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Teo MY, Bambury RM, Zabor EC, Jordan E, Al-Ahmadie H, Boyd ME, Bouvier N, Mullane SA, Cha EK, Roper N, Ostrovnaya I, Hyman DM, Bochner BH, Arcila ME, Solit DB, Berger MF, Bajorin DF, Bellmunt J, Iyer G, Rosenberg JE. Commentary on "DNA damage response and repair gene alterations are associated with improved survival in patients with platinum-treated advanced urothelial carcinoma.". Urol Oncol 2018; 36:345-346. [PMID: 29859727 DOI: 10.1016/j.urolonc.2018.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Platinum-based chemotherapy remains the standard treatment for advanced urothelial carcinoma by inducing DNA damage. We hypothesize that somatic alterations in DNA damage response and repair (DDR) genes are associated with improved sensitivity to platinum-based chemotherapy. EXPERIMENTAL DESIGN Patients with diagnosis of locally advanced and metastatic urothelial carcinoma treated with platinum-based chemotherapy who had exon sequencing with the Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) assay were identified. Patients were dichotomized based on the presence/absence of alterations in a panel of 34 DDR genes. DDR alteration status was correlated with clinical outcomes and disease features. RESULTS One hundred patients were identified, of which 47 harbored alterations in DDR genes. Patients with DDR alterations had improved progression-free survival (9.3 vs. 6.0 months, log-rank P = 0.007) and overall survival (23.7 vs. 13.0 months, log-rank P = 0.006). DDR alterations were also associated with higher number mutations and copy-number alterations. A trend toward positive correlation between DDR status and nodal metastases and inverse correlation with visceral metastases were observed. Different DDR pathways also suggested variable effect on clinical outcomes. CONCLUSIONS Somatic DDR alteration is associated with improved clinical outcomes in platinum-treated patients with advanced urothelial carcinoma. Once validated, it can improve patient selection for clinical practice and future study enrollment.
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Orsola A, Werner L, de Torres I, Martin-Doyle W, Raventos CX, Lozano F, Mullane SA, Leow JJ, Barletta JA, Bellmunt J, Morote J. Reexamining treatment of high-grade T1 bladder cancer according to depth of lamina propria invasion: a prospective trial of 200 patients. Br J Cancer 2015; 112:468-74. [PMID: 25535728 PMCID: PMC4453654 DOI: 10.1038/bjc.2014.633] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/21/2014] [Accepted: 11/30/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Management of high-grade T1 (HGT1) bladder cancer represents a major challenge. We studied a treatment strategy according to substaging by depth of lamina propria invasion. METHODS In this prospective observational cohort study, patients received initial transurethral resection (TUR), mitomycin-C, and BCG. Subjects with shallower lamina propria invasion (HGT1a) were followed without further surgery, whereas subjects with HGT1b received a second TUR. Association of clinical and histological features with outcomes (primary: progression; secondary: recurrence and cancer-specific survival) was assessed using Cox regression. RESULTS Median age was 71 years; 89.5% were males, with 89 (44.5%) cases T1a and 111 (55.5%) T1b. At median follow-up of 71 months, disease progression was observed in 31 (15.5%) and in univariate analysis, substaging, carcinoma in situ, tumour size, and tumour pattern predicted progression. On multivariate analysis only substaging, associated carcinoma in situ, and tumour size remained significant for progression. CONCLUSIONS In HGT1 bladder cancer, the strategy of performing a second TUR only in T1b cases results in a global low progression rate of 15.5%. Tumours deeply invading the lamina propria (HGT1b) showed a three-fold increase in risk of progression. Substaging should be routinely evaluated, with HGT1b cases being thoroughly evaluated for cystectomy. Inclusion in the TNM system should also be carefully considered.
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Affiliation(s)
- A Orsola
- Department of Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA
| | - L Werner
- Departments of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - I de Torres
- Department of Pathology, Vall d'Hebron Hospital, Barcelona 08035, Spain
| | - W Martin-Doyle
- University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - C X Raventos
- Department of Urology, Vall d'Hebron Hospital, Barcelona 08035, Spain
| | - F Lozano
- Department of Urology, Vall d'Hebron Hospital, Barcelona 08035, Spain
| | - S A Mullane
- Department of Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA
| | - J J Leow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA 02215, USA
- Division of Urology, Brigham and Women's Hospital, Boston, MA 02215, USA
| | - J A Barletta
- Department of Pathology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA
| | - J Bellmunt
- Department of Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA
| | - J Morote
- Department of Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA
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Bellmunt J, Mullane SA, Werner L, Fay AP, Callea M, Leow JJ, Taplin ME, Choueiri TK, Hodi FS, Freeman GJ, Signoretti S. Association of PD-L1 expression on tumor-infiltrating mononuclear cells and overall survival in patients with urothelial carcinoma. Ann Oncol 2015; 26:812-817. [PMID: 25600565 DOI: 10.1093/annonc/mdv009] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Programmed death-1 (PD-1) receptor/PD-1 ligand (PD-L1) pathway negatively regulates T-cell-mediated responses. The prognostic impact of PD-L1 expression needs to be defined in urothelial carcinoma (UC). PATIENTS AND METHODS Formalin-fixed paraffin-embedded tumor samples from 160 patients with UC were retrieved. PD-L1 expression was evaluated by immunohistochemistry using a mouse monoclonal anti-PD-L1 antibody (405.9A11). PD-L1 positivity on tumor cell membrane was defined as ≥5% of tumor cell membrane staining. The extent of tumor-infiltrating mononuclear cells (TIMCs) as well as PD-L1 expression on TIMCs was scored from 0 to 4. A score of 2, 3, or 4 was considered PD-L1-positive. Clinico-pathological variables were documented. The Cox regression model was used to assess the association of PD-L1 expression with overall survival (OS) in patients who developed metastases. RESULTS TIMCs were present in 143 of the 160 patient samples. Out of 160 samples, 32 (20%) had positive PD-L1 expression in tumor cell membrane. Out of 143 samples with TIMCs, 58 (40%) had positive PD-L1 expression in TIMCs. Smoking history, prior BCG use and chromosome 9 loss did not correlate with PD-L1 expression in either tumor cell membrane or TIMCs. PD-L1 positivity was not different between non-invasive or invasive UC. In patients who developed metastases (M1) and were treated with systemic therapy (n = 100), PD-L1 positivity on tumor cell membrane was seen in 14% of patients and did not correlate with OS (P = 0.45). Out of 89 M1 patients who had evaluable PD-L1 on TIMCs, PD-L1 expression was seen in 33% of patients and was significantly associated with longer OS on multivariate analysis (P = 0.0007). CONCLUSION PD-L1 is widely expressed in tumor cell membrane and TIMCs in UC. PD-L1 in tumor cells was not predictive of OS. However, positive PD-L1 expression in TIMCs was significantly associated with longer survival in those patients who developed metastases.
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Affiliation(s)
- J Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston.
| | - S A Mullane
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - L Werner
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston
| | - A P Fay
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - M Callea
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - J J Leow
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston
| | - M E Taplin
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - T K Choueiri
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - F S Hodi
- Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston; Center for Immuno-oncology, Dana-Farber Cancer Institute, Boston, USA
| | - G J Freeman
- Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - S Signoretti
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
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