tumor-penetrating peptide and 5-fluorouracil (5-FU) for colon cancer. Materials and Methods Inhibitory effect of p28 with or without iRGD/5-FU was studied in CT26 and HT29, as well as the xenograft animal model of cancer. The effect of p28 alone or along with iRGD/5-FU on cell migration, apoptotic activity, and cell cycle of the cell lines was assessed. Level of the BAX and BCL2 genes, tumor suppressor genes [(p53 and collagen type-Iα1 (COL1A1), collagen type-Iα2 (COL1A2)] were assessed by quantitative RT-PCR. Results These findings show that using p28 with or without iRGD and 5-FU raised the level of p53 and BAX but decreased BCL2, compared with control and 5-FU groups in tissues of the tumor, which result in raising the apoptosis. Conclusion It seems that p28 may be used as a new therapeutic approach in colon cancer therapy that can enhance the anti-tumor effect of 5-FU.
Collapse
Affiliation(s)
- Atieh Yaghoubi
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aref Movaqar
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshteh Asgharzadeh
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Derakhshan
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kiarash Ghazvini
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hasanian
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical, Sciences, Mashhad, Iran
| | - Amir Avan
- Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asma Mostafapour
- Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Majid Khazaei
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saman Soleimanpour
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
13
|
Yaghoubi A, Ghazvini K, Hasanian SM, Avan A, Soleimanpour S, Khazaei M. Bacterial Peptides and Bacteriocins as a Promising Therapy for Solid Tumor. Curr Pharm Des 2022; 28:3105-3113. [PMID: 36154595 DOI: 10.2174/1381612828666220921150037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/24/2022] [Indexed: 01/28/2023]
Abstract
The conventional treatment is faced with limitations in treating solid tumors due to their specific pathophysiology. Several novel therapeutics have been introduced in recent decades to treat solid tumors. Among these new methods, tumor therapy using bacterial products like bacteriocins and peptides has been of great interest due to their unique characteristics and advantages of them in comparison to the conventional treatment, including that they can precisely target tumor cells, selective toxicity for tumor cells, low side effect on normal cells, toxicity activity for MDR cancer cells, used as the target delivery vehicles and enhancing drug delivery. Moreover, their small size and low molecular weight have made them easy to synthesize and modify. Furthermore, in recent years, genetic engineering has expanded the therapeutic ability of peptides to treat solid tumors, which results in overcoming the peptide drawbacks. The present review mainly focuses on the new advances in applying bacterial peptides and bacteriocins in treating human solid tumors.
Collapse
Affiliation(s)
- Atieh Yaghoubi
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kiarash Ghazvini
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hasanian
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical, Sciences, Mashhad, Iran
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saman Soleimanpour
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khazaei
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Burcher KM, Burcher JT, Inscore L, Bloomer CH, Furdui CM, Porosnicu M. A Review of the Role of Oral Microbiome in the Development, Detection, and Management of Head and Neck Squamous Cell Cancers. Cancers (Basel) 2022; 14:4116. [PMID: 36077651 PMCID: PMC9454796 DOI: 10.3390/cancers14174116] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
The role of the microbiome in the development and propagation of head and neck squamous cell cancer (HNSCC) is largely unknown and the surrounding knowledge lags behind what has been discovered related to the microbiome and other malignancies. In this review, the authors performed a structured analysis of the available literature from several databases. The authors discuss the merits and detriments of several studies discussing the microbiome of the structures of the aerodigestive system throughout the development of HNSCC, the role of the microbiome in the development of malignancies (generally and in HNSCC) and clinical applications of the microbiome in HNSCC. Further studies will be needed to adequately describe the relationship between HNSCC and the microbiome, and to push this relationship into a space where it is clinically relevant outside of a research environment.
Collapse
Affiliation(s)
| | | | - Logan Inscore
- Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | | | | | | |
Collapse
|
16
|
Goldberg IP, Lichtbroun B, Singer EA, Ghodoussipour S. Pharmacologic Therapies for Non-Muscle Invasive Bladder Cancer: Current and Future Treatments. ARCHIVES OF PHARMACOLOGY AND THERAPEUTICS 2022; 4:13-22. [PMID: 36051251 PMCID: PMC9431226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Bladder cancer is the sixth most common malignancy in the United States and 70% of cases are non-muscle invasive at the time of diagnosis. Effective treatment is crucial to prevent progression, which occurs in about 30% of patients. The American Urological Association (AUA) guidelines recommend treatment of non-muscle invasive bladder cancer (NMIBC) with intravesical Bacille Calmette-Guerin (BCG) and chemotherapy. However, ongoing shortages and high rates of BCG unresponsiveness creates a major need for novel therapies. In this narrative review, we discuss the evolving landscape of therapeutic options for NMIBC. Pembrolizumab, an anti-programmed cell death (PD)-1 antibody, was the first systemic therapy to be FDA-approved for BCG-unresponsive, high-risk disease. Promising new agents under investigation include various other checkpoint inhibitors and adenovirus-based therapies including CG0070 and nadofaragene firadenovec (rAd-IFNa/Syn3). Finally, new mechanisms of drug delivery are under investigation, including delivery with the GemRIS (TAR-200) device and delivery of intravesical chemotherapy at higher temperatures. With the promise of novel therapies on the horizon, we can expect the role of urologists in the management of NMIBC to evolve and expand.
Collapse
Affiliation(s)
| | - Benjamin Lichtbroun
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Correspondence should be addressed to Saum Ghodoussipour, MD,
| |
Collapse
|
17
|
Marques-Neto LM, Piwowarska Z, Kanno AI, Moraes L, Trentini MM, Rodriguez D, Silva JLSC, Leite LCC. Thirty years of recombinant BCG: new trends for a centenary vaccine. Expert Rev Vaccines 2021; 20:1001-1011. [PMID: 34224293 DOI: 10.1080/14760584.2021.1951243] [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] [Indexed: 12/12/2022]
Abstract
Introduction: Global perception of the potential for Bacille Calmette-Guérin (BCG), and consequently recombinant BCG (rBCG), in a variety of prophylactic and therapeutic applications has been increasing. A century of information on BCG, and three decades of experience with rBCG, has generated solid knowledge in this field.Area covered: Here, we review the current state of knowledge of BCG and rBCG development. Molecular tools have facilitated the expression of a variety of molecules in BCG, with the aim of improving its efficacy as a tuberculosis vaccine, generating polyvalent vaccines against other pathogens, including viruses, bacteria, and parasites, and developing immunotherapy approaches against noninvasive bladder cancer. BCG's recently appraised heterologous effects and prospects for expanding its application to other diseases are also addressed.Expert opinion: There are high expectations for new tuberculosis vaccines currently undergoing advanced clinical trials, which could change the prospects of the field. Systems biology could reveal effective biomarkers of protection, which would greatly support vaccine development. The development of appropriate large-scale production processes would further support implementation of new vaccines and rBCG products. The next few years should consolidate the broader applications of BCG and produce insights into improvements using the recombinant BCG technology.
Collapse
Affiliation(s)
| | - Zuzanna Piwowarska
- Laboratório De Desenvolvimento De Vacinas, Instituto Butantan, São Paulo, Brazil.,UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Alex I Kanno
- Laboratório De Desenvolvimento De Vacinas, Instituto Butantan, São Paulo, Brazil
| | - Luana Moraes
- Laboratório De Desenvolvimento De Vacinas, Instituto Butantan, São Paulo, Brazil.,Programa De Pós-Graduação Interunidades Em Biotecnologia USP-Instituto Butantan-IPT, São Paulo, Brazil
| | - Monalisa M Trentini
- Laboratório De Desenvolvimento De Vacinas, Instituto Butantan, São Paulo, Brazil
| | - Dunia Rodriguez
- Laboratório De Desenvolvimento De Vacinas, Instituto Butantan, São Paulo, Brazil
| | - Jose L S C Silva
- Laboratório De Desenvolvimento De Vacinas, Instituto Butantan, São Paulo, Brazil.,Programa De Pós-Graduação Interunidades Em Biotecnologia USP-Instituto Butantan-IPT, São Paulo, Brazil
| | - Luciana C C Leite
- Laboratório De Desenvolvimento De Vacinas, Instituto Butantan, São Paulo, Brazil
| |
Collapse
|
18
|
Plasek J, Weissert J, Downs T, Richards K, Ravvaz K. Clinicopathological Criteria Predictive of Recurrence Following Bacillus Calmette-Guérin Therapy Initiation in Non-Muscle-Invasive Bladder Cancer: Retrospective Cohort Study. JMIR Cancer 2021; 7:e25800. [PMID: 34156341 PMCID: PMC8277393 DOI: 10.2196/25800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 01/31/2023] Open
Abstract
Background Bacillus Calmette-Guérin (BCG) is currently the most clinically effective intravesical treatment for non–muscle-invasive bladder cancer (NMIBC), particularly for patients with high-risk NMIBC such as those with carcinoma in situ. BCG treatments could be optimized to improve patient safety and conserve supply by predicting BCG efficacy based on tumor characteristics or clinicopathological criteria. Objective The aim of this study is to assess the ability of specific clinicopathological criteria to predict tumor recurrence in patients with NMIBC who received BCG therapy along various treatment timelines. Methods A total of 1331 patients (stage Ta, T1, or carcinoma in situ) who underwent transurethral resection of a bladder tumor between 2006 and 2017 were included. Univariate analysis, including laboratory tests (eg, complete blood panels, creatinine levels, and hemoglobin A1c levels) within 180 days of BCG therapy initiation, medications, and clinical and demographic variables to assess their ability to predict NMIBC recurrence, was completed. This was followed by multivariate regression that included the elements of the Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model and variables that were significant predictors of recurrence in univariate analysis. Results BCG was administered to 183 patients classified as intermediate or high risk, and 76 (41.5%) experienced disease recurrence. An abnormal neutrophil-to-lymphocyte ratio measured within 180 days of induction BCG therapy was a significant predictor (P=.047) of future cancer recurrence and was a stronger predictor than the CUETO score or the individual variables included in the CUETO scoring model through multivariate analysis. Conclusions An abnormal neutrophil-to-lymphocyte ratio within 180 days of BCG therapy initiation is predictive of recurrence and could be suggestive of additional or alternative interventions.
Collapse
Affiliation(s)
- Joseph Plasek
- Advocate Aurora Research Institute, Milwaukee, WI, United States
| | - John Weissert
- Advocate Aurora Research Institute, Milwaukee, WI, United States
| | - Tracy Downs
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kyle Richards
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kourosh Ravvaz
- Advocate Aurora Research Institute, Milwaukee, WI, United States
| |
Collapse
|
19
|
Bogen JP, Grzeschik J, Jakobsen J, Bähre A, Hock B, Kolmar H. Treating Bladder Cancer: Engineering of Current and Next Generation Antibody-, Fusion Protein-, mRNA-, Cell- and Viral-Based Therapeutics. Front Oncol 2021; 11:672262. [PMID: 34123841 PMCID: PMC8191463 DOI: 10.3389/fonc.2021.672262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/11/2021] [Indexed: 01/02/2023] Open
Abstract
Bladder cancer is a frequent malignancy and has a clinical need for new therapeutic approaches. Antibody and protein technologies came a long way in recent years and new engineering approaches were applied to generate innovative therapeutic entities with novel mechanisms of action. Furthermore, mRNA-based pharmaceuticals recently reached the market and CAR-T cells and viral-based gene therapy remain a major focus of biomedical research. This review focuses on the engineering of biologics, particularly therapeutic antibodies and their application in preclinical development and clinical trials, as well as approved monoclonal antibodies for the treatment of bladder cancer. Besides, newly emerging entities in the realm of bladder cancer like mRNA, gene therapy or cell-based therapeutics are discussed and evaluated. As many discussed molecules exhibit unique mechanisms of action based on innovative protein engineering, they reflect the next generation of cancer drugs. This review will shed light on the engineering strategies applied to develop these next generation treatments and provides deeper insights into their preclinical profiles, clinical stages, and ongoing trials. Furthermore, the distribution and expression of the targeted antigens and the intended mechanisms of action are elucidated.
Collapse
Affiliation(s)
- Jan P Bogen
- Institute for Organic Chemistry and Biochemistry, Technical University of Darmstadt, Darmstadt, Germany.,Ferring Darmstadt Laboratory, Biologics Technology and Development, Darmstadt, Germany
| | - Julius Grzeschik
- Ferring Darmstadt Laboratory, Biologics Technology and Development, Darmstadt, Germany
| | - Joern Jakobsen
- Ferring Pharmaceuticals, International PharmaScience Center, Copenhagen, Denmark
| | - Alexandra Bähre
- Ferring Pharmaceuticals, International PharmaScience Center, Copenhagen, Denmark
| | - Björn Hock
- Global Pharmaceutical Research and Development, Ferring International Center S.A., Saint-Prex, Switzerland
| | - Harald Kolmar
- Institute for Organic Chemistry and Biochemistry, Technical University of Darmstadt, Darmstadt, Germany
| |
Collapse
|
20
|
First time intravesically administered trifunctional antibody catumaxomab in patients with recurrent non-muscle invasive bladder cancer indicates high tolerability and local immunological activity. Cancer Immunol Immunother 2021; 70:2727-2735. [PMID: 33837852 PMCID: PMC8360869 DOI: 10.1007/s00262-021-02930-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Abstract
Transurethral resection of the tumor (TUR-B) followed by adjuvant intravesical treatment with cytostatic drugs or Bacillus Calmette–Guérin (BCG) as standard therapy of non-muscle-invasive bladder cancer (NMIBC) is associated with a high recurrence rate of about 60–70%, considerable side effects and requires close monitoring. Alternative treatment options are warranted. Two patients with epithelial cell adhesion molecule (EpCAM)-positive recurrent non-muscle invasive bladder cancer were treated the first time by an intravesical administration of the trifunctional bispecific EpCAM targeting antibody catumaxomab (total dosage of 470 and 1120 µg, respectively). The binding and killing activity of catumaxomab in urine milieu was evaluated in vitro. In contrast to its previous systemic application catumaxomab was well tolerated without any obvious signs of toxicity. Relevant cytokine plasma levels were not detected and no significant systemic drug release was observed. The induction of a human anti-mouse-antibody (HAMA) reaction was either absent or untypically weak contrary to the high immunogenicity of intraperitoneal applied catumaxomab. Tumor cells that were detectable in urine patient samples disappeared after catumaxomab therapy. Endoscopically confirmed recurrence-free intervals were 32 and 25 months. Our data suggest that intravesical administration of catumaxomab in NMIBC is feasible, safe and efficacious, thus arguing for further clinical development of catumaxomab in this indication.
Collapse
|
21
|
Di Maida F, Scalici Gesolfo C, Tellini R, Mari A, Sanfilippo C, Lambertini L, Grosso AA, Carini M, Minervini A, Serretta V. Fibronectin urothelial gene expression as a new reliable biomarker for early detection of local toxicity secondary to adjuvant intravesical therapy for non-muscle invasive bladder cancer. Ther Adv Urol 2021; 13:1756287221995683. [PMID: 33717214 PMCID: PMC7923969 DOI: 10.1177/1756287221995683] [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] [Received: 09/19/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background: A marker of urothelial damage could be helpful for early detection and monitoring of local toxicity due to intravesical therapy for non-muscle invasive bladder cancer (NMIBC). The aim of the study was to investigate the correlation between fibronectin (FN) gene expression in bladder washings and local toxicity secondary to adjuvant intravesical therapy. Materials and methods: Patients undergoing adjuvant intravesical therapy for NMIBC and age-matched healthy patients were enrolled. Real time polymerase chain reaction was performed to analyze FN expression in bladder washings. Local toxicity was classified as: 0–1 mild (no medical therapy), 2 moderate (medical therapy and/or instillation postponed), 3 severe (discontinuation of therapy). Results: Seventy-two patients and 21 controls entered the study. A useful pellet was obtained in 58 patients and 18 controls. Intravesical Bacillus Calmette–Guerin (BCG), Epirubicin and Mitomycin C was offered to 69%, 13.8% and 17.2% of patients respectively. Compared with healthy controls (FN = 1.0 fold), overall median FN expression before adjuvant intravesical therapy was 1.73 fold [interquartile range (IQR) 0.8–2.3], while during therapy median FN expression increased to 3.41 (IQR: 1.6–6.1) fold. Considering 40 intermediate and high-risk patients undergoing intravesical BCG, median FN expression before adjuvant treatment was 1.92 [(IQR: 1.0–2.7) fold, increasing up to 4.1 (IQR: 1.9–6.6) during therapy. In more detail, FN increased during BCG therapy, showing a median expression of 4.22 (IQR: 2.2–5.5) and 6.16 (IQR: 2.6–8.7) fold in presence of grade 2 and 3 toxicity respectively, while remaining more or less stable in asymptomatic patients. After receiver operating characteristic curve analysis, FN value of 3.6 fold resulted, corresponding to 75% sensitivity and 69% specificity to predict grade 2–3 toxicity events (area under the curve 0.74, 95% confidence interval 0.63–0.85, p = 0.001). Conclusion: Our study validated the correlation between FN expression and urothelial damage. BCG seems to induce a urothelial activation with FN overexpression during adjuvant intravesical therapy. Grade of toxicity was related to FN expression.
Collapse
Affiliation(s)
- Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Largo Brambilla 3, San Luca Nuovo, Firenze 50134, Italy
| | - Cristina Scalici Gesolfo
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Sicilia, Italy
| | - Riccardo Tellini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | | | - Luca Lambertini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Vincenzo Serretta
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Sicilia, Italy
| |
Collapse
|
22
|
Graham CH, Paré JF, Cotechini T, Hopman W, Hindmarch CCT, Ghaffari A, Marginean D, Chenard S, Koti M, Siemens DR. Innate immune memory is associated with increased disease-free survival in bladder cancer patients treated with bacillus Calmette-Guérin. Can Urol Assoc J 2021; 15:E412-E417. [PMID: 33410746 DOI: 10.5489/cuaj.7066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION While studies suggest that innate immune memory acquired by circulating monocytes may mediate the benefit of bacillus Calmette-Guérin (BCG) in the treatment of patients with high-risk non-muscle-invasive bladder cancer (NMIBC), prospective studies are lacking. Innate immune memory is defined by enhanced release of pro-inflammatory cytokines by innate immune cells following a secondary challenge with pattern recognition receptor (PRR) ligands. METHODS Peripheral blood monocytes isolated from 33 patients with intermediate- or high-risk NMIBC before and after two or five induction BCG instillations were stimulated with the PRR ligand lipopolysaccharide (LPS). Inflammatory cytokine levels in the culture medium were measured. Extent of innate immune memory acquisition was determined by dividing the levels of cytokines released after BCG instillation by the levels released prior to BCG therapy. RESULTS Monocytes secreted variable levels of TNFα, IL-1β, IL-6, IFNγ, IL-12, and IL-10. Compared with patients with recurrences, the post-BCG:pre-BCG ratio of IL-12 in monocyte cultures from patients without recurrences after five BCG instillations was significantly increased. Patients with no innate immune memory (based on IL-12 ratios) had significantly shorter time to recurrence than patients with innate immune memory (p<0.001). Eighty-four percent (16/19) of patients with innate immune memory vs. only 22% (2/9) of patients without memory had disease-free survival of over 500 days. CONCLUSIONS Results demonstrate a potential link between BCG-induced innate immune memory peripherally and local anti-tumor responses. Further validation will increase our understanding of the mode of action of BCG and, therefore, will be used to enhance its effectiveness.
Collapse
Affiliation(s)
- Charles H Graham
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Department of Urology, Queen's University, Kingston, ON, Canada
| | - Jean-François Paré
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Tiziana Cotechini
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Wilma Hopman
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Abdi Ghaffari
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Diana Marginean
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Stephen Chenard
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Department of Urology, Queen's University, Kingston, ON, Canada
| | - D Robert Siemens
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Department of Urology, Queen's University, Kingston, ON, Canada
| |
Collapse
|
23
|
Temiz MZ, Colakerol A, Ulus I, Kilic E, Paslanmaz F, Sahin S, Yuruk E, Kandirali E, Semercioz A, Muslumanoglu AY. Prediction of non-muscle-invasive bladder cancer recurrence during intravesical BCG immunotherapy by use of peripheral blood eosinophil count and percentage: a preliminary report. Cancer Immunol Immunother 2021; 70:245-252. [PMID: 32700089 DOI: 10.1007/s00262-020-02673-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine whether there is an association between blood eosinophil count and percentage with the recurrence of nonmuscle invasive bladder cancer (NMIBC) during Bacillus Calmette-Guérin (BCG) maintenance therapy with our preliminary results. METHODS A total of 53 patients with NMIBC underwent BCG immunotherapy between January 2015 and September 2018, and met our inclusion criteria were included in the study. The parameters age, gender, smoking status, comorbidity, blood neutrophil, lymphocyte and eosinophil counts, blood eosinophil percentage, previous single postoperative intravesical chemotherapy instillation, tumor characteristic, and total and maintenance dose numbers of BCG were extracted from our medical records and compared between patients with response and with recurrence. RESULTS Blood eosinophil count and percentage were significantly higher in patients with recurrence compared to patients with response (0.263 ± 0.37 vs. 0.0134 ± 0.021, p = 0.01 and 0.31 ± 0.29 vs. 0.17 ± 0.27, p = 0.01). Other parameters were similar in patients with recurrence and response. Receiver-operating characteristic analysis showed a considerable diagnostic value of blood eosinophil count and percentage in the prediction of bladder cancer recurrence during BCG immunotherapy. CONCLUSION Blood eosinophil count and percentage in patients with NMIBC can predict the disease recurrence during the BCG immunotherapy. Our research raised new questions and assumptions about the role of eosinophils during BCG immunotherapy.
Collapse
Affiliation(s)
- Mustafa Zafer Temiz
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey.
| | - Aykut Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey
| | - Ismail Ulus
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey
| | - Enes Kilic
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey
| | - Filip Paslanmaz
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey
| | - Sergen Sahin
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey
| | - Emrah Yuruk
- Department of Urology, University of Health Sciences/Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey
| | - Engin Kandirali
- Department of Urology, University of Health Sciences/Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, University of Health Sciences/Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey
| | - Ahmet Yaser Muslumanoglu
- Department of Urology, University of Health Sciences/Bagcilar Training and Research Hospital, Merkez Mh, Dr. Sadık Ahmet Caddesi, Bagcilar, 34100, Istanbul, Turkey
| |
Collapse
|
24
|
Chiancone F, Fabiano M, Fedelini M, Meccariello C, Carrino M, Fedelini P. Outcomes and complications of Hyperthermic IntraVesical Chemotherapy using mitomycin C or epirubicin for patients with non-muscle invasive bladder cancer after bacillus Calmette-Guérin treatment failure. Cent European J Urol 2020; 73:287-294. [PMID: 33133655 PMCID: PMC7587473 DOI: 10.5173/ceju.2020.0148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Chemohyperthermia is a feasible option in BCG (bacillus Calmette-Guérin) failure patients who desire bladder preservation. We aimed to assess outcomes and complications of chemohyperthermia using mitomycin C (MMC) or epirubicin (EPI). Material and methods From March 2017 to February 2020, 103 BCG failure or intolerance patients with high-risk NMIBC (non-muscle invasive bladder cancer) underwent a hyperthermic intravesical chemotherapy (HIVEC) regimen. Five patients did not complete at least 5 instillations and were excluded from analysis. MMC was used in 72 out of 98 patients (Group A) while EPI was used in 26 patients (Group B). Response to HIVEC, predictive factors for treatment outcome and the disease-free survival (DFS) were defined as primary endpoints. The complications of chemohyperthermia were assessed as a secondary endpoint. Results No significant differences were found in recurrence and progression after induction course between Groups A and B. Kaplan-Meier disease-free survival was 22.61 months in Group A and 21.93 in Group B. The log-rank test showed no statistically significant difference between the two curves (p = .627). In the multivariate analysis, patients with tumor size ≥3 cm (p = .029), recurrence rate >1/year (p = .034), concomitant carcinoma in situ (CIS) during transurethral resection of bladder (TURB) (p = .039) and BCG-unresponsive status (p = .048) were associated with a worse response to chemohyperthermia. The use of MMC or EPI did not influence the response to treatment (p = .157). A slightly significant higher rate of overall complications (p = .0488) was observed in Group B. A significantly higher rate of Grade 3 frequency/urgency (p = .0064) contributed to this difference. The use of EPI was the only independent factor associated with severe urinary frequency/urgency (p = .017). No patients experienced Grade 4/5 adverse events. Conclusions HIVEC can be considered a feasible option in BCG failure/intolerant NMIBC patients, avoiding or postponing radical cystectomy in some particular subclasses of patients.
Collapse
Affiliation(s)
| | - Marco Fabiano
- AORN A. Cardarelli, Department of Urology, Naples, Italy
| | | | | | | | - Paolo Fedelini
- AORN A. Cardarelli, Department of Urology, Naples, Italy
| |
Collapse
|
25
|
Sayed A, Munir M, Eweis N, Wael D, Shazly O, Awad AK, Elbadawy MA, Eissa S. An overview on precision therapy in bladder cancer. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2020.1801346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ahmed Sayed
- Faculty of Medicine, Undergraduate Medical Students, Ain Shams University, Cairo, Egypt
| | - Malak Munir
- Faculty of Medicine, Undergraduate Medical Students, Ain Shams University, Cairo, Egypt
| | - Noor Eweis
- Faculty of Medicine, Undergraduate Medical Students, Ain Shams University, Cairo, Egypt
| | - Doaa Wael
- Faculty of Medicine, Undergraduate Medical Students, Ain Shams University, Cairo, Egypt
| | - Omar Shazly
- Faculty of Medicine, Undergraduate Medical Students, Ain Shams University, Cairo, Egypt
| | - Ahmed K. Awad
- Faculty of Medicine, Undergraduate Medical Students, Ain Shams University, Cairo, Egypt
| | - Marihan A. Elbadawy
- Faculty of Medicine, Undergraduate Medical Students, Ain Shams University, Cairo, Egypt
| | - Sanaa Eissa
- Faculty of Medicine, Professor of Medical Biochemistry and Molecular Biology, Ain Shams University, Cairo, Egypt
| |
Collapse
|
26
|
Carando R, Soldini E, Cotrufo S, Zazzara M, Ludovico GM. Electro-mediated drug administration of mitomycin C in preventing non-muscle-invasive bladder cancer recurrence and progression after transurethral resection of the bladder tumour in intermediate- and high-risk patients. Arab J Urol 2020; 19:71-77. [PMID: 33763251 PMCID: PMC7954506 DOI: 10.1080/2090598x.2020.1816150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To evaluate the effectiveness of electro-mediated drug administration of mitomycin C (EMDA/MMC) after transurethral resection of the bladder tumour (TURBT) in preventing non-muscle-invasive bladder cancer (NMIBC) recurrence and progression and to explore clinical and demographic factors associated with treatment response. Patients and methods Between April 2016 and August 2019, 112 patients diagnosed with intermediate- or high-risk NMIBC underwent a TURBT followed by an EMDA/MMC treatment. The percentage of treatment responders and progression-free survivors at 3 and 6 months were evaluated. Results Follow-up data were available for 101 patients (90%) at 3 months and 92 (82%) at 6 months. Response rates to EMDA/MMC treatment were 85% at 3 months and 75% at 6 months, and progression-free rates were 94% and 90%, respectively. No statistically significant differences were seen between intermediate- and high-risk patients. A higher risk of tumour recurrence and progression was associated with previous Bacillus Calmette–Guérin (BCG) failure. According to the Clavien–Dindo classification, only low-grade complications were observed. Conclusions EMDA/MMC after TURBT was associated with high response and progression-free rates at 3 and 6 months, with only low-grade adverse events. These results confirm the efficacy and safety of EMDA/MMC as a therapeutic option for both intermediate- and high-risk patients. However, patients with BCG failure responded poorly to EMDA/MMC. Abbreviations: ACCI: age-adjusted Charlson Comorbidity Index; CHT: chemohyperthermia; CIS: carcinoma in situ; EMDA: electro-mediated drug administration; EORTC: European Organisation for Research and Treatment of Cancer; IQR: interquartile range; (N)MIBC: (non-)muscle-invasive bladder cancer; MMC: mitomycin C; OR, odds ratio; TURBT: transurethral resection of the bladder tumour
Collapse
Affiliation(s)
- Roberto Carando
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland.,Clinica Luganese Moncucco, Lugano, Switzerland.,Clinica S. Anna, Sorengo, Switzerland.,Clinica S. Chiara, Locarno, Switzerland
| | - Emiliano Soldini
- Department of Business Economics, Health and Social Care, Research Methodology Competence Centre, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Simone Cotrufo
- Department of Urology, Ospedale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Michele Zazzara
- Department of Urology, Ospedale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Giuseppe M Ludovico
- Department of Urology, Ospedale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| |
Collapse
|
27
|
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: 42] [Impact Index Per Article: 10.5] [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.
Collapse
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
| |
Collapse
|
28
|
Abstract
OBJECTIVE Colon cancer is a great health concern worldwide, as it is the second leading cause of cancer-related death. Conventional treatment of cancer such as surgery, radiotherapy, and chemotherapy are faced with limitations and side effects. Therefore, strategies for the treatment of cancer need to be modified or new strategies replacing the old one. AIMS The aim of this study is to review the role of bacteria or their products (such as peptides, bacteriocins, and toxins) as a therapeutic agent for colon cancer. RESULTS AND CONCLUSION Recently, the therapeutic role of bacteria and their products in colon cancer treatment holds promise as emerging novel anti-cancer agents. Unlike the conventional treatments, targeted therapy based on the use of bacteria that are able to directly target tumor cells without affecting normal cells is evolving as an alternative strategy. Moreover, several bacterial species were used in live, attenuated or genetically modified that are able to multiply selectively in tumors and inhibiting their growth.
Collapse
|
29
|
Rao MY, Kang P, Tarajkowski JC, Mobley DL, Lamm DL. Salvage Hyperthermic Gemcitabine and Docetaxel Combination Chemotherapy After BCG Failure in Non-Muscle Invasive Bladder Cancer Patients. Bladder Cancer 2020. [DOI: 10.3233/blc-190245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Bacillus Calmette-Guerin (BCG) is the recommended therapy for high and intermediate risk non-muscle invasive bladder cancer (NMIBC), but treatment failure is common. While a radical cystectomy is recommended after BCG failure, some patients desire bladder preservation and others are poor surgical candidates. Salvage chemotherapy treatments may be offered to this subgroup of patients. OBJECTIVE: To assess if combination, hyperthermic Gemcitabine and Docetaxel chemotherapy (GEM/DOCE) is a safe and effective salvage option for treating NMIBC. METHODS: Sixty patients who received our GEM/DOCE protocol between 2007–2017 were identified (51 BCG failures, 9 BCG naïve). This study measured overall treatment success, defined as no recurrence, progression, cystectomy, nor death due to bladder cancer. Kaplan-Meier curves were used to ascertain probability of treatment success. The log-rank test was used to identify factors associated with treatment success. RESULTS: Sixty patients received treatment with a median follow-up of 14.9 months. All patients completed the induction course with no significant adverse effects. Overall treatment success was 83% at first surveillance, 69% at 1 year, and 55% at 2 years in the entire cohort, and 90% at first surveillance, 74% at 1 year, and 56% at 2 years in the BCG-failure patients. All-cause and bladder-cancer-specific survival were both 97.9% at 1 year, 85.9% and 94.6% respectively at 2 years. Three patients underwent cystectomy at a median of 10.2 months, two of these were secondary to recurrences. Three patients had progression of their disease. CONCLUSIONS: Hyperthermic GEM/DOCE seems to be a well-tolerated salvage regimen that demonstrates a reasonable efficacy and warrants further investigation.
Collapse
Affiliation(s)
- Mounica Y. Rao
- University of Arizona College of Medicine- Phoenix, Phoenix, AZ, USA
| | - Paul Kang
- University of Arizona College of Medicine- Phoenix, Phoenix, AZ, USA
| | | | | | - Donald L. Lamm
- University of Arizona College of Medicine- Phoenix, Phoenix, AZ, USA
- BCG Oncology, Phoenix, AZ, USA
| |
Collapse
|
30
|
Daniels MJ, Barry E, Milbar N, Schoenberg M, Bivalacqua TJ, Sankin A, Kates M. An evaluation of monthly maintenance therapy among patients receiving intravesical combination gemcitabine/docetaxel for nonmuscle-invasive bladder cancer. Urol Oncol 2020; 38:40.e17-40.e24. [DOI: 10.1016/j.urolonc.2019.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/20/2019] [Accepted: 07/27/2019] [Indexed: 12/22/2022]
|
31
|
Daniels MJ, Barry E, Schoenberg M, Lamm DL, Bivalacqua TJ, Sankin A, Kates M. Contemporary oncologic outcomes of second induction course BCG in patients with nonmuscle invasive bladder cancer. Urol Oncol 2020; 38:5.e9-5.e16. [DOI: 10.1016/j.urolonc.2019.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022]
|
32
|
Yaghoubi A, Khazaei M, Hasanian SM, Avan A, C. Cho W, Soleimanpour S. Bacteriotherapy in Breast Cancer. Int J Mol Sci 2019; 20:E5880. [PMID: 31771178 PMCID: PMC6928964 DOI: 10.3390/ijms20235880] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the second most common cause of cancer-related mortality among women around the world. Conventional treatments in the fight against breast cancer, such as chemotherapy, are being challenged regarding their effectiveness. Thus, strategies for the treatment of breast cancer need to be continuously refined to achieve a better patient outcome. We know that a number of bacteria are pathogenic and some are even associated with tumor development, however, recent studies have demonstrated interesting results suggesting some bacteria may have potential for cancer therapy. Therefore, the therapeutic role of bacteria has aroused attention in medical and pharmaceutical studies. Furthermore, genetic engineering has been used in bacterial therapy and may led to greater efficacy with few side effects. Some genetically modified non-pathogenic bacterial species are more successful due to their selectivity for cancer cells but with low toxicity for normal cells. Some live, attenuated, or genetically modified bacterias are capable to multiply in tumors and inhibit their growth. This article aims to review the role of bacteria and their products including bacterial peptides, bacteriocins, and toxins for the treatment of breast cancer.
Collapse
Affiliation(s)
- Atieh Yaghoubi
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad 91387-35499, Iran;
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91387-35499, Iran
| | - Majid Khazaei
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9138735499, Iran;
| | - Seyed Mahdi Hasanian
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical, Sciences, Mashhad 91387-35499, Iran;
| | - Amir Avan
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad 91387-35499, Iran;
| | - William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Saman Soleimanpour
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad 91387-35499, Iran;
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91387-35499, Iran
| |
Collapse
|
33
|
Jack S, Madhivanan K, Ramadesikan S, Subramanian S, Edwards DF, Elzey BD, Dhawan D, McCluskey A, Kischuk EM, Loftis AR, Truex N, Santos M, Lu M, Rabideau A, Pentelute B, Collier J, Kaimakliotis H, Koch M, Ratliff TL, Knapp DW, Aguilar RC. A novel, safe, fast and efficient treatment for Her2-positive and negative bladder cancer utilizing an EGF-anthrax toxin chimera. Int J Cancer 2019; 146:449-460. [PMID: 31584195 DOI: 10.1002/ijc.32719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/10/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
Bladder cancer is the sixth most common cancer in the United States, and it exhibits an alarming 70% recurrence rate. Thus, the development of more efficient antibladder cancer approaches is a high priority. Accordingly, this work provides the basis for a transformative anticancer strategy that takes advantage of the unique characteristics of the bladder. Unlike mucin-shielded normal bladder cells, cancer cells are exposed to the bladder lumen and overexpress EGFR. Therefore, we used an EGF-conjugated anthrax toxin that after targeting EGFR was internalized and triggered apoptosis in exposed bladder cancer cells. This unique agent presented advantages over other EGF-based technologies and other toxin-derivatives. In contrast to known agents, this EGF-toxin conjugate promoted its own uptake via receptor microclustering even in the presence of Her2 and induced cell death with a LC50 < 1 nM. Furthermore, our data showed that exposures as short as ≈3 min were enough to commit human (T24), mouse (MB49) and canine (primary) bladder cancer cells to apoptosis. Exposure of tumor-free mice and dogs with the agent resulted in no toxicity. In addition, the EGF-toxin was able to eliminate cells from human patient tumor samples. Importantly, the administration of EGF-toxin to dogs with spontaneous bladder cancer, who had failed or were not eligible for other therapies, resulted in ~30% average tumor reduction after one treatment cycle. Because of its in vitro and in vivo high efficiency, fast action (reducing treatment time from hours to minutes) and safety, we propose that this EGF-anthrax toxin conjugate provides the basis for new, transformative approaches against bladder cancer.
Collapse
Affiliation(s)
- Sherwin Jack
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Biological Sciences, Purdue University, West Lafayette, IN
| | - Kayalvizhi Madhivanan
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Biological Sciences, Purdue University, West Lafayette, IN
| | - Swetha Ramadesikan
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Biological Sciences, Purdue University, West Lafayette, IN
| | - Sneha Subramanian
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Biological Sciences, Purdue University, West Lafayette, IN
| | - Daniel F Edwards
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Biological Sciences, Purdue University, West Lafayette, IN
| | - Bennett D Elzey
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Comparative Pathobiology, Purdue University, West Lafayette, IN.,Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Deepika Dhawan
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN
| | | | - Erin M Kischuk
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Comparative Pathobiology, Purdue University, West Lafayette, IN
| | - Alexander R Loftis
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA
| | - Nicholas Truex
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA
| | - Michael Santos
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA
| | - Mike Lu
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA
| | - Amy Rabideau
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA
| | - Bradley Pentelute
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA.,Koch Institute MIT, Cambridge, MA.,Broad Institute of Harvard and MIT, Cambridge, MA.,Center for Environmental Health Sciences MIT, Cambridge, MA
| | - John Collier
- Department of Microbiology, Harvard Medical School, Boston, MA
| | | | - Michael Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy L Ratliff
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Comparative Pathobiology, Purdue University, West Lafayette, IN
| | - Deborah W Knapp
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN
| | - Ruben C Aguilar
- Purdue University Center for Cancer Research, West Lafayette, IN.,Department of Biological Sciences, Purdue University, West Lafayette, IN
| |
Collapse
|
34
|
Wang TW, Yuan H, Diao WL, Yang R, Zhao XZ, Guo HQ. Comparison of gemcitabine and anthracycline antibiotics in prevention of superficial bladder cancer recurrence. BMC Urol 2019; 19:90. [PMID: 31615492 PMCID: PMC6794870 DOI: 10.1186/s12894-019-0530-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Because of the failure, shortage and related toxicities of Bacillus Calmette-Guérin (BCG), the other intravesical chemotherapy drugs are also widely used in clinical application. Gemcitabine and anthracycline antibiotics (epirubicin and pirarubicin) are widely used as first-line or salvage therapy, but which drug is better is less discussed. Methods A total of 124 primary NMIBC patients administered intravesical therapy after transurethral resection of bladder tumor (TURBT) at Nanjing Drum Tower hospital from January 1996 to July 2018. After TURBT, all patients accepted standard intravesical chemotherapy. Recurrence was defined as the occurrence of a new tumor in the bladder. Progression was defined as confirmed tumor invading muscular layer. Treatment failure was defined as need for radical cystectomy (RC), systemic chemotherapy and radiation therapy. Results Of the 124 patients who underwent intravesical chemotherapy, 84 patients were given gemcitabine, 40 patients were given epirubicin or pirarubicin, with mean follow-up times (mean ± SD) of (34.8 ± 17.9) and (35.9 ± 22.1) months respectively. The clinical and pathological features of patients show no difference between two groups. Recurrence rate of patients given gemcitabine was 8.33% (7 out of 84), the recurrence rate was 45% (18 out of 40) for epirubicin or pirarubicin (P < 0.0001). The progression rates of gemcitabine, anthracycline antibiotics groups were 2.38% (2 out of 84) and 20% (8 out of 40), respectively (P < 0.001). The rate of treatment failure is 8.33% (7 out of 84) and 25% (10 out of 40), respectively (P = 0.012). Gemcitabine intravesical chemotherapy group was significantly related to a lower rate of recurrence (HR = 0.165, 95% CI 0.069–0.397, P = 0.000), progression (HR = 0.160, 95% CI 0.032–0.799, P = 0.026) and treatment failure (HR = 0.260, 95% CI 0.078–0.867, P = 0.028). Conclusion In conclusion, gemcitabine intravesical chemotherapy group was significantly related to a lower rate of recurrence, progression and treatment failure. Gemcitabine could be considered as a choice for these patients who are not suitable for BCG.
Collapse
Affiliation(s)
- Tian-Wei Wang
- Nanjing Medical University, 101 Longmian Rd, Nanjing, 211166, China
| | - Hui Yuan
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Wen-Li Diao
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Rong Yang
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Xiao-Zhi Zhao
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Hong-Qian Guo
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, China.
| |
Collapse
|
35
|
Mucopenetration and biocompatibility of polydopamine surfaces for delivery in an Ex Vivo porcine bladder. J Control Release 2019; 300:161-173. [DOI: 10.1016/j.jconrel.2019.02.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 11/13/2022]
|
36
|
Alhunaidi O, Zlotta AR. The use of intravesical BCG in urothelial carcinoma of the bladder. Ecancermedicalscience 2019; 13:905. [PMID: 30915163 PMCID: PMC6411413 DOI: 10.3332/ecancer.2019.905] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 02/04/2023] Open
Abstract
The high recurrence and progression rates of non-muscle invasive bladder cancer (NMIBC) have led investigators to study the use of intravesical therapy in order to prevent them. Bacillus Calmette–Guérin (BCG) has been successfully used for this indication to treat NMIBC for more than four decades. BCG is the only intravesical agent shown to reduce the risk of progression of NMIBC to muscle-invasive disease. Despite over 40 years of clinical use, the precise mechanism of action for what has often been considered the most successful cancer immunotherapy in humans remains largely unknown. Unfortunately, BCG therapy is not a universal panacea and it still fails in up to 40% of patients. Many of these patients, especially in the high-risk category (T1 high-grade disease, carcinoma in situ) will require aggressive therapy like cystectomy or in selected cases, bladder-sparing options like chemo-radiation. Indeed, there is no gold standard intravesical treatment after BCG failure.
Collapse
Affiliation(s)
- Omar Alhunaidi
- Department of Surgical Oncology, Division of Urology, University of Toronto and University Health Network, Toronto, ON M5G 1L7, Canada.,Department of Surgery, Division of Urology, Al-Amiri Hospital, Kuwait City, PO Box 4077, Safat 13041, Kuwait
| | - Alexandre R Zlotta
- Department of Surgical Oncology, Division of Urology, University of Toronto and University Health Network, Toronto, ON M5G 1L7, Canada.,Department of Surgery (Urology), Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| |
Collapse
|
37
|
Plote D, Choi W, Mokkapati S, Sundi D, Ferguson JE, Duplisea J, Parker NR, Yla-Herttuala S, Committee SCB, McConkey D, Schluns KS, Dinney CP. Inhibition of urothelial carcinoma through targeted type I interferon-mediated immune activation. Oncoimmunology 2019; 8:e1577125. [PMID: 31069136 PMCID: PMC6493227 DOI: 10.1080/2162402x.2019.1577125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/04/2019] [Accepted: 01/24/2019] [Indexed: 12/26/2022] Open
Abstract
Type I interferon (IFN-I) has potent anti-tumor effects against urothelial carcinoma (UC) and may be an alternative treatment option for patients who do not respond to Bacillus Calmette-Guerin. However, the mechanisms that mediate the IFN-I-stimulated immune responses against UC have yet to be elucidated. Herein, we evaluated the anti-tumor mechanisms of IFN-I in UC in human patients and in mice. Patient tumors from a Phase I clinical trial with adenoviral interferon-α (Ad-IFNα/Syn3) showed increased expression of T cell and checkpoint markers following treatment with Ad-IFNα/Syn3 by RNAseq and immunohistochemistry analysis in 25% of patients. In mice, peritumoral injections of poly(I:C) into MB49 UC tumors was used to incite an IFN-driven inflammatory response that significantly inhibited tumor growth. IFN-I engaged both innate and adaptive cells, seen in increased intratumoral CD8 T cells, NK cells, and CD11b+Ly6G+ cells, but tumor inhibition was not reliant on any one immune cell type. Nonetheless, poly(I:C)-mediated tumor regression and change in the myeloid cell landscape was dependent on IL-6. Mice were also treated with poly(I:C) in combination with anti-PD-1 monoclonal antibody (mAb) to assess for additional benefit to tumor growth and animal survival. When used in combination with anti-PD-1 mAb, IFN-I stimulation prolonged survival, coinciding with inhibition of angiogenesis and enriched gene signatures of metabolism, extracellular matrix organization, and MAPK/AKT signaling. Altogether, these findings suggest IFN-I's immune-driven antitumor response in UC is mediated by IL-6 and a collaboration of immune cells, and its use in combination with checkpoint blockade therapy can increase clinical benefit.
Collapse
Affiliation(s)
- Devin Plote
- Cancer Biology Graduate Program, The University of Texas MD Anderson Cancer Center; University of Texas Health Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Woonyoung Choi
- James Buchanan Brady Urological Institute, Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Sharada Mokkapati
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debasish Sundi
- Department of Urology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - James E Ferguson
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jon Duplisea
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Seppo Yla-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - David McConkey
- James Buchanan Brady Urological Institute, Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Kimberly S Schluns
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Colin P Dinney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
38
|
Jallad S, Thomas P, Newport MJ, Kern F. Baseline Cytokine Profiles of Tuberculin-Specific CD4 + T Cells in Non-Muscle-Invasive Bladder Cancer May Predict Outcomes of BCG Immunotherapy. Cancer Immunol Res 2018; 6:1212-1219. [PMID: 30120103 DOI: 10.1158/2326-6066.cir-18-0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/08/2018] [Accepted: 08/08/2018] [Indexed: 11/16/2022]
Abstract
Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy preserves the bladder after resection of high-risk non-muscle-invasive bladder cancer (NMIBC). About 30% of patients experience treatment failure, which cannot be predicted a priori and carries a high risk of disease progression. We examined the in vitro tuberculin responsiveness of CD4+ T cells before BCG immunotherapy in 42 patients with high-risk NMIBC. The frequencies and functionalities of cytokine-expressing CD4+ T cells immediately before and after BCG immunotherapy induction were assessed by flow cytometry after overnight tuberculin stimulation. Tuberculin-induced secreted mediators were measured by electrochemiluminescence. We correlated the results with recurrence-free patient survival 6 months after induction. A tuberculin-induced, secreted, IL2 concentration > 250 pg/mL was the best predictor of recurrence-free survival, providing 79% sensitivity, 86% specificity (AUC = 0.852, P = 0.000), and overall correct classification in 78.6% of cases. In 50% of patients later experiencing recurrence, but not in any of the recurrence-free survivors, IL2 secretion was < 120 pg/mL. Other parameters predicting recurrence-free survival included secreted IFNγ (AUC = 0.796, P = 0.002) and the frequencies of TNF-producing (TNF+) CD4+ T cells (AUC = 0.745, P = 0.010). "Polyfunctional" CD4+ T cells (IFNγ+/IL2+/TNF+) were significantly associated with recurrence-free survival (AUC = 0.801, P = 0.002). Thus, the amount of IL2 secretion from CD4+ T cells after overnight in vitro incubation with tuberculin predicted the outcome of BCG immunotherapy. As many as half of potential BCG failures could be identified before induction therapy is begun, enabling better choices regarding treatment. Cancer Immunol Res; 6(10); 1212-9. ©2018 AACR.
Collapse
Affiliation(s)
- Samer Jallad
- Department of Urology, Imperial College Healthcare NHS Trust, London, United Kingdom.,Department of Urology, Brighton and Sussex University Hospital Trust (BSUH), Brighton, United Kingdom
| | - Philip Thomas
- Department of Urology, Brighton and Sussex University Hospital Trust (BSUH), Brighton, United Kingdom
| | - Melanie J Newport
- Department of Global Health and Infectious Diseases, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Florian Kern
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom.
| |
Collapse
|
39
|
Yılmaz Y, Kahya MC, Dilek FH, Köse O, Özcan S, Can E, Akın Y, Ergani B, Dindar AS. Can tumor recurrence be reduced with plasma-kinetic vaporization of the area around the tumor in nonmuscle invasive bladder cancer? Investig Clin Urol 2018; 59:223-231. [PMID: 29984336 PMCID: PMC6028467 DOI: 10.4111/icu.2018.59.4.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/03/2018] [Indexed: 01/21/2023] Open
Abstract
Purpose To investigate the effect on recurrence of vaporization of the tumor surroundings and suspicious areas with a plasma-kinetic (PK) system after transurethral resection (TUR) of nonmuscle invasive bladder cancer. Materials and Methods The study included 121 patients with a primary superficial bladder tumor who were randomized as those who underwent TUR with the PK system (Group 1, n=62) and those who underwent TUR with the monopolar system (Group 2, n=59). The vaporization procedure was performed by suppressing the cutting option of the PK system for a period, which would accumulate energy sufficient to make swelling-waves on the mucosa very close to the area of the loop to be vaporized. Results A total of 121 patients who met the study criteria were included for evaluation. Recurrence was determined in 21 patients in Group 1 (33.87%) and in 29 patients in Group 2 (49.15%) (p=0.088). Recurrence was close to the old resection site in 6 of 21 patients in Group 1, and in 13 patients in Group 2 (p=0.028); the difference was statistically significant. No statistically significant difference was determined between the two groups with respect to age, gender, number of tumor foci, rate or range of additional treatments applied, cigarette smoking rate, repeat TUR rate and rate of tumor en- countered in repeat TUR, T-stage, and tumor grade. Conclusions The effect of vaporization on recurrence by the PK system may seem similar to the effect of standard TUR, the recurrence- lowering effect surrounding nonmuscle invasive bladder cancers is better.
Collapse
Affiliation(s)
- Yüksel Yılmaz
- Department of Urology, İzmir Katip Çelebi University, İzmir, Turkey
| | | | | | - Osman Köse
- Department of Urology, İzmir Katip Çelebi University, İzmir, Turkey
| | - Serkan Özcan
- Department of Urology, İzmir Katip Çelebi University, İzmir, Turkey
| | - Ertan Can
- Department of Urology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Yiğit Akın
- Department of Urology, İzmir Katip Çelebi University, İzmir, Turkey
| | - Batuhan Ergani
- Department of Urology, Tepecik Education and Research Hospital, İzmir, Turkey
| | | |
Collapse
|
40
|
Teke K, Yilmaz H, Uslubas AK, Akpinar G, Kasap M, Mutlu O, Yildiz DK, Guzel N, Dillioglugil O. Histopathologic and molecular comparative analyses of intravesical Aurora kinase-A inhibitor Alisertib with bacillus Calmette-Guérin on precancerous lesions of bladder in a rat model. Int Urol Nephrol 2018; 50:1417-1425. [PMID: 29931492 DOI: 10.1007/s11255-018-1914-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/13/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Recent studies have shown that Aurora-A expression is associated with bladder cancer initiation and progression. In this study, the effects of intravesical Aurora-A inhibitor Alisertib (ALS) and bacillus Calmette-Guérin (BCG) were compared on bladder carcinogenesis. METHODS Two mg N-Methyl-N-nitrosourea was administered intravesically to forty of Wistar-albino rats every other week for 8 weeks. At week 10, rats were divided into four groups (10/group): No-treatment (vehicle), ALS-alone, BCG-alone, and ALS + BCG. The intravesical treatment of ALS, BCG, and ALS plus BCG was performed once a week for 6 weeks. At week 16, bladders were collected for immunohistopathological and Western blot analysis. The cell cycle regulators p53, p21, Aurora-A, phosphorylated Aurora-A (p-Aurora-A), and apoptotic marker cleavage of poly [ADP-ribose] polymerase (c-PARP) were determined by Western blot. RESULTS Histopathologically relatively healthy urothelium was observed in ALS + BCG group (87.5%) compared to the ALS-alone (50%) and the BCG-alone (50%) groups. The lowest expression of p21 and p53 was detected in the BCG-alone, while the highest level of expression was evident in no-treatment group. The ALS treatment alone caused a slight decrease in Aurora-A while there was a dramatic decrease in p-Aurora-A in comparison to no-treatment group. In overall combined treatment with ALS + BCG significantly increased c-PARP compared to all mono-treatments, and decreased all cell cycle parameters compared to no-treatment group. CONCLUSIONS Although intravesical ALS treatment has similar antiproliferative effects like BCG, ALS + BCG combined treatment led to a best histopathologic and apoptotic response. Consequently, BCG combined with Aurora-A inhibition may provide a new intravesical treatment modality in the prevention of bladder carcinogenesis.
Collapse
Affiliation(s)
- Kerem Teke
- Department of Urology, Kocaeli University School of Medicine, 41380, Kocaeli, Turkey.
| | - Hasan Yilmaz
- Department of Urology, Kocaeli University School of Medicine, 41380, Kocaeli, Turkey
| | - Ali Kemal Uslubas
- Department of Urology, Kocaeli University School of Medicine, 41380, Kocaeli, Turkey
| | - Gurler Akpinar
- Department of Medical Biology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Murat Kasap
- Department of Medical Biology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Oguz Mutlu
- Department of Pharmacology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Demir Kursat Yildiz
- Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Nil Guzel
- Department of Medical Biology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ozdal Dillioglugil
- Department of Urology, Kocaeli University School of Medicine, 41380, Kocaeli, Turkey
| |
Collapse
|
41
|
Ceylan C, Yahşi S, Doğan S, ÖztÜrk E, Ceylan G. Emphasis of FAS/FASL gene polymorphism in patients with non-muscle invasive bladder cancer. Ir J Med Sci 2018; 187:1115-1119. [PMID: 29453645 DOI: 10.1007/s11845-018-1764-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bladder cancer (BCa) is the seventh most common cancer among males worldwide. Some reliable markers in blood, urine, and tumor tissue, including clinicopathologic variables, molecular and inflammatory markers, gene polymorphisms, and tumor gene expression profiles are identified for predicting response to BCG immunotherapy in high-risk BCa patients. AIMS We aimed to determine if FAS and FASL polymorphisms are associated with lack of response to BCG in patients with BCa. METHODS The study included patients with primary non-muscle invasive BCa that had undergone transurethral resection (TUR). Patient demographics, BCa characteristics, use of BCG immunotherapy, lack of response to BCG (if administered), BCa recurrence, and fatty acid synthetase/fatty acid syntethase ligand (FAS/FASL) polymorphisms were investigated. RESULTS The study included 127 patients with primary BCa. Mean age of the 107 (84.3%) male and 20 (15.7%) female patients was 59.3 ± 13.2 years. Among the patients that received BCG immunotherapy, more FAS homozygous patients had BCa recurrence than FAS polymorphism-negative patients (P < 0.001) and more patients with homozygote FASL polymorphisms had BCa recurrence than those with heterozygous FASL polymorphisms and no polymorphism. CONCLUSION Evaluation of FAS/FASL polymorphisms can predict lack of response to BCG immunotherapy and prevent the loss of valuable time before such alternative treatments as early cystectomy are initiated.
Collapse
Affiliation(s)
- Cavit Ceylan
- Yuksek Ihtisas Training and Research Hospital, Clinic of Urology, Health Sciences University, 06230, Ankara, Turkey
| | - Sedat Yahşi
- Yuksek Ihtisas Training and Research Hospital, Clinic of Urology, 06230, Ankara, Turkey
| | - Serkan Doğan
- Yuksek Ihtisas Training and Research Hospital, Clinic of Urology, 06230, Ankara, Turkey
| | - Elife ÖztÜrk
- Department of Medical Genetics, Ataturk Training and Research Hospital, 06800, Ankara, Turkey
| | - Gulay Ceylan
- Department of Medical Genetics, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey.
| |
Collapse
|
42
|
Shimizu T, Tomogane M, Miyashita M, Ukimura O, Ashihara E. Low dose gemcitabine increases the cytotoxicity of human Vγ9Vδ2 T cells in bladder cancer cells in vitro and in an orthotopic xenograft model. Oncoimmunology 2018; 7:e1424671. [PMID: 29721384 DOI: 10.1080/2162402x.2018.1424671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/11/2017] [Accepted: 01/02/2018] [Indexed: 01/05/2023] Open
Abstract
Human γδT cell immunotherapy is well tolerated and has shown promising results in clinical trials; however, its antitumor efficacy is limited, including results in solid tumors. Ex-vivo expanded γδT cell stimulated by zoledronic acid (ZOL) activates the γδT cell subpopulation of so called Vγ9Vδ2 T cells. To improve the clinical outcomes of Vγ9Vδ2 T cell (abbreviated as γδT cell here) immunotherapy, we aimed to increase the cytotoxicity of γδT cells by focusing on two issues: recognition of tumor cells by γδT cells and the effector (γδT cell)-to-target (tumor cell) (E/T) ratio. Ex vivo-expanded γδT cells showed potent cytotoxicity against urinary bladder cancer (UBC) cells in in vitro assays. Combination treatment with standard anticancer agents showed that low dose gemcitabine pretreatment significantly enhanced the cytotoxicity of γδT cells by upregulating the expression of MICA and MICB (MICA/B), which are tumor-associated antigens recognized by γδT cells. These effects were abrogated by small interfering RNA-mediated knockdown of MICA/B in UBC cells, suggesting that pre-exposing cancer cells to anticancer agents could be a promising strategy. A bladder instillation approach was used to increase the E/T ratio. The efficacy of ex vivo-expanded γδT cell immunotherapy was examined in an orthotopic xenograft model. In Vivo Imaging System analysis revealed the potent cytotoxicity of weekly intravesical administration of γδT cells, and weekly gemcitabine pretreatment enhanced the cytotoxicity of γδT cells in vivo. In conclusion, intravesical γδT cell immunotherapy and combination therapy with low dose gemcitabine may be a promising strategy in UBC.
Collapse
Affiliation(s)
- Teruki Shimizu
- Department of Clinical and Translational Physiology, Kyoto Pharmaceutical University, 5 Nakauchi, Yamashina-ku, Kyoto, Japan.,Department of Urology, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, Japan
| | - Mako Tomogane
- Department of Clinical and Translational Physiology, Kyoto Pharmaceutical University, 5 Nakauchi, Yamashina-ku, Kyoto, Japan
| | - Masatsugu Miyashita
- Department of Clinical and Translational Physiology, Kyoto Pharmaceutical University, 5 Nakauchi, Yamashina-ku, Kyoto, Japan.,Department of Urology, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, Japan
| | - Eishi Ashihara
- Department of Clinical and Translational Physiology, Kyoto Pharmaceutical University, 5 Nakauchi, Yamashina-ku, Kyoto, Japan
| |
Collapse
|
43
|
Kramer MG, Masner M, Ferreira FA, Hoffman RM. Bacterial Therapy of Cancer: Promises, Limitations, and Insights for Future Directions. Front Microbiol 2018; 9:16. [PMID: 29472896 PMCID: PMC5810261 DOI: 10.3389/fmicb.2018.00016] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/05/2018] [Indexed: 01/21/2023] Open
Abstract
Spontaneous tumors regression has been associated with microbial infection for 100s of years and inspired the use of bacteria for anticancer therapy. Dr. William B. Coley (1862-1936), a bone- sarcoma surgeon, was a pioneer in treating his patients with both live bacterial-based and mixture of heat-killed bacteria known as "Coley's toxins." Unfortunately, Coley was forced to stop his work which interrupted this field for about half a century. Currently, several species of bacteria are being developed against cancer. The bacterial species, their genetic background and their infectious behavior within the tumor microenvironment are thought to be relevant factors in determining their anti-tumor effectiveness in vivo. In this perspective article we will update the most promising results achieved using bacterial therapy (alone or combined with other strategies) in clinically-relevant animal models of cancer and critically discuss the impact of the bacterial variants, route of administration and mechanisms of bacteria-cancer-cell interaction. We will also discuss strategies to apply this information using modern mouse models, molecular biology, genetics and imaging for future bacterial therapy of cancer patients.
Collapse
Affiliation(s)
- M. Gabriela Kramer
- Department of Biotechnology, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Laboratory of Carbohydrates and Glycoconjugates, Department of Organic Chemistry, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Martín Masner
- Department of Biotechnology, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Fernando A. Ferreira
- Department of Biotechnology, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Laboratory of Carbohydrates and Glycoconjugates, Department of Organic Chemistry, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Robert M. Hoffman
- AntiCancer, Inc., San Diego, CA, United States
- Department of Surgery, University of California, San Diego, San Diego, CA, United States
| |
Collapse
|
44
|
Potts KG, Irwin CR, Favis NA, Pink DB, Vincent KM, Lewis JD, Moore RB, Hitt MM, Evans DH. Deletion of F4L (ribonucleotide reductase) in vaccinia virus produces a selective oncolytic virus and promotes anti-tumor immunity with superior safety in bladder cancer models. EMBO Mol Med 2017; 9:638-654. [PMID: 28289079 PMCID: PMC5412795 DOI: 10.15252/emmm.201607296] [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] [Indexed: 12/21/2022] Open
Abstract
Bladder cancer has a recurrence rate of up to 80% and many patients require multiple treatments that often fail, eventually leading to disease progression. In particular, standard of care for high-grade disease, Bacillus Calmette-Guérin (BCG), fails in 30% of patients. We have generated a novel oncolytic vaccinia virus (VACV) by mutating the F4L gene that encodes the virus homolog of the cell-cycle-regulated small subunit of ribonucleotide reductase (RRM2). The F4L-deleted VACVs are highly attenuated in normal tissues, and since cancer cells commonly express elevated RRM2 levels, have tumor-selective replication and cell killing. These F4L-deleted VACVs replicated selectively in immune-competent rat AY-27 and xenografted human RT112-luc orthotopic bladder cancer models, causing significant tumor regression or complete ablation with no toxicity. It was also observed that rats cured of AY-27 tumors by VACV treatment developed anti-tumor immunity as evidenced by tumor rejection upon challenge and by ex vivo cytotoxic T-lymphocyte assays. Finally, F4L-deleted VACVs replicated in primary human bladder cancer explants. Our findings demonstrate the enhanced safety and selectivity of F4L-deleted VACVs, with application as a promising therapy for patients with BCG-refractory cancers and immune dysregulation.
Collapse
Affiliation(s)
- Kyle G Potts
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Li Ka Shing Institute of Virology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Cancer Research Institute of Northern Alberta (CRINA), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chad R Irwin
- Li Ka Shing Institute of Virology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Cancer Research Institute of Northern Alberta (CRINA), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Medical Microbiology & Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nicole A Favis
- Li Ka Shing Institute of Virology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Cancer Research Institute of Northern Alberta (CRINA), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Medical Microbiology & Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Desmond B Pink
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Cancer Research Institute of Northern Alberta (CRINA), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Krista M Vincent
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Cancer Research Institute of Northern Alberta (CRINA), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Anatomy & Cell Biology, Faculty of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - John D Lewis
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Cancer Research Institute of Northern Alberta (CRINA), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ronald B Moore
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Cancer Research Institute of Northern Alberta (CRINA), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mary M Hitt
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Li Ka Shing Institute of Virology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Cancer Research Institute of Northern Alberta (CRINA), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David H Evans
- Li Ka Shing Institute of Virology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada .,Cancer Research Institute of Northern Alberta (CRINA), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Medical Microbiology & Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
45
|
Milbar N, Kates M, Chappidi MR, Pederzoli F, Yoshida T, Sankin A, Pierorazio PM, Schoenberg MP, Bivalacqua TJ. Oncological Outcomes of Sequential Intravesical Gemcitabine and Docetaxel in Patients with Non-Muscle Invasive Bladder Cancer. Bladder Cancer 2017; 3:293-303. [PMID: 29152553 PMCID: PMC5676758 DOI: 10.3233/blc-170126] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Bacillus Calmette-Guérin (BCG) unresponsive/relapsing patients with non-muscle invasive bladder cancer (NMIBC) who prefer bladder preservation over radical cystectomy (RC) or those who do not qualify for surgery may be offered intravesical therapies. Gemcitabine (GEM) combined with Docetaxel (DOCE) has been offered at Johns Hopkins Hospital (JHH). Objective To evaluate experience with GEM/DOCE, to confirm safety of the regimen, to identify populations that may benefit most, and to consider the appropriate endpoints for judging efficacy of second line therapies. Methods Thirty-three patients who received full induction GEM/DOCE since 2011, per the protocol adapted from U. Iowa, were identified and characterized. Multivariable logistic regression was used to determine factors associated with recurrence. Cox proportional hazard models evaluated risk factors for disease-free survival (DFS) and high-grade recurrence-free survival (HG-RFS). Results There were no serious adverse effects of therapy. Across all patients, median follow-up time was 18.6 months with a median DFS of 6.5 months, 42% 1-year, and 24% 2-year DFS. Median HG-RFS was 17.1 months with 56% 1-year and 42% 2-year HG-RFS. Among patients initially presenting with HG-NMIBC, 46% (13/28) had HG recurrence. BCG unresponsive/relapsing patients (N = 25) displayed 49% 1-year HG-RFS and 34% 2-year HG-RFS. In total, there were 5 LG and 16 HG recurrences, with 5 progressions and 8 cystectomies among these. Conclusions GEM/DOCE is a well-tolerated therapy that deserves further study as an alternative to immediate RC for highly selected patients with HG-NMIBC. BCG naïve patients responded more effectively than BCG unresponsive/relapsing patients. As anticipated, GEM/DOCE efficacy was improved for HG only patients.
Collapse
Affiliation(s)
- Niv Milbar
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Max Kates
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meera R Chappidi
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Takahiro Yoshida
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander Sankin
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark P Schoenberg
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
46
|
Zhang Y, Jia L, Zhang Y, Ji W, Li H. Higher expression of FOXOs correlates to better prognosis of bladder cancer. Oncotarget 2017; 8:96313-96322. [PMID: 29221208 PMCID: PMC5707102 DOI: 10.18632/oncotarget.22029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023] Open
Abstract
Background We aimed to explore the expression of forkhead box class O (FOXO) and relations between expressions of FOXOs and clinicopathological characteristics and prognosis of bladder cancer. Methods We enrolled a cohort of 276 patients with bladder cancer in our study. Expressions of FOXOs in bladder cancer tissue and adjacent tissue were measured by quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry (IHC). Correlations between expression of FOXOs and clinicopathological characteristics and prognosis were analyzed. The relationship between expression of FOXOs and survival time of patients with bladder cancer was analyzed by the Kaplan-Meier survival analysis and the Log-rank test; individual variables which may affect the prognosis of bladder cancer were detected by the Cox proportional hazard regression model. Results Compared with bladder cancer tissue, a higher expression of FOXOs was detected in paracancerous tissue. We found significant associations between histological grade and the expressions of FOXOs, clinical stage and the expressions of FOXOs, and lymph node metastasis and the expressions of FOXOs (all P < 0.05). When used for diagnosing bladder cancer, the mRNA expression of FOXO1/3/4 produced cut off values of 1.475, 1.305, and 1.295, respectively, exhibiting relatively high specificity and sensitivity. The Kaplan-Meier curves indicated that patients with a higher expression of FOXOs tended to have a longer overall survival than those with lower expression. The Cox regression analysis revealed that lymph node metastasis, high clinical stage, and low expression of FOXOs were independent risk factors for bladder cancer prognosis. Conclusion Our results indicate that the expression of FOXOs is closely correlated with clinicopathological characteristics and prognosis of bladder cancer.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun 130033, P.R. China
| | - Linpei Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing 100000, P.R. China
| | - Ying Zhang
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, P.R. China
| | - Wei Ji
- Department of Vascular Surgery, Jilin Provincial People's Hospital, Changchun 130000, P.R. China
| | - Hai Li
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun 130033, P.R. China
| |
Collapse
|
47
|
Association between Metabolic Syndrome and Recurrence of Nonmuscle Invasive Bladder Cancer following bacillus Calmette-Guérin Treatment. UROLOGY PRACTICE 2017; 5:132-138. [PMID: 29577063 DOI: 10.1016/j.urpr.2017.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Intravesical bacillus Calmette-Guérin (BCG) therapy is the gold standard adjuvant treatment for patients with high-grade non-muscle-invasive bladder cancer (NMIBC). Despite the association between metabolic syndrome (MetS) and bladder cancer, the association between MetS and BCG failure is unknown. The objective of this study was to characterize disease recurrence following BCG in patients with and without MetS. Methods We retrospectively evaluated the records of patients undergoing TURBT at our institution in 2012-2015 for NMIBC and identified those who received adjuvant BCG therapy. MetS was defined as having three of four components: diabetes mellitus, hyperlipidemia, hypertension, or body mass index (BMI)≥30kg/m2. The primary outcome was recurrence or progression. Descriptive statistics, chi-squared analysis, Kaplan-Meier survival analysis, and Cox multivariable regression analyses were performed. Results High grade was present in 83/90 (92.2%) patients. MetS was present in 27/90 (30%) patients. Median follow-up was 20 months. On Kaplan-Meier analysis, patients with MetS had worse DFS compared with patient without MetS. On multivariable analysis, BMI≥30 kg/m2 was a significant predictor of recurrence or progression (HR 2.94, 95% CI: 1.43-6.03). Presence of MetS did not significantly affect the type of BCG failure. Conclusions The association between MetS and failure to respond to BCG therapy is multifactorial but is in part associated with obesity. Elevated BMI is strongly associated with recurrence or progression. Further studies are warranted to investigate the relationship between increased adiposity and response to BCG, especially as other novel immunotherapeutic agents are likely to enter the NMIBC space.
Collapse
|
48
|
Sasaki H, Yoshiike M, Nozawa S, Usuba W, Katsuoka Y, Aida K, Kitajima K, Kudo H, Hoshikawa M, Yoshioka Y, Kosaka N, Ochiya T, Chikaraishi T. Expression Level of Urinary MicroRNA-146a-5p Is Increased in Patients With Bladder Cancer and Decreased in Those After Transurethral Resection. Clin Genitourin Cancer 2016; 14:e493-e499. [PMID: 27157639 DOI: 10.1016/j.clgc.2016.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/18/2016] [Accepted: 04/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bladder cancer is the most prevalent malignancy involving the urinary system and exhibits a markedly high recurrence rate. Therefore, reliable and noninvasive diagnostic and surveillance methods are desperately needed. PATIENTS AND METHODS Candidate microRNAs (miRNAs) were selected from the miRNAs that were differentially expressed in bladder cancer cell lines (T24 and RT4) compared to normal ureteral epithelial tissue using miRNA-microarray analysis. The candidate miRNAs were validated by quantitative reverse transcription polymerase chain reaction assay using voided urine samples. RESULTS We identified 3 miRNAs (miR-301b, -563, and -146a-5p) that demonstrated > 2-fold higher expression levels in cancer cell lines than in the normal ureteral epithelial tissue. Of these, only miR-146a-5p was consistently and significantly higher in urine samples from the patients with bladder cancer than in those from the normal individuals (P = .0014). The patients with high-grade tumors exhibited significantly higher urinary miR-146a-5p levels than those with low-grade tumors, and the patients with invasive tumors tended to show higher urinary miR-146a-5p levels than those with noninvasive tumors. Elevated urinary miR-146a-5p levels in patients with bladder cancer were decreased to the normal level after transurethral resection of the tumors (P = .0214). CONCLUSION Our study suggested that urinary miR-146a-5p might be useful as a new noninvasive diagnostic marker, therapeutic target, or anticancer agent for bladder cancer, as well as for increasing our understanding of cancer biology.
Collapse
Affiliation(s)
- Hideo Sasaki
- Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
| | - Miki Yoshiike
- Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shiari Nozawa
- Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Wataru Usuba
- Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yuichi Katsuoka
- Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kouichirou Aida
- Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kazuki Kitajima
- Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroya Kudo
- Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahiro Hoshikawa
- Department of Pathology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yusuke Yoshioka
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Nobuyoshi Kosaka
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Takahiro Ochiya
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Tatsuya Chikaraishi
- Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| |
Collapse
|
49
|
The Role of Interferon in the Management of BCG Refractory Nonmuscle Invasive Bladder Cancer. Adv Urol 2015; 2015:656918. [PMID: 26550012 PMCID: PMC4621325 DOI: 10.1155/2015/656918] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/20/2015] [Indexed: 12/02/2022] Open
Abstract
Background. Thirty to forty percent of patients with high grade nonmuscle invasive bladder cancer (NMIBC) fail to respond to intravesical therapy with bacillus Calmette-Guerin (BCG). Interferon-α2B plus BCG has been shown to be effective in a subset of patients with NMIBC BCG refractory disease. Here we present a contemporary series on the effectiveness and safety of intravesical BCG plus interferon-α2B therapy in patients with BCG refractory NMIBC. Methods. From January of 2005 to April of 2014 we retrospectively found 44 patients who underwent induction with combination IFN/BCG for the management of BCG refractory NMIBC. A chart review was performed to assess initial pathological stage/grade, pathological stage/grade at the time of induction, time to IFN/BCG failure, pathological stage/grade at failure, postfailure therapy, and current disease state. Results. Of the 44 patients who met criteria for the analysis. High risk disease was found in 88.6% of patients at induction. The 12-month and 24-month recurrence-free survival were 38.6% and 18.2%, respectively. 25 (56.8%) ultimately had disease recurrence. Radical cystectomy was performed in 16 (36.4%) patients. Conclusion. Combination BCG plus interferon-α2B remains a reasonably safe alternative treatment for select patients with BCG refractory disease prior to proceeding to radical cystectomy.
Collapse
|
50
|
Cheng C, Varn FS, Marsit CJ. E2F4 Program Is Predictive of Progression and Intravesical Immunotherapy Efficacy in Bladder Cancer. Mol Cancer Res 2015; 13:1316-24. [PMID: 26032289 PMCID: PMC4734892 DOI: 10.1158/1541-7786.mcr-15-0120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/19/2015] [Indexed: 11/16/2022]
Abstract
UNLABELLED Bladder cancer is a common malignant disease, with non-muscle-invasive bladder cancer (NMIBC) representing the majority of tumors. This cancer subtype is typically treated by transurethral resection. In spite of treatment, up to 70% of patients show local recurrences. Intravesical BCG (Bacillus Calmette-Guerin) immunotherapy has been widely used to treat NMIBC, but it fails to suppress recurrence of bladder tumors in up to 40% of patients. Therefore, the development of prognostic markers is needed to predict the progression of bladder cancer and the efficacy of intravesical BCG treatment. This study demonstrates the effectiveness of an E2F4 signature for prognostic prediction of bladder cancer. E2F4 scores for each sample in a bladder cancer expression dataset were calculated by summarizing the relative expression levels of E2F4 target genes identified by ChIP-seq, and then the scores were used to stratify patients into good- and poor-outcome groups. The molecular signature was investigated in a single bladder cancer dataset and then its effectiveness was confirmed in two meta-bladder datasets consisting of specimens from multiple independent studies. These results were consistent in different datasets and demonstrate that the E2F4 score is predictive of clinical outcomes in bladder cancer, with patients whose tumors exhibit an E2F4 score >0 having significantly shorter survival times than those with an E2F4 score <0, in both non-muscle-invasive, and muscle-invasive bladder cancer. Furthermore, although intravesical BCG immunotherapy can significantly improve the clinical outcome of NMIBC patients with positive E2F4 scores (E2F4>0 group), it does not show significant treatment effect for those with negative scores (E2F4<0 group). IMPLICATIONS The E2F4 signature can be applied to predict the progression/recurrence and the responsiveness of patients to intravesical BCG immunotherapy in bladder cancer.
Collapse
Affiliation(s)
- Chao Cheng
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Institute for Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | - Frederick S Varn
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Carmen J Marsit
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| |
Collapse
|