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Lewerich J, Schmid SC, Gschwend JE, Retz M. [Value of immunotherapy in the perioperative treatment of localized muscle invasive bladder cancer]. Urologie 2023; 62:279-287. [PMID: 36449033 PMCID: PMC9998310 DOI: 10.1007/s00120-022-01983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 12/03/2022]
Abstract
Immune checkpoint inhibitors are standard of care in the treatment of metastatic and locally advanced urothelial cancer. Their use in perioperative treatment is currently under investigation as monotherapy as well as in combination with chemotherapy or radiation regimens. This article provides an overview of recent trials, current data as well as an outlook on future developments in the perioperative management of urothelial cancer.
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Affiliation(s)
- J Lewerich
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland. .,Interdisziplinare Arbeitsgruppe BlasenCarcinom (IABC) der DKG e. V., Deutsche Krebsgesellschaft, Berlin, Deutschland.
| | - S C Schmid
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.,Interdisziplinare Arbeitsgruppe BlasenCarcinom (IABC) der DKG e. V., Deutsche Krebsgesellschaft, Berlin, Deutschland
| | - J E Gschwend
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.,Interdisziplinare Arbeitsgruppe BlasenCarcinom (IABC) der DKG e. V., Deutsche Krebsgesellschaft, Berlin, Deutschland
| | - M Retz
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.,Interdisziplinare Arbeitsgruppe BlasenCarcinom (IABC) der DKG e. V., Deutsche Krebsgesellschaft, Berlin, Deutschland
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2
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Schmid SC, Lewerich J, Retz M, Rödel C. ["Surgery only" is not enough: potential of multimodal therapy in urothelial bladder carcinoma]. Urologie 2022; 61:1332-1340. [PMID: 36352266 DOI: 10.1007/s00120-022-01963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Using perioperative cisplatin-based chemotherapy, 5‑year overall survival rates are 5% higher with neoadjuvant chemotherapy compared to local therapy alone. New multimodal concepts have been developed to improve oncologic efficacy and to reduce treatment-related morbidity. Perioperative use of checkpoint inhibitors aims at improving efficacy, while bladder-preserving concepts try to avoid cystectomy in good responders. This article reviews new developments in radioimmunotherapy and perioperative combination therapies as well as bladder-preserving concepts like trimodal bladder therapy.
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Affiliation(s)
- S C Schmid
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - J Lewerich
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - M Retz
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - Claus Rödel
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum der Goethe-Universität Frankfurt, Frankfurt, Deutschland
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Koshkin V, Powles T, Iyer G, Loriot Y, Drakaki A, Duran Martinez I, De Santis M, Retz M, Jain R, Chan S, Ichimaru M, Galsky M. 1779TiP Phase II clinical study evaluating the efficacy and safety of disitamab vedotin in patients (pts) with HER2-expressing urothelial carcinoma (RC48G001). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Tauber R, Retz M, Knorr K, D’Alessandria C, Grigorascu S, Hansen K, Wester HJ, Gschwend J, Weber W, Eiber M, Langbein T. 1414P Treatment efficacy and safety of 177Lu-PSMA radioligand therapy in octogenarians with metastatic castration-resistant prostate cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Yu E, Park S, Goh J, Shin S, Mehra N, McDermott R, Sala Gonzalez M, Fong P, Greil R, Retz M, Sade J, Huang YH, Begbie S, Rey F, Kramer G, Suzuki H, Zhang J, Kim J, Poehlein C, Antonarakis E. 1362MO Pembrolizumab + olaparib vs abiraterone (abi) or enzalutamide (enza) for patients (pts) with previously treated metastatic castration-resistant prostate cancer (mCRPC): Randomized open-label phase III KEYLYNK-010 study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Schmid S, Schiller K, Seitz A, Koll F, Beckert F, Korn P, Lewerich J, Maisch P, Sauter A, Rödel C, Flentje M, Riedel T, Combs S, Zengerling F, Bolenz C, Kübler H, Gschwend J, Retz M. RACE IT - A prospective, single arm, multicenter, phase II-trial to assess safety and efficacy of preoperative RAdiation therapy before radical CystEctomy combined with ImmunoTherapy in locally advanced urothelial carcinoma of the bladder (AB 65/18). Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Petrylak D, Perez-Gracia J, Lacombe L, Bastos D, Mahammedi H, Kwan E, Zschäbitz S, Armstrong A, Pachynski R, Goh J, Burotto M, Gravis G, McCune S, Vázquez Limón J, Retz M, Saad F, Amin N, Li J, Unsal-Kacmaz K, Fizazi K. 579MO CheckMate 9KD cohort A2 final analysis: Nivolumab (NIVO) + rucaparib for chemotherapy (CT)-naïve metastatic castration-resistant prostate cancer (mCRPC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1092] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Rexer H, Grimm MO, Retz M. Neoadjuvante Therapieschemen kombiniert mit adjuvanter Therapie bei muskelinvasivem Blasenkrebs vor bzw. nach radikaler Zystektomie. Aktuelle Urol 2021; 52:428-429. [PMID: 34428822 DOI: 10.1055/a-1533-7750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H. Rexer
- AUO Geschäftsstelle, Seestr. 11, 17252 Schwarz
| | - M-O. Grimm
- Leiter der klinischen Prüfung (LKP), Universitätsklinikum Jena, Klinik und Poliklinik für Urologie, Am Klinikum 1, 07747 Jena
| | - M. Retz
- Organgruppensprecherin der Arbeitsgemeinschaft Urologische Onkologie in der Deutschen Krebsgesellschaft e. V., Kuno-Fischer-Str. 8, 14057 Berlin
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Heinzelbecker J, Spieler N, Kühn M, Fischer C, Volkmer B, Von Rundstedt FC, Albers P, Becht E, Bannowsky A, Weber H, Hofmann R, Müller M, Langbein S, Steiner G, Retz M, Kamradt J, Wellek S, Lehmann J, Stöckle M. Adjuvant vs. progression-triggered treatment with gemcitabine after radical cystectomy in platinum-ineligible patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (AUO-AB 22-00): Long-term follow-up of a randomized multicenter phase 3 trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01203-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rexer H, Retz M, Kramer M. Erstlinientherapie beim lokal fortgeschrittenen oder metastasierten Urothelkarzinom. Aktuelle Urol 2021; 52:28-29. [PMID: 33525026 DOI: 10.1055/a-1252-8608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- H. Rexer
- AUO Geschäftsstelle, Seestr. 11, 17252 Schwarz
| | - M. Retz
- Organgruppensprecherin der Arbeitsgemeinschaft Urologische Onkologie in der Deutschen Krebsgesellschaft e. V., Kuno-Fischer-Str. 8, 14057 Berlin
| | - M. Kramer
- Leiter der klinischen Prüfung (LKP) in Deutschland, Universitätsklinikum Lübeck, Klinik für Urologie, Ratzeburger Allee 160, 23538 Lübeck
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Joshua A, Gurney H, Retz M, Tafreshi A, Fong P, Shore N, Romano E, Augustin M, Piulats J, Berry W, Kolinsky M, Sridhar S, Conter H, Todenhöfer T, Appleman L, Wu H, Schloss C, Poehlein C, de Bono J, Yu E. 217O Pembrolizumab (pembro) combination therapies in patients with metastatic castration-resistant prostate cancer (mCRPC): Cohorts A-C of the phase Ib/II KEYNOTE-365 study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Romano E, Sridhar S, Kolinsky M, Gravis G, Mourey L, Piulats J, Berry W, Gurney H, Retz M, Appleman L, Boegemann M, de Bono J, Joshua A, Emmenegger U, Conter H, Laguerre B, Wu H, Qiu P, Schloss C, Yu E. 620P Pembrolizumab (pembro) plus docetaxel and prednisone in patients with abiraterone acetate (abi)- or enzalutamide (enza)–pretreated metastatic castration-resistant prostate cancer (mCRPC): KEYNOTE-365 cohort B update. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mourey L, Conter H, Shore N, Berry W, Fong P, Piulats J, Appleman L, Todenhöfer T, Gravis G, Laguerre B, Gurney H, Retz M, Romano E, de Bono J, Kam A, Emmenegger U, Wu H, Qiu P, Schloss C, Yu E. 625P Pembrolizumab (pembro) plus enzalutamide (enza) in patients with abiraterone acetate (abi)-pretreated metastatic castration-resistant prostate cancer (mCRPC): KEYNOTE-365 Cohort C update. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Gravis G, Kolinsky M, Mourey L, Piulats J, Sridhar S, Romano E, Berry W, Gurney H, Retz M, Appleman L, Boegemann M, De Bono J, Joshua A, Emmenegger U, Conter H, Laguerre B, Wu H, Schloss C, Poehlein C, Yu E. KEYNOTE-365 cohort B updated results: Pembrolizumab (pembro) plus docetaxel and prednisone in abiraterone (abi) or enzalutamide (enza) pre-treated patients with metastatic castration-resistant prostate cancer (mCRPC). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Horwich A, Babjuk M, Bellmunt J, Bruins HM, De Reijke TM, De Santis M, Gillessen S, James N, Maclennan S, Palou J, Powles T, Ribal MJ, Shariat SF, Van Der Kwast T, Xylinas E, Agarwal N, Arends T, Bamias A, Birtle A, Black PC, Bochner BH, Bolla M, Boormans JL, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Chiti A, Choudhury A, Compérat E, Crabb S, Culine S, De Bari B, DeBlok W, De Visschere PJL, Decaestecker K, Dimitropoulos K, Dominguez-Escrig JL, Fanti S, Fonteyne V, Frydenberg M, Futterer JJ, Gakis G, Geavlete B, Gontero P, Grubmüller B, Hafeez S, Hansel DE, Hartmann A, Hayne D, Henry AM, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa BA, Jones R, Kamat AM, Khoo V, Kiltie AE, Krege S, Ladoire S, Lara PC, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Carmen Mir M, Moschini M, Mostafid H, Müller AC, Müller CR, N'Dow J, Necchi A, Neuzillet Y, Oddens JR, Oldenburg J, Osanto S, Oyen WJG, Pacheco-Figueiredo L, Pappot H, Patel MI, Pieters BR, Plass K, Remzi M, Retz M, Richenberg J, Rink M, Roghmann F, Rosenberg JE, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk RJ, Smits A, Stenzl A, Thalmann GN, Tombal B, Turkbey B, Vahr Lauridsen S, Valdagni R, Van Der Heijden AG, Van Poppel H, Vartolomei MD, Veskimäe E, Vilaseca A, Vives Rivera FA, Wiegel T, Wiklund P, Williams A, Zigeuner R, Witjes JA. EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees†. Ann Oncol 2019; 30:1697-1727. [PMID: 31740927 PMCID: PMC7360152 DOI: 10.1093/annonc/mdz296] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. SETTING Online Delphi survey and consensus conference. PARTICIPANTS The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.
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Affiliation(s)
- A Horwich
- Emeritus Professor, The Institute of Cancer Research, London, UK; Emeritus Professor, The Institute of Cancer Research, London, UK.
| | - M Babjuk
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - J Bellmunt
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Harvard Medical School, Boston, USA
| | - H M Bruins
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - T M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - M De Santis
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Charité University Hospital, Berlin, Germany
| | - S Gillessen
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Division of Oncology and Haematology, Kantonsspital St Gallen, St Gallen; University of Bern, Bern, Switzerland
| | - N James
- University Hospitals Birmingham NHS Foundation Trust, Birmingham; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
| | - S Maclennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - J Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Powles
- The Royal Free NHS Trust, London; Barts Cancer Institute, Queen Mary University of London, London, UK
| | - M J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - S F Shariat
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York; Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - T Van Der Kwast
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris; Paris Descartes University, Paris, France
| | - N Agarwal
- Huntsman Cancer Institute, University of Utah (NCI-CCC), Salt Lake City, USA
| | - T Arends
- Urology Department, Canisius-Wilhelmina Ziekenhuis Nijmegen, Nijmegen, The Netherlands
| | - A Bamias
- 2nd Propaedeutic Dept of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - A Birtle
- Division of Cancer Sciences, University of Manchester, Manchester; Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK
| | - P C Black
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - B H Bochner
- Department of Urology, Weill Cornell Medical College, New York; Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M Bolla
- Emeritus Professor of Radiation Oncology, Grenoble - Alpes University, Grenoble, France
| | - J L Boormans
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - A Briganti
- Department of Urology, Urological Research Institute, Milan; Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - I Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - M Burger
- Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - D Castellano
- Medical Oncology Department, 12 de Octubre University Hospital (CIBERONC), Madrid, Spain
| | - R Cathomas
- Department Innere Medizin, Abteilung Onkologie und Hämatologie, Kantonsspital Graubünden, Chur, Switzerland
| | - A Chiti
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy
| | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - E Compérat
- Department of Pathology, Tenon Hospital, HUEP, Paris; Sorbonne University, Paris, France
| | - S Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - S Culine
- Department of Cancer Medicine, Hôpital Saint Louis, Paris
| | - B De Bari
- Radiation Oncology Department, Centre Hospitalier Régional Universitaire "Jean Minjoz" of Besançon, INSERM UMR 1098, Besançon, France; Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
| | - W DeBlok
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P J L De Visschere
- Department of Radiology and Nuclear Medicine, Division of Genitourinary Radiology and Mammography, Ghent University Hospital, Ghent
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - K Dimitropoulos
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - J L Dominguez-Escrig
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - S Fanti
- Department of Nuclear Medicine, Policlinico S Orsola, University of Bologna, Bologna, Italy
| | - V Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
| | - M Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - J J Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Gakis
- Department of Urology and Paediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Würzburg, Germany
| | - B Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - P Gontero
- Division of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy
| | - B Grubmüller
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D E Hansel
- Department of Urology, University of California, San Diego Pathology, La Jolla, USA
| | - A Hartmann
- Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - D Hayne
- Department of Urology, UWA Medical School, University of Western Australia, Perth, Australia
| | - A M Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - V Hernandez
- Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - H Herr
- Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - K Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Centre for Cancer Treatment, London, UK
| | - J Huguet
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - R Jones
- Institute of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - A M Kamat
- Department of Urology - Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, USA
| | - V Khoo
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Medicine, University of Melbourne, Melbourne; Monash University, Melbourne, Australia
| | - A E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - S Krege
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - S Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - P C Lara
- Department of Oncology, Hospital Universitario San Roque, Canarias; Universidad Fernando Pessoa, Canarias, Spain
| | - A Leliveld
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - V Løgager
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - A Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Y Loriot
- Département de Médecine Oncologique, Gustave Roussy, INSERM U981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - R Meijer
- UMC Utrecht Cancer Center, MS Oncologic Urology, Utrecht, The Netherlands
| | - M Carmen Mir
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - M Moschini
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - H Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - A-C Müller
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
| | - C R Müller
- Cancer Treatment Centre, Sorlandet Hospital, Kristiansand, Norway
| | - J N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - A Necchi
- Department of Medical Oncology, Istituto Nazionale Tumori of Milan, Milan, Italy
| | - Y Neuzillet
- Department of Urology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - J R Oddens
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Osanto
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - W J G Oyen
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - L Pacheco-Figueiredo
- Department of Urology, Centro Hospitalar São João, Porto; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - M I Patel
- Department of Urology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - B R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam
| | - K Plass
- EAU Guidelines Office, Arnhem, The Netherlands
| | - M Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - M Retz
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - J Richenberg
- Department of Imaging and Nuclear Medicine, Royal Sussex County Hospital, Brighton; Brighton and Sussex Medical School, Brighton, UK
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - F Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | - J E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York, USA
| | - M Rouprêt
- Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - O Rouvière
- Hospices Civils de Lyon, Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Lyon; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - C Salembier
- Department of Radiation Oncology, Europe Hospitals Brussels, Brussels, Belgium
| | - A Salminen
- Department of Urology, University Hospital of Turku, Turku, Finland
| | - P Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - S Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne; Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - A Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - R J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Smits
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - A Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - G N Thalmann
- Department of Urology, Inselspital, Bern University Hospital, Berne, Switzerland
| | - B Tombal
- Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | - B Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, USA
| | - S Vahr Lauridsen
- Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - R Valdagni
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - H Van Poppel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - M D Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - E Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - A Vilaseca
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - F A Vives Rivera
- Clinica HematoOncologica Bonadona Prevenir, Universidad Metropolitana, Clinica Club de Leones, Barranquilla, Colombia
| | - T Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - P Wiklund
- Icahn School of Medicine, Mount Sinai Health System, New York City, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - A Williams
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - R Zigeuner
- Department of Urology, Medizinische Universität Graz, Graz, Austria
| | - J A Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen
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Tauber R, Feuerecker B, Knorr K, Beheshti A, Seidl C, D’Alessandria C, Bruchertseifer F, Retz M, Gschwend J, Weber W, Morgenstern A, Eiber M. Safety and efficacy of Ac-225-PSMA-617 in metastatic castration resistant prostate cancer (mCRPC) after failure of Lu-177-PSMA. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
BACKGROUND Beside the classical anticancer treatment tumor patients try to find proactive alternative therapies to fight their disease. Lifestyle changes such as introducing a ketogenic diet is one of the most popular among them. The German Association of Urological Oncology (AUO, Arbeitsgemeinschaft Urologische Onkologie) presents a systematic review investigating the evidence of ketogenic diet in cancer patients. MATERIALS AND METHODS A systematic literature research was conducted in the databases Medline, Livivo, and the Cochrane Library. Only clinical studies of tumor patients receiving chemotherapy while on a ketogenic diet were included. The assessment of the results was performed according to the predefined primary endpoints overall survival and progression-free survival and secondary endpoints quality of life and reduction of adverse effects induced by cytostatics. RESULTS Nine studies met the inclusion criteria: eight prospective and one retrospective study case series respectively cohort-studies, with a total of 107 patients. Currently there is no evidence of a therapeutic effect of a ketogenic diet in patients with malignant tumors regarding the clinical outcome or quality of life. CONCLUSION Based on the current data, a ketogenic diet can not be recommended to cancer patients because prospective, randomized trials are missing.
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Affiliation(s)
- P Maisch
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland. .,Arbeitsgemeinschaft Urologische Onkologie (AUO) der Deutschen Krebsgesellschaft e. V, Berlin, Deutschland.
| | - J E Gschwend
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.,Arbeitsgemeinschaft Urologische Onkologie (AUO) der Deutschen Krebsgesellschaft e. V, Berlin, Deutschland
| | - M Retz
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.,Arbeitsgemeinschaft Urologische Onkologie (AUO) der Deutschen Krebsgesellschaft e. V, Berlin, Deutschland
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Rexer H, Retz M, Waller C. Erstlinientherapie beim unbehandelten nicht resektablen oder metastasierten Urothelkarzinom: Eine offene, randomisierte, Phase-III Studie zu Nivolumab in Kombination mit Ipilimumab oder mit Standardchemotherapie gegenüber Standard-Chemotherapie bei Patienten mit bisher unbehandeltem inoperablen oder metastasierten Urothelkarzinom (CheckMate-901) – AB 59/17 der AUO. Aktuelle Urol 2019; 50:20-21. [PMID: 30731500 DOI: 10.1055/a-0790-9608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H Rexer
- AUO Geschäftsstelle, Seestr. 11, 17252 Schwarz
| | - M Retz
- Organgruppensprecher der Arbeitsgemeinschaft Urologische Onkologie in der Deutschen Krebsgesellschaft e. V., Kuno-Fischer-Str. 8, 14057 Berlin
| | - C Waller
- Leiter der klinischen Prüfung (LKP), Uniklinikum Freiburg, Klinik für Innere Medizin I, Hugstetter Str. 55, 79106 Freiburg
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Tauber R, Knorr K, Schwaiger S, Retz M, Maurer T, D'Alessandria C, Wester HJ, Gschwend J, Weber W, Schwaiger M, Heck M, Eiber M. Clinical experience with 100 consecutive patients treated with Lu-177-labeled PSMA-I&T radioligand therapy for metastatic castration-resistant prostate cancer: Final analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bellmunt J, Eigl BJ, Senkus E, Loriot Y, Twardowski P, Castellano D, Blais N, Sridhar SS, Sternberg CN, Retz M, Pal S, Blumenstein B, Jacobs C, Stewart PS, Petrylak DP. Borealis-1: a randomized, first-line, placebo-controlled, phase II study evaluating apatorsen and chemotherapy for patients with advanced urothelial cancer. Ann Oncol 2018; 28:2481-2488. [PMID: 28961845 DOI: 10.1093/annonc/mdx400] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Five-year survival of patients with inoperable, advanced urothelial carcinoma treated with the first-line chemotherapy is 5%-15%. We assessed whether the Hsp27 inhibitor apatorsen combined with gemcitabine plus cisplatin (GC) could improve overall survival (OS) in these patients. Patients and methods This placebo-controlled, double-blind, phase II trial randomized 183 untreated urothelial carcinoma patients (North America and Europe) to receive GC plus either placebo (N = 62), 600 mg apatorsen (N = 60), or 1000 mg apatorsen (N = 61). In the experimental arm, treatment included loading doses of apatorsen followed by up to six cycles of apatorsen plus GC. Patients receiving at least four cycles could continue apatorsen monotherapy as maintenance until progression or unacceptable toxicity. The primary end point was OS. Results OS was not significantly improved in the single or combined 600- or 1000-mg apatorsen arms versus placebo [hazard ratio (HR), 0.86 and 0.90, respectively]. Exploratory study of specific statistical modeling showed a trend for improved survival in patients with baseline poor prognostic features treated with 600 mg apatorsen compared with placebo (HR = 0.72). Landmark analysis of serum Hsp27 (sHsp27) levels showed a trend toward survival benefit for poor-prognosis patients in 600- and 1000-mg apatorsen arms who achieved lower area under the curve sHsp27 levels, compared with the placebo arm (HR = 0.45 and 0.62, respectively). Higher baseline circulating tumor cells (≥5 cells/7.5 ml) was observed in patients with poor prognosis in correlation with poor survival. Treatment-emergent adverse events were manageable and more common in both apatorsen-treatment arms. Conclusions Even though apatorsen combined with standard chemotherapy did not demonstrate a survival benefit in the overall study population, patients with poor prognostic features might benefit from this combination. Serum Hsp27 levels may act as a biomarker to predict treatment outcome. Further exploration of apatorsen in poor-risk patients is warranted.
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Affiliation(s)
- J Bellmunt
- Department of Medical Oncology, Hospital del Mar-IMIM, Barcelona, Spain; and Dana Farber Cancer Institute/Harvard Medical School, Boston.
| | - B J Eigl
- British Columbia Cancer Agency, Vancouver, Canada
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Y Loriot
- Medical Oncolgy, Centre Hospitalier Universitaire, Institut Gustave Roussy, Villejuif, France
| | - P Twardowski
- Medical Oncology, City of Hope National Medical Center, Duarte, USA
| | - D Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre (CiberOnc), Madrid, Spain
| | - N Blais
- Department of Medicine, Centre Hospitalier Universitaire de Montréal, Hospital Notre-Dame, Montreal
| | - S S Sridhar
- Medical Oncology, Princess Margaret Hospital, Toronto, Canada
| | - C N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - M Retz
- Department of Urology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - S Pal
- Medical Oncology, City of Hope National Medical Center, Duarte, USA
| | | | - C Jacobs
- OncoGenex Pharmaceuticals Inc., Bothell
| | | | - D P Petrylak
- Department of Medical Oncology, Yale University School of Medicine, New Haven, USA
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Retz M, Bardenheuer HJ. [Supportive therapy, best supportive care, and palliative medicine]. Urologe A 2018; 57:530-531. [PMID: 29744546 DOI: 10.1007/s00120-018-0640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M Retz
- Urologische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, München, Deutschland.
| | - H J Bardenheuer
- Klinik für Anästhesiologie , Überregionales Zentrum für Schmerztherapie und Palliativmedizin , Universitäre Palliativmedizin Krhs. St. Vincentius, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 131, 69120, Heidelberg, Deutschland.
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Maisch P, Gschwend JE, Retz M. Unzureichende Studienergebnisse und fehlender positiver klinischer Nutzen der ketogenen Diät. Urologe A 2018; 57:607-608. [DOI: 10.1007/s00120-018-0638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Horn T, Krege S, Retz M. [Advanced bladder cancer : From chemo- to immunotherapy]. Urologe A 2018; 57:686-692. [PMID: 29637216 DOI: 10.1007/s00120-018-0626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In November 2016, the results of a phase III clinical trial with the protein cell death (PD)-1 inhibitor pembrolizumab for second-line treatment of metastatic urothelial carcinoma were published and showed an overall survival benefit in comparison with conventional chemotherapy with vinflunine, docetaxel, or paclitaxel. In a similar trial the PD-L1 antibody atezolizumab showed no significant benefit in comparison to chemotherapy in the subgroup of PD-L1-positive patients and, thus, missed its primary endpoint. For other PD-1/PD-L1 directed substances, large phase I/II trials reported data concerning response rates and overall survival. This substance class will most likely become the new treatment standard in second-line treatment of metastatic urothelial cancer. Currently, PD-1/PD-L1 inhibitors are also being tested within randomized phase III trials for first-line treatment using different approaches either as a monotherapy or a combination with conventional chemotherapy or cytotoxic T‑lymphocyte-associated protein (CTLA)-4 inhibitors. Whereas data from single-arm phase II clinical trials have already been published, preliminary phase III data are expected in 2018.
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Affiliation(s)
- T Horn
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland.
| | - S Krege
- Abteilung für Urologie, Kinderurologie und Urologische Onkologie, Klinikum Essen-Mitte, Henricistraße 92, 45136, Essen, Deutschland
| | - M Retz
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland
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Heck M, Schwaiger S, Knorr K, Retz M, Maurer T, Janssen F, D`Alessandria C, Wester HJ, Gschwend J, Schwaiger M, Tauber R, Eiber M. Radioligand therapy with Lutetium 177-labeled PSMA-I&T for metastatic castration-resistant prostate cancer: Clinical experience with 100 consecutive patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31442-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rexer H, Ohlmann CH, Retz M. Erstlinientherapie beim lokal fortgeschrittenen oder metastasierten Urothelkarzinom: Eine randomisierte, kontrollierte Phase-III-Studie zum Vergleich von Pembrolizumab mit und ohne platinbasierter Kombinations-Chemotherapie und der alleinigen Chemotherapie bei Patienten mit fortgeschrittenem oder metastasiertem Urothelkarzinom (Keynote-361) AB 54/16 der AUO. Aktuelle Urol 2018; 49:21-22. [PMID: 29390213 DOI: 10.1055/s-0043-125341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H. Rexer
- AUO Geschäftsstelle, Seestr. 11, 17252 Schwarz,
| | - C.-H. Ohlmann
- Organgruppe Blasenkarzinom der Arbeitsgemeinschaft Urologische Onkologie in der Deutschen Krebsgesellschaft e. V., Kuno-Fischer-Str. 8, 14057 Berlin
| | - M. Retz
- Leiterin der klinischen Prüfung (LKP), TU München, Klinikum r. d. I., Urologische Klinik und Poliklinik, Ismaninger Str. 22, 81675 München
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Retz M, Bedke J, Herrmann E, Grimm MO, Zimmermann U, Müller L, Leiber C, Teber D, Wirth M, Bolenz C, van Alphen R, De Santis M, Beeker A, Frank M, Gschwend J. Phase III randomized, sequential, open-label study to evaluate the efficacy and safety of sorafenib-pazopanib versus pazopanib-sorafenib in the treatment of metastatic renal cell carcinoma (SWITCH-II). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Radioligand therapy (RLT) directed against prostate-specific membrane antigen (PSMA) enables tumor-specific treatment directed against PSMA-overexpressing prostate cancer cells. Several PSMA ligands such as PSMA-617 or PSMA-I&T have been developed that can be labeled with β‑radiating lutetium-177. These are currently applied in compassionate use programs to treat metastatic castration-resistant prostate cancer (mCRPC). PSMA-directed RLT is currently being offered in several nuclear medicine departments throughout Germany. Several retrospective case series demonstrate its activity with a prostate-specific antigen (PSA) decrease >50% in 30-60% of mCRPC patients. The toxicity seems to be low. Hematologic grade 4 toxicity has not been observed and grade 3 toxicities rarely occur. The main nonhematologic adverse events are intermittent dry mouth because of unspecific PSMA expression in the salivary glands as well as fatigue and nausea. Currently there are no prospective studies available for evaluation of PSMA-targeted RLT and a survival benefit over approved standard therapies such as abiraterone, enzalutamide, radium-223-dichloride, docetaxel or cabazitaxel has not been shown. PSMA-targeted RLT should therefore currently only be offered after critical evaluation in patients who exhausted the approved standard therapies.
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Affiliation(s)
- M M Heck
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - M Retz
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - R Tauber
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - K Knorr
- Institut für Nuklearmedizin, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - C Kratochwil
- Radiologische Klinik und Poliklinik, Abteilung Nuklearmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - M Eiber
- Institut für Nuklearmedizin, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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Rexer H, Ohlmann CH, Retz M. [First-line therapy for locally advanced or metastatic urothelial carcinoma : A randomized, controlled phase III trial comparing pembrolizumab with or without platinum-based combination chemotherapy and chemotherapy only in patients with advanced or metastatic urothelial carcinoma (keynote 361-AB 54/16 of the AUO)]. Urologe A 2017; 56:659-661. [PMID: 28349185 DOI: 10.1007/s00120-017-0380-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H Rexer
- AUO Geschäftsstelle, Seestr. 11, 17252, Schwarz, Deutschland.
| | - C-H Ohlmann
- Organgruppe Blasenkarzinom, Arbeitsgemeinschaft Urologische Onkologie in der Deutschen Krebsgesellschaft e.V., Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland
| | - M Retz
- Klinische Prüfung (LKP), TU München, Klinikum r. d. I., Ismaninger Str. 22, 81675, München, Deutschland
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Erlmeier F, Seitz AK, Hatzichristodoulou G, Stecher L, Retz M, Gschwend JE, Weichert W, Kübler HR, Horn T. The Role of PD-L1 Expression and Intratumoral Lymphocytes in Response to Perioperative Chemotherapy for Urothelial Carcinoma. Bladder Cancer 2016; 2:425-432. [PMID: 28035323 PMCID: PMC5181663 DOI: 10.3233/blc-160067] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Immunological pathways are relevant for the effectiveness of conventional cytotoxic chemotherapy. Recently, checkpoint inhibition of the PD-1/PD-L1 axis has been shown to be therapeutically relevant in urothelial carcinoma. Objective: To monitor PD-L1 expression on tumor cells and intratumoral infiltration with CD8 positive lymphocytes during perioperative chemotherapy for urothelial cancer and to evaluate their use as potential predictive markers for chemotherapy. Patients and Methods: Sixty-four patients with muscle-invasive urothelial cancer were included in the analysis. Twenty-two patients received preoperative chemotherapy and 42 were treated in an adjuvant setting for locally advanced disease or lymph node metastases. PD-L1 status and the density of infiltration with CD8-positive cells were assessed by immunohistochemistry and analysed for their association with survival (adjuvant group) and response to chemotherapy (preoperative group). For PD-L1 positivity we used a cutoff of 10% positive tumor cells. Results: In the adjuvant group, 11 of 42 patients (26.2%) had PD-L1 positive tumor cells. Twenty-six of 42 (61.9%) patients were highly infiltrated with CD8 + lymphocytes. There was no significant evidence of an association with overall survival for PD-L1 status nor for CD8 infiltration density (p = 0.63 and 0.71). In the preoperative group, eight of the 22 (36.4%) patients were PD-L1 positive and 13 (59%) were highly infiltrated with CD8 + lymphocytes before chemotherapy. There was no evidence of associations with response or survival. Eight patients showed a pathological response to preoperative treatment. These had a significantly longer overall survival than non-responders (p = 0.01). In the preoperative group the pre-treatment expression of the immunologic markers could be compared to the post-treatment status. Only one patient showed a changed PD-L1 status and three patients a changed CD8 status. Conclusions: The tumoral expression of PD-L1 in urothelial carcinoma does not seem to be largely influenced by chemotherapy. Our data do not provide evidence that tumoral expression of PD-L1 and CD8 are useful as prognostic or predictive markers. Small sample size is the major limitation of our study.
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Affiliation(s)
- F Erlmeier
- Institute for Pathology and Pathological Anatomy, Technische Universität München , Munich, Germany
| | - A K Seitz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München , Munich, Germany
| | - G Hatzichristodoulou
- Department of Urology, Klinikum rechts der Isar, Technische Universität München , Munich, Germany
| | - L Stecher
- Institute for Medical Statistics and Epidemiology, Technische Universität München , Munich, Germany
| | - M Retz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München , Munich, Germany
| | - J E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technische Universität München , Munich, Germany
| | - W Weichert
- Institute for Pathology and Pathological Anatomy, Technische Universität München, Munich, Germany; Member of the German Cancer Consortium (DKTK)
| | - H R Kübler
- Department of Urology, Klinikum rechts der Isar, Technische Universität München , Munich, Germany
| | - T Horn
- Department of Urology, Klinikum rechts der Isar, Technische Universität München , Munich, Germany
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Tannir N, Powles T, Motzer R, Rolland F, Gravis G, Staehler M, Rink M, Retz M, Csoszi T, McCaffrey J, De Giorgi U, Caserta C, Cheporov S, Esteban Gonzalez E, Duran I, Larkin J, Berg W, Clary D, Escudier B, Choueiri T. Analysis of regional differences in the phase 3 METEOR study of cabozantinib (cabo) versus everolimus (eve) in advanced renal cell carcinoma (RCC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Galsky M, Retz M, Siefker-Radtke A, Baron A, Necchi A, Bedke J, Plimack E, Vaena D, Grimm MO, Bracarda S, Arija JA, Pal S, Ohyama C, Saci A, Lambert A, Krishnan S, Azrilevich A, Sharma P. Efficacy and safety of nivolumab monotherapy in patients with metastatic urothelial cancer (mUC) who have received prior treatment: Results from the phase II CheckMate 275 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Loriot Y, Rosenberg J, Powles T, Necchi A, Hussain S, Morales R, Retz M, Niegisch G, Duran I, Theodore C, Perez-Gracia J, Grande Pulido E, Thåström A, Danner B, Mariathasan S, Abidoye O, van der Heijden M. Atezolizumab (atezo) in platinum (plat)-treated locally advanced/metastatic urothelial carcinoma (mUC): Updated OS, safety and biomarkers from the Ph II IMvigor210 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bellmunt J, Balar A, Galsky M, Loriot Y, Theodore C, Grande Pulido E, Castellano D, Retz M, Niegisch G, Bracarda S, Necchi A, Vaishampayan U, Sridhar S, Eigl B, Hussain S, van der Heijden M, Danner B, Mariathasan S, Legrand F, Rosenberg J. IMvigor210: updated analyses of first-line (1L) atezolizumab (atezo) in cisplatin (cis)-ineligible locally advanced/metastatic urothelial carcinoma (mUC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Eiber M, Pyka T, Okamoto S, Rauscher I, Dahlbender M, Tauber R, Retz M, Gschwend J, Schwaiger M, Maurer T. 566 68Gallium-HBED-CC-PSMA PET compared to conventional bone scintigraphy for evaluation of bone metastases in prostate cancer patients. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1569-9056(16)60568-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Retz M, Gschwend JE, Schmid SC. [Update 2016 - Immunotherapy for urothelial carcinoma]. Urologe A 2016; 55:246-52. [PMID: 26767648 DOI: 10.1007/s00120-015-0024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Advanced urothelial carcinoma of the bladder is an aggressive tumor with a poor prognosis. Besides surgical therapy, classical chemotherapy with platinum compounds is the mainstay of advanced bladder cancer treatment. In recent years, immune modulating therapies have come into the focus of clinical trials. This review provides an overview of the biological mechanisms and immuno-oncological drugs that are currently being analyzed in clinical trials as well as established standard therapies.
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Affiliation(s)
- M Retz
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - J E Gschwend
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - S C Schmid
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland.
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Abstract
Therapeutic intervention using oncolytic viruses is called virotherapy. This type of virus is defined by the ability to replicate in tumor cells only and to destroy these cells upon replication. In addition, this virus type is able to induce a tumor-directed immune response. Early clinical trials have confirmed the safety profile of oncolytic viruses. Currently, different groups are working on the development of oncolytic viruses with a focus on treatment of nonmuscle invasive bladder cancer (NMIBC). A preliminary active recruiting clinical phase II/III trial ongoing in patients with a NMIBC was recently implemented in the United States. Our research group developed an oncolytic adenovirus that will soon enter a clinical phase I trial in patients diagnosed with glioma. This virus is being further modified for the treatment of NMIBC. In this review article, recent developments in the design and use of virotherapy in bladder cancer are summarized.
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Affiliation(s)
- P S Holm
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - M Retz
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - J E Gschwend
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - R Nawroth
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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Rosenberg J, Petrylak D, Abidoye O, Van der Heijden M, Hofman-Censits J, Necchi A, O'Donnell P, Balmanoukian A, Loriot Y, Retz M, Perez-Gracia J, Dawson N, Balar A, Galsky M, Fleming M, Powles T, Cui N, Mariathasan S, Fine G, Dreicer R. 21LBA Atezolizumab in patients (pts) with locally-advanced or metastatic urothelial carcinoma (mUC): Results from a pivotal multicenter phase II study (IMvigor 210). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31942-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Petrylak D, Eigl B, Senkus E, Loriot Y, Twardowski P, Castellano D, Blais N, Sridhar S, Sternberg C, Retz M, Blumenstein B, Jacobs C, Stewart P, Bellmunt J. 2637 Baseline circulating tumor cells (CTC) and serum heat shock protein 27 (Hsp27) levels are increased in advanced bladder cancer (BC) patients with poor prognostic factors: Results from the randomized phase 2 Borealis-1™ trial of first-line gemcitabine/cisplatin plus apatorsen or placebo. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31454-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Horn T, Laus J, Seitz AK, Maurer T, Schmid SC, Wolf P, Haller B, Winkler M, Retz M, Nawroth R, Gschwend JE, Kübler HR, Slotta-Huspenina J. The prognostic effect of tumour-infiltrating lymphocytic subpopulations in bladder cancer. World J Urol 2015; 34:181-7. [PMID: 26055646 DOI: 10.1007/s00345-015-1615-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/02/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Intratumoural lymphocytic infiltration is strongly associated with the outcome of many human epithelial cancers. The current paper investigated whether subpopulations of tumour-infiltrating T lymphocytes are associated with certain clinicopathological parameters and the prognosis of patients with invasive bladder cancer (BCa). PATIENTS AND METHODS The infiltration densities of the adaptive immune markers CD3 (the whole T cell population), FOXP3 (regulatory T cells; Tregs), CD8 (T effector cells) and CD45R0 (T effector memory cells) were analysed by immunohistochemistry and image analysis with tissue microarrays of tumour tissues from 149 patients with invasive BCa treated with radical cystectomy. The findings were correlated with certain clinicopathological parameters. RESULTS Higher FOXP3/CD3 [OS: p = 0.016, HR 1.29, 95% confidence intervals (95% CIs 1.05-1.59)] and FOXP3/CD8 (OS: p = 0.013, HR 1.32, 95% CIs 1.06-1.65) ratios were significantly associated with briefer overall survival and time to cancer-specific death; the latter ratio represented an independent prognostic factor according to a multivariate analysis adjusted for pathological T and N stages (HR 1.32, 95% CIs 1.05-1.67, p = 0.018). The infiltration densities of individual markers (CD3, CD8, FOXP3 and CD45R0) were not significantly associated with clinicopathological parameters or survival; however, a trend towards a better outcome was observed for higher log-transformed CD8 (p = 0.070, HR 0.80, 95% CIs 0.63-1.02) and CD3 (p = 0.113, HR 0.84, 95% CIs 0.68-1.04) infiltration values. CONCLUSIONS A high fraction of Tregs amongst CD3- and CD8-positive lymphocytes indicated a poor prognosis, thereby emphasising the important role that Tregs play in the suppression of the anti-tumour immune response. No single lymphocytic marker was significantly correlated with clinical outcomes, but high CD3 and CD8 infiltration showed trends towards better prognosis.
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Affiliation(s)
- T Horn
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. .,Urologische Klinik und Poliklinik der Technischen Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - J Laus
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - A K Seitz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - T Maurer
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - S C Schmid
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - P Wolf
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - B Haller
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - M Winkler
- Institute for Pathology and Pathological Anatomy, Technische Universität München, Munich, Germany
| | - M Retz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - R Nawroth
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - J E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H R Kübler
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - J Slotta-Huspenina
- Institute for Pathology and Pathological Anatomy, Technische Universität München, Munich, Germany
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43
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Thalgott M, Heck MM, Eiber M, Souvatzoglou M, Hatzichristodoulou G, Kehl V, Krause BJ, Rack B, Retz M, Gschwend JE, Andergassen U, Nawroth R. Circulating tumor cells versus objective response assessment predicting survival in metastatic castration-resistant prostate cancer patients treated with docetaxel chemotherapy. J Cancer Res Clin Oncol 2015; 141:1457-64. [PMID: 25708944 DOI: 10.1007/s00432-015-1936-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/09/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Circulating tumor cell (CTC) counts might display a superior prognostic value for overall survival (OS) compared to objective response criteria (OR) in metastatic castration-resistant prostate cancer (mCRPC) patients. METHODS CTCs were detected using the CellSearch™ System out of 122 samples during docetaxel chemotherapy (75 mg/m(2)) at baseline (q0) and after 1 (q1), 4 (q4) and 10 (q10) cycles, in mCRPC patients (n = 33). OR was evaluated by morphologic RECIST and clinical criteria after 4 (q4) and 10 (q10) cycles. RESULTS For OS, analyses revealed a significant prognostic value for categorical (<5 vs. ≥5) CTC counts (q0, p = 0.005; q1, p = 0.001; q4, p < 0.001; q10, p = 0.002), RECIST (q4, p < 0.001; q10, p = 0.02) and clinical criteria (q4, p < 0.001; q10, p = 0.02). Concordance of CTC counts with OR revealed a sensitivity of 83.3-87.5 % and a specificity of 68.0-76.5 % with complementary discriminatory power for OS. Comparing CTC counts with concomitant OR at q4 in multivariate analyses, an independent prognostic value for OS was found for CTC counts (HR 3.3; p = 0.02) similar to clinical (HR 4.9; p = 0.02) and radiologic response (HR 3.4; p = 0.051). Comparing the predictive value for death, early post-treatment CTC counts at q1 demonstrated significant accuracy with an area under the curve of 79.5 % (p = 0.004) similar to CTC counts at q4 (76.7 %; p = 0.009). Radiologic and clinical response at q4 displayed accuracy similar to early CTC counts at q1 (72.2 %; p = 0.03 and 75.0 %; p = 0.02) despite low sensitivities. CONCLUSIONS CTC counts appear to be an earlier and more sensitive predictor for survival and treatment response than current OR approaches and may provide complementary information toward individualized treatment strategies.
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Affiliation(s)
- M Thalgott
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany,
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44
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Abstract
The prognosis of prostate and bladder cancer patients is predominantly determined by the detection of distant sites of metastasis. In clinical routine, virtually only lymph node staging is of relevance to determine metastasis. Detection and characterization of disseminated tumor cells in peripheral blood or bone marrow is an additional parameter of prognostic significance. In this article, we will summarize recent progress on the prognostic value of disseminated tumor cells in bone marrow and its translation into routine clinical analysis.
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Affiliation(s)
- R Nawroth
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland,
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45
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Sathe A, Guerth F, Cronauer MV, Heck MM, Thalgott M, Gschwend JE, Retz M, Nawroth R. Mutant PIK3CA controls DUSP1-dependent ERK 1/2 activity to confer response to AKT target therapy. Br J Cancer 2014; 111:2103-13. [PMID: 25349966 PMCID: PMC4260039 DOI: 10.1038/bjc.2014.534] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/29/2014] [Accepted: 09/08/2014] [Indexed: 11/13/2022] Open
Abstract
Background: Alterations in the phosphoinositide 3-kinase/AKT/mammalian target of rapamycin (PI3K/AKT/mTOR) signalling pathway are frequent in urothelial bladder cancer (BLCA) and thus provide a potential target for novel therapeutic strategies. We investigated the efficacy of the AKT inhibitor MK-2206 in BLCA and the molecular determinants that predict therapy response. Methods: Biochemical and functional effects of the AKT inhibitor MK-2206 were analysed on a panel of 11 BLCA cell lines possessing different genetic alterations. Cell viability (CellTiter-Blue, cell counts), apoptosis (caspase 3/7 activity) and cell cycle progression (EdU incorporation) were analysed to determine effects on cell growth and proliferation. cDNA or siRNA transfections were used to manipulate the expression of specific proteins such as wild-type or mutant PIK3CA, DUSP1 or CREB. For in vivo analysis, the chicken chorioallantoic membrane model was utilised and tumours were characterised by weight and biochemically for the expression of Ki-67 and AKT phosphorylation. Results: Treatment with MK-2206 suppressed AKT and S6K1 but not 4E-BP1 phosphorylation in all cell lines. Functionally, only cell lines bearing mutations in the hotspot helical domain of PIK3CA were sensitive to the drug, independent of other genetic alterations in the PI3K or MAPK signalling pathway. Following MK-2206 treatment, the presence of mutant PIK3CA resulted in an increase in DUSP1 expression that induced a decrease in ERK 1/2 phosphorylation. Manipulating the expression of mutant or wild-type PIK3CA or DUSP1 confirmed that this mechanism is responsible for the induction of apoptosis and the inhibition of tumour proliferation in vitro and in vivo, to sensitise cells to AKT target therapy. Conclusion or interpretation: PIK3CA mutations confer sensitivity to AKT target therapy in BLCA by regulating DUSP1 expression and subsequent ERK1/2 dephosphorylation and can potentially serve as a stratifying biomarker for treatment.
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Affiliation(s)
- A Sathe
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich 81675, Germany
| | - F Guerth
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich 81675, Germany
| | - M V Cronauer
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse 43, Ulm 89075, Germany
| | - M M Heck
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich 81675, Germany
| | - M Thalgott
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich 81675, Germany
| | - J E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich 81675, Germany
| | - M Retz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich 81675, Germany
| | - R Nawroth
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich 81675, Germany
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46
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Schmid SC, Gschwend JE, Retz M. [Pharmaceutical treatment of advanced urinary bladder cancer: new developments in 2014]. Urologe A 2014; 53:1535-42. [PMID: 25234951 DOI: 10.1007/s00120-014-3641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The perioperative treatment of muscle-invasive bladder cancer has become a standard procedure in recent years. New agents, such as programmed cell death protein 1 (PD1) and PD1-ligand 1 (PD1-L1) inhibitors have opened up the door for immunomodulation therapy of metastasized bladder cancer. This article focuses on data which have changed or have the potential to change the pharmaceutical treatment of advanced bladder cancer with a review of the literature in Medline PubMed and proceedings of major meetings, e.g. the European Association of Urology (EAU), the American Society of Clinical Oncology (ASCO), the ASCO Genitourinary Cancers Symposium (ASCO GU) and the American Urological Association (AUA).
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Affiliation(s)
- S C Schmid
- Arbeitsgemeinschaft Urologische Onkologie der Deutschen Krebsgesellschaft (AUO), Urologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland,
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47
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Abstract
The prognosis of advanced penile carcinomas is extremely poor. Low numbers of available studies on chemotherapy over a long time, decentralized treatment as well as rareness of disease have not improved the prognosis. This article focuses on important clinical trials and developments for chemotherapy in penile cancer. Considering the latest study data there is a strong recommendation for multimodal approaches, including lymph node dissection and perioperative treatments with cisplatin/taxane-based chemotherapy. A systematic, centralized registration and evaluation by the "Rostocker-AUO-Register" for penile cancer should improve conditions for affected patients. Furthermore, molecular targeted therapy might be a promising therapeutic option but until now only very few case reports have been published. Further prospective clinical trials are necessary to establish these agents in the therapeutic landscape of penile cancer. Decision for palliative chemotherapy in advanced penile cancer should be well considered and depends on the patient's age and general condition particularly regarding possible adverse events of chemotherapy. Notably, best supportive care might be an important alternative for some patients and should be taken in consideration.
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Affiliation(s)
- A. Seitz
- Klinikum rechts der Isar der Technischen Universität München, München
| | - C. Protzel
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Rostock
| | - M. Retz
- Klinikum rechts der Isar der Technischen Universität München, München
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48
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Schmid S, Gschwend J, Retz M. [Current developments in the medical treatment of advanced urothelial carcinoma of the bladder]. Aktuelle Urol 2014; 45:55-63; quiz 64-5. [PMID: 24500963 DOI: 10.1055/s-0033-1360281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medical treatment of advanced urothelial carcinoma of the bladder consists of perioperative treatments as well as palliative chemotherapy in advanced stages. This article focuses on important clinical trials and developments of the last two years, with a review of literature and proceedings of the relevant meetings (ASCO, GU-ASCO, EAU, AUA). The general benefit of perioperative chemotherapy is confirmed. Chemotherapy with Gemcitabin/Cisplatin remains the therapy of choice in the palliative setting. So far, targeted therapies did not show convincing results.
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Affiliation(s)
- S. Schmid
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München
| | - J. Gschwend
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München
| | - M. Retz
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München
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49
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50
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Abstract
This review focuses on current options in the medical therapy of metastasized urothelial carcinoma of the bladder. Standard treatments as well as new, recently published therapeutic approaches are evaluated and discussed.
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Affiliation(s)
- M Retz
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland,
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