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Tang Y, Lin L, Xiao Y, Meng L, Yang Y, Li X. Predictors of trimodality therapy in patients with muscle-invasive bladder cancer and effect on survival. Clin Transl Oncol 2024; 26:446-455. [PMID: 37389736 DOI: 10.1007/s12094-023-03264-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Due to its unique advantages over radical cystectomy (RC), trimodality therapy (TMT) is increasingly being utilized by patients diagnosed with muscle-invasive bladder cancer (MIBC) who are not suitable for or refuse RC. However, achieving a satisfactory oncological outcome with TMT requires strict patient selection criteria, and the comparative oncological outcomes of TMT versus RC remain controversial. METHODS Patients diagnosed with non-metastatic MIBC who underwent TMT or RC were identified from the SEER database during 2004-2015. Before one-to-one propensity score matching (PSM), logistic regression was utilized to identify predictors of TMT. After matching, K-M curves were generated to estimate cancer-specific survival (CSS) and overall survival (OS) with log-rank to test the significance. Finally, we conducted univariate and multivariate Cox analyses to identify independent prognostic factors for CSS and OS. RESULTS The RC and TMT groups included 5812 and 1260 patients, respectively, and the TMT patients were significantly older than the RC patients. Patients with advanced age, separated, divorced, or widowed (SDW) or unmarried marital status (married as reference), and larger tumor size (< 40 mm as reference) were more likely to be treated with TMT. After PSM, TMT was found to be associated with worse CSS and OS, and it was identified as an independent risk factor for both CSS and OS. CONCLUSION MIBC patients may not be carefully evaluated prior to TMT, and some non-ideal candidates underwent TMT. TMT resulted in worse CSS and OS in the contemporary era, but these results may be biased. Strict TMT candidate criteria and TMT treatment modality should be required.
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Affiliation(s)
- Yaxiong Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Lede Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Yunfei Xiao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Linghao Meng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Yujia Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Xiang Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China.
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Xu C, Zou W, Wang Y, Liu X, Wang J. Bladder-sparing treatment for muscle-invasive bladder carcinoma using immune checkpoint inhibitors. Crit Rev Oncol Hematol 2023; 191:104137. [PMID: 37717879 DOI: 10.1016/j.critrevonc.2023.104137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023] Open
Abstract
Multimodal bladder preservation therapy is already an alternative for patients with muscle-invasive bladder cancer (MIBC) who are unable or unwilling to undergo radical cystectomy. Various bladder-preserving strategies that employ immune checkpoint inhibitors (ICIs) for MIBC have been investigated. There are three common modes of ICI-based bladder preservation therapy, of which the most studied is ICIs combined with chemoradiotherapy. The bladder-preserving strategy of ICIs combined with radiation has been investigated in patients who poorly tolerate chemotherapy. ICIs combined with chemotherapy have also been explored in patients who responded to neoadjuvant therapy with a clinical complete response. All the above-described strategies have shown promising efficacy and manageable safety profiles. However, the value of programmed death-ligand 1 (PD-L1) expression, tumor mutation burden and gene alterations for predicting the efficacy of immune-based bladder preservation therapy is still controversial. There remain some challenges for immune-based bladder preservation therapy, and large-sample randomized trials are needed.
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Affiliation(s)
- Chao Xu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen Zou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jingjing Wang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China.
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Abstract
Bladder cancer is a global health issue with sex differences in incidence and prognosis. Bladder cancer has distinct molecular subtypes with multiple pathogenic pathways depending on whether the disease is non-muscle invasive or muscle invasive. The mutational burden is higher in muscle-invasive than in non-muscle-invasive disease. Commonly mutated genes include TERT, FGFR3, TP53, PIK3CA, STAG2 and genes involved in chromatin modification. Subtyping of both forms of bladder cancer is likely to change considerably with the advent of single-cell analysis methods. Early detection signifies a better disease prognosis; thus, minimally invasive diagnostic options are needed to improve patient outcomes. Urine-based tests are available for disease diagnosis and surveillance, and analysis of blood-based cell-free DNA is a promising tool for the detection of minimal residual disease and metastatic relapse. Transurethral resection is the cornerstone treatment for non-muscle-invasive bladder cancer and intravesical therapy can further improve oncological outcomes. For muscle-invasive bladder cancer, radical cystectomy with neoadjuvant chemotherapy is the standard of care with evidence supporting trimodality therapy. Immune-checkpoint inhibitors have demonstrated benefit in non-muscle-invasive, muscle-invasive and metastatic bladder cancer. Effective management requires a multidisciplinary approach that considers patient characteristics and molecular disease characteristics.
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Affiliation(s)
- Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Donna E Hansel
- Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Margaret A Knowles
- Division of Molecular Medicine, Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, UK
| | - Matthew D Galsky
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Dan Theodorescu
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Xu C, Zou W, Zhang L, Xu R, Li Y, Feng Y, Zhao R, Wang Y, Liu X, Wang J. Real-world retrospective study of immune checkpoint inhibitors in combination with radiotherapy or chemoradiotherapy as a bladder-sparing treatment strategy for muscle-invasive bladder urothelial cancer. Front Immunol 2023; 14:1162580. [PMID: 37283762 PMCID: PMC10239884 DOI: 10.3389/fimmu.2023.1162580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023] Open
Abstract
Background Recent developments in MIBC treatment suggest good efficacy of bladder sparing treatment combined with immune checkpoint inhibitor. However, there is no standard treatment mode. A retrospective analysis was conducted to reveal the efficacy and safety of PD-1 inhibitor in combination with radiotherapy or chemoradiotherapy. Methods We retrospectively analyzed 25 patients with MIBC T2-T3N0M0 disease who were unfit or unwilling to undergo RC. These patients underwent the maximum TURBT followed by PD-1 inhibitor (Tislelizumab or Toripalimab) in combination with radiotherapy or chemoradiotherapy (gemcitabine plus cisplatin) between April 2020 and May 2022. The primary outcome was clinical complete response (cCR) rate. The secondary outcomes were disease free survival (DFS) and overall survival (OS). Results Revised: Of 25 patients, 22 were T2 (88%), while 3 were T3 (12%). The median age is 65 years (51-80). Twenty-one patients had programmed cell death ligand 1 (PD-L1) combined positive score (CPS) of 1 or more, and 4 patients had CPS<1 or unknown. Sixteen patients received chemoradiotherapy. Tislelizumab and Toripalimab were administered to 19 and 6 patients, respectively. The median number of cycles of immunotherapy was 8. Twenty-three patients (92%) achieved cCR. Following a median of 13 months of follow-up (range, 5-34 months), 1-year DFS and OS rate were 92% and 96%, respectively. In the univariate analysis, T stage significantly influenced OS and ORR, and efficacy evaluation significantly influenced OS, DFS, and ORR. The expression of PD-L1 and chemotherapy had no effect on prognosis. In the multivariate analysis, no independent prognostic factors were found. Grade 3 or 4 adverse events (AE) were reported in 35.7% patients. Conclusions Bladder sparing therapy with PD-1 inhibitor in combination with radiotherapy or chemoradiotherapy is feasible, safe, and highly effective for patients who were unfit or unwilling to undergo RC.
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Affiliation(s)
- Chao Xu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen Zou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Zhang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yeqian Feng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Runtian Zhao
- Department of Oncology, Guilin Hospital of the Second Xiangya Hospital, Central South University, Guilin, China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jingjing Wang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
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Häggström C, Rowley M, Liedberg F, Coolen ACC, Holmberg L. Latent heterogeneity of muscle-invasive bladder cancer in patient characteristics and survival: A population-based nation-wide study in the Bladder Cancer Data Base Sweden (BladderBaSe). Cancer Med 2023. [PMID: 37096787 DOI: 10.1002/cam4.5981] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/13/2023] [Accepted: 04/08/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Patients with muscle-invasive bladder cancer (MIBC) constitute a heterogenous group in terms of patient and tumour characteristics ('case-mix') and prognosis. The aim of the current study was to investigate whether differences in survival could be used to separate MIBC patients into separate classes using a recently developed latent class regression method for survival analysis with competing risks. METHODS We selected all participants diagnosed with MIBC in the Bladder Cancer Data Base Sweden (BladderBase) and analysed inter-patient heterogeneity in risk of death from bladder cancer and other causes. RESULTS Using data from 9653 MIBC patients, we detected heterogeneity with six distinct latent classes in the studied population. The largest, and most frail class included 50% of the study population and was characterised by a somewhat larger proportion of women, higher age at diagnosis, more advanced disease and lower probability of curative treatment. Despite this, patients in this class treated with curative intent by radical cystectomy or radiotherapy had a lower association to risk of death. The second largest class included 23% and was substantially less frail as compared to the largest class. The third and fourth class included each around 9%-10%, whereas the fifth and sixth class included each 3%-4% of the population. CONCLUSIONS Results from the current study are compatible with previous research and the method can be used to adjust comparisons in prognosis between MIBC populations for influential differences in the distribution of sub-classes.
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Affiliation(s)
- Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Northern Registry Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå University, Umeå, Sweden
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Mark Rowley
- Saddle Point Science, York, UK
- Saddle Point Science Europe, Nijmegen, The Netherlands
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Anthony C C Coolen
- Saddle Point Science, York, UK
- Saddle Point Science Europe, Nijmegen, The Netherlands
- Department of Biophysics, Faculty of Science, Donders Institute, Radboud University, Nijmegen, The Netherlands
| | - Lars Holmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College, London, UK
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Mignot F, Fabiano E, Xylinas E, Alati A, Méjean A, Masson-Lecomte A, Hermieu JF, Desgrandchamps F, Hennequin C, Durdux C, Quéro L. Clinical outcomes of adapted hypofractionated radiotherapy for bladder cancer in elderly patients. BJU Int 2023. [PMID: 36745012 DOI: 10.1111/bju.15983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/07/2023]
Abstract
OBJECTIVE To investigate the feasibility, efficacy, and safety of trimodal therapy (TMT) using a bifractionated split-course hypofractionated radiotherapy (RT) for non-metastatic muscle-invasive bladder cancer (MIBC) in elderly patients. PATIENTS AND METHODS We retrospectively reviewed the characteristics and outcomes of patients aged >75 years with non-metastatic MIBC suitable or not for radical cystectomy (RC) and treated with transurethral resection of bladder tumour followed by concomitant radio-chemotherapy (platinum salt and 5-fluorouracil) at two institutions (Saint Louis Hospital, Paris, France and European Georges Pompidou Hospital, Paris, France) between 1990 and 2021. RT consisted of an adapted bifractionated split-course hypofractionated RT. Acute toxicities were reported according to Common Terminology Criteria for Adverse Events version 5.0 and late toxicities were reported according to the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema. The primary end-point was overall survival (OS). Secondary end-points included other survivals outcomes and safety. RESULTS A total of 122 patients were identified, with a median (range) follow-up of 51.1 (0.5-210.8) months. In all, 83.5% of patients completed radio-chemotherapy. The OS rate was 61.7% at 3 years and 51.2% at 5 years. In multivariate analysis, the completion of RT and concomitant chemotherapy were significantly associated with better OS and cancer-specific survival. For patients fit for RC, a complete histological response was achieved for 77 patients (91.7%) with radio-chemotherapy and the bladder conservation rate was 90.5%. Acute and late Grade ≥3 toxicities were <5%. CONCLUSION Bifractionated split-course hypofractionated RT with concomitant chemotherapy regimen appears to be well-tolerated and effective. Trimodal treatment seems to be a curative option for elderly patients unfit for radical surgery compared with palliative care and may contribute to improved survival in these patients.
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Affiliation(s)
- Fabien Mignot
- Department of Radiation Oncology, Saint Louis Hospital, AP-HP, Paris, France
| | - Emmanuelle Fabiano
- Department of Radiation Oncology, European George Pompidou Hospital, AP-HP, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Aurélia Alati
- Department of Radiation Oncology, European George Pompidou Hospital, AP-HP, Paris, France
| | - Arnaud Méjean
- Department of Urology, European George Pompidou Hospital, AP-HP, Paris, France
| | | | | | | | | | - Catherine Durdux
- Department of Radiation Oncology, European George Pompidou Hospital, AP-HP, Paris, France
| | - Laurent Quéro
- Department of Radiation Oncology, Saint Louis Hospital, AP-HP, Paris, France.,INSERM U1160, Alloimmunity-Autoimmunity-Transplantation Research Unit, University of Paris, Paris, France
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7
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Chen T, Shi S, Zheng P, Zhan X, Zhang J, Li Y, Li D, Fu B, Chen L. Predictive nomograms for early death in metastatic bladder cancer. Front Surg 2023; 9:1037203. [PMID: 36713648 PMCID: PMC9879302 DOI: 10.3389/fsurg.2022.1037203] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/11/2022] [Indexed: 01/15/2023] Open
Abstract
Background Metastatic bladder cancer (MBC) is an incurable malignancy, which is prone to early death. We aimed to establish models to evaluating the risk of early death in patients with metastatic bladder cancer. Methods The data of 1,264 patients with MBC registered from 2010 to 2015 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. We utilized X-tile software to determine the optimal cut-off points of age and tumor size in diagnosis. Univariate and multivariate logistic regression analyses were used to identify significant independent risk factors for total early death and cancer-specific early death, then we construct two practical nomograms. In order to validate our prediction models, we performed calibration plots, receiver operating characteristics (ROCs) curves, decision curve analysis (DCA) and clinical impact curve (CIC). Result A total of 1,216 patients with MBC were included in this study. 463 patients died prematurely (≤3 months), and among them 424 patients died of cancer-specific early death. The nomogram of total premature death was created by surgery, chemotherapy, tumor size, histological type, liver metastases, and nomogram of cancer-specific early death was based on surgery, race, tumor size, histological type, chemotherapy, and metastases (liver, brain). Through the verify of calibration plots, receiver operating characteristics (ROCs) curves, decision curve analysis (DCA) and clinical impact curve (CIC), we concluded that nomogram were a valid tool with excellent clinical utility to help clinicians predict premature death in MBC patients. Conclusions The nomograms derived from the analysis of patients with MBC, which can provide refined prediction of premature death and furnish clinicians with useful ideas for patient-specific treatment options and follow-up scheduling.
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Affiliation(s)
- Tao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Shuibo Shi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Ping Zheng
- Department of Urology, Shangrao Municipal Hospital, Shangrao City, China
| | - Xiangpeng Zhan
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Ji Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Yihe Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Dongshui Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China,Correspondence: DongShui Li Luyao Chen Bin Fu
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China,Correspondence: DongShui Li Luyao Chen Bin Fu
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China,Correspondence: DongShui Li Luyao Chen Bin Fu
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Biswas PK, Kwak Y, Kim A, Seok J, Kwak HJ, Lee M, Dayem AA, Song K, Park JY, Park KS, Shin HJ, Cho SG. TTYH3 Modulates Bladder Cancer Proliferation and Metastasis via FGFR1/H-Ras/A-Raf/MEK/ERK Pathway. Int J Mol Sci 2022; 23:10496. [PMID: 36142409 DOI: 10.3390/ijms231810496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 12/09/2022] Open
Abstract
Tweety family member 3 (TTYH3) is a calcium-activated chloride channel with a non-pore-forming structure that controls cell volume and signal transduction. We investigated the role of TTYH3 as a cancer-promoting factor in bladder cancer. The mRNA expression of TTYH3 in bladder cancer patients was investigated using various bioinformatics databases. The results demonstrated that the increasingly greater expression of TTYH3 increasingly worsened the prognosis of patients with bladder cancer. TTYH3 knockdown bladder cancer cell lines were constructed by their various cancer properties measured. TTYH3 knockdown significantly reduced cell proliferation and sphere formation. Cell migration and invasion were also significantly reduced in knockdown bladder cancer cells, compared to normal bladder cancer cells. The knockdown of TTYH3 led to the downregulation of H-Ras/A-Raf/MEK/ERK signaling by inhibiting fibroblast growth factor receptor 1 (FGFR1) phosphorylation. This signaling pathway also attenuated the expression of c-Jun and c-Fos. The findings implicate TTYH3 as a potential factor regulating the properties of bladder cancer and as a therapeutic target.
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Wollny T, Wnorowska U, Piktel E, Suprewicz Ł, Król G, Głuszek K, Góźdź S, Kopczyński J, Bucki R. Sphingosine-1-Phosphate-Triggered Expression of Cathelicidin LL-37 Promotes the Growth of Human Bladder Cancer Cells. Int J Mol Sci 2022; 23:7443. [PMID: 35806446 PMCID: PMC9267432 DOI: 10.3390/ijms23137443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
It has been proven that tumour growth and progression are regulated by a variety of mediators released during the inflammatory process preceding the tumour appearance, but the role of inflammation in the development of bladder cancer is ambiguous. This study was designed around the hypothesis that sphingosine-1-phosphate (S1P), as a regulator of several cellular processes important in both inflammation and cancer development, may exert some of the pro-tumorigenic effects indirectly due to its ability to regulate the expression of human cathelicidin (hCAP-18). LL-37 peptide released from hCAP-18 is involved in the development of various types of cancer in humans, especially those associated with infections. Using immunohistological staining, we showed high expression of hCAP-18/LL-37 and sphingosine kinase 1 (the enzyme that forms S1P from sphingosine) in human bladder cancer cells. In a cell culture model, S1P was able to stimulate the expression and release of hCAP-18/LL-37 from human bladder cells, and the addition of LL-37 peptide dose-dependently increased their proliferation. Additionally, the effect of S1P on LL-37 release was inhibited in the presence of FTY720P, a synthetic immunosuppressant that blocks S1P receptors. Together, this study presents the possibility of paracrine relation in which LL-37 production following cell stimulation by S1P promotes the development and growth of bladder cancer.
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Daneshmand S, Brummelhuis IS, Pohar KS, Steinberg GD, Aron M, Cutie CJ, Keegan KA, Maffeo JC, Reynolds DL, Raybold B, Chau A, Witjes JA. The safety, tolerability, and efficacy of a neoadjuvant gemcitabine intravesical drug delivery system (TAR-200) in muscle-invasive bladder cancer patients: a phase I trial. Urol Oncol 2022; 40:344.e1-344.e9. [DOI: 10.1016/j.urolonc.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/13/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
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11
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Møller CT, Fosså SD, Tafjord G, Babigumira R, Berge V, Andreassen BK. Primary versus secondary muscle-invasive bladder cancer: survival after curative treatment. Scand J Urol 2022; 56:214-220. [PMID: 35506475 DOI: 10.1080/21681805.2022.2056633] [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: 10/18/2022]
Abstract
PURPOSE To assess if cancer-specific survival (CSS) following curative intent treatment (CIT) for muscle-invasive bladder cancer (MIBC) differs between patients presenting with MIBC (primary) and patients presenting with non-muscle-invasive bladder cancer who progress to MIBC (secondary). METHODS This study uses data from the Cancer Registry of Norway on patients initially diagnosed with bladder cancer in 2008-2012 and treated with radical cystectomy (RC) or radiotherapy (RT). To ensure a clinically relevant population, we selected patients with a pre-treatment histology confirming muscle-invasion. Survival models were applied to evaluate differences in observed and adjusted CSS by type of MIBC and stratified by type of CIT. Adjustment was made for age group, sex, previous cancer, diagnostic hospital's academic status and geographical region, and type of CIT. RESULTS We identified 650 eligible patients: 589 (91%) primary MIBC and 61 (9%) secondary MIBC. A total of 556 (86%) patients underwent RC and 94 (14%) RT. The 5-year CSS for primary MIBC was 56% and 59% for secondary MIBC (p = 0.68). The type of MIBC did not impact the risk of bladder cancer death (HR = 0.85, CI = 0.55-1.33, p = 0.48), nor when stratified for CIT (RC: HR = 0.93, CI = 0.57-1.53, p = 0.78); RT: HR = 0.71, CI = 0.24-2.16, p = 0.55). CONCLUSION This first nation-wide population-based study comparing CSS between primary and secondary MIBC showed no significant difference in survival regardless of type of CIT. Continued surveillance of patients with non-muscle-invasive bladder cancer is necessary to detect early progression to MIBC. Future studies should include molecular and genetic characteristics in addition to detailed clinicopathologic information.
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Affiliation(s)
- Christina Tanem Møller
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sophie D Fosså
- Faculty of Medicine, University of Oslo, Oslo, Norway.,National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Gunnar Tafjord
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Viktor Berge
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Urology, Oslo University Hospital, Oslo, Norway
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Wang J, Shao J, Lu Y, Su W, Dong H, Wang P, Lin Z, Feng J, Wang D, Zhao H, Tan J. Screening Differential CircRNAs Expression Profiles Reveals the Regulatory Role of the has_circTPT1_003-has-miR-218-5p-CCNE2/SMC4 Signaling Axis in Bladder Carcinoma Progression. DNA Cell Biol 2022; 41:128-141. [PMID: 35005988 DOI: 10.1089/dna.2021.0240] [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: 11/13/2022] Open
Abstract
Circular RNAs (circRNAs) are a class of noncoding RNAs closely related to the development and progression of various human cancers. However, it is unclear whether circRNAs play an important role in the development of bladder cancer. We utilized human circRNA array V2 microarrays to screen circRNA expression profiles in bladder cancer tissues. Bioinformatic tools including circBank, dbDEMC 2.0, miRCancer, TarBase v7.0, miRtarbase, TCGA-BLCA, Cytoscape-MCODE, String, ENCORI, and Venny 2.1 were then employed to construct the circRNA-miRNA-mRNA regulatory networks. In total, 105 upregulated circRNAs and 167 downregulated circRNAs (fold change >2 and p < 0.001) were filtered out. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of filtered dysregulated circRNAs disclosed that the circRNAs regulatory network was closely related with mRNA processing and cell cycle, etc. Further excavation analysis showed that seven differentially overexpressed circRNAs including hsa_circ_0000133, hsa_circ_0023610, hsa_circ_0005615, hsa_circ_0030162, hsa_circ_0077007, hsa_circ_0001140, and hsa_circ_0107031 were associated with bladder cancer invasiveness, and the cell cycle signal axis. has_circTPT1_003-has-miR-218-5p-CCNE2/SMC4 was finally clarified as a possible mechanism for bladder cancer progression. Based on results derived from multiple approaches, we identified that has_circTPT1_003-has-miR-218-5p-CCNE2/SMC4 signal axis may be involved in the invasion process of bladder cancer.
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Affiliation(s)
- Jie Wang
- Fujian Provincial Key Laboratory of Transplant Biology, Department of Urology, 900 Hospital of the Joint Logistics Team (Dongfang Hospital), Xiamen University, Fuzhou, Fujian, P.R. China.,Ningbo First Hospital Jiangbei Branch, Ningbo, Zhejiang, P.R. China
| | - Jichun Shao
- Department of Urology, Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, P.R. China
| | - Yuan Lu
- Respiratory Department, Zhongda Hospital, Southeast University, Nanjing, P.R. China
| | - Weipeng Su
- Fujian Provincial Key Laboratory of Transplant Biology, Department of Urology, 900 Hospital of the Joint Logistics Team (Dongfang Hospital), Xiamen University, Fuzhou, Fujian, P.R. China
| | - Huiyue Dong
- Fujian Provincial Key Laboratory of Transplant Biology, Department of Urology, 900 Hospital of the Joint Logistics Team (Dongfang Hospital), Xiamen University, Fuzhou, Fujian, P.R. China
| | - Ping Wang
- Fujian Provincial Key Laboratory of Transplant Biology, Department of Urology, 900 Hospital of the Joint Logistics Team (Dongfang Hospital), Xiamen University, Fuzhou, Fujian, P.R. China
| | - Zhijie Lin
- Fujian Provincial Key Laboratory of Transplant Biology, Department of Urology, 900 Hospital of the Joint Logistics Team, Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Jing Feng
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, Fujian, P.R. China
| | - Dong Wang
- Fujian Provincial Key Laboratory of Transplant Biology, Department of Urology, 900 Hospital of the Joint Logistics Team (Dongfang Hospital), Xiamen University, Fuzhou, Fujian, P.R. China
| | - Hu Zhao
- Fujian Provincial Key Laboratory of Transplant Biology, Department of Urology, 900 Hospital of the Joint Logistics Team (Dongfang Hospital), Xiamen University, Fuzhou, Fujian, P.R. China.,Department of General Surgery, 900 Hospital of the Joint Logistics Team, Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Jianming Tan
- Fujian Provincial Key Laboratory of Transplant Biology, Department of Urology, 900 Hospital of the Joint Logistics Team (Dongfang Hospital), Xiamen University, Fuzhou, Fujian, P.R. China
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13
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Korkes F, Timóteo F, Martins S, Nascimento M, Monteiro C, Santiago JH, Baccaglini W, Silveira MA, Pedroso EF, Gava MM, Patel P, Spiess PE, Glina S. Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project. JCO Glob Oncol 2021; 7:1547-1555. [PMID: 34767463 PMCID: PMC8594663 DOI: 10.1200/go.21.00104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil. PATIENTS AND METHODS A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared. RESULTS Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 (P < .002). One-year mortality was also lower in group 2. CONCLUSION Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.
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Affiliation(s)
- Fernando Korkes
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital Municipal da Vila Santa Catarina and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Frederico Timóteo
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital Municipal da Vila Santa Catarina and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Suelen Martins
- Division of Oncology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | - Camila Monteiro
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - José H Santiago
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Willy Baccaglini
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital Municipal da Vila Santa Catarina and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcel A Silveira
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Eduardo F Pedroso
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Marcello M Gava
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | - Sidney Glina
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
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Xiao JF, Caliri AW, Duex JE, Theodorescu D. Targetable Pathways in Advanced Bladder Cancer: FGFR Signaling. Cancers (Basel) 2021; 13:4891. [PMID: 34638374 PMCID: PMC8507635 DOI: 10.3390/cancers13194891] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 08/17/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 01/08/2023] Open
Abstract
Bladder cancer is the 10th most commonly diagnosed cancer in the world, accounting for around 573,000 new cases and 213,000 deaths in 2020. The current standard treatment for locally advanced bladder cancer is neoadjuvant cisplatin (NAC)-based chemotherapy followed by cystectomy. The significant progress being made in the genomic and molecular understandings of bladder cancer has uncovered the genetic alterations and signaling pathways that drive bladder cancer progression. These developments have led to a dramatic increase in the evaluation of molecular agents targeting at these alterations. One example is Erdafitinib, a first-in-class FGFR inhibitor being approved as second-line treatment for locally advanced or metastatic urothelial carcinoma with FGFR mutations. Immunotherapy has also been approved as second-line treatment for advanced and metastatic bladder cancer. Preclinical studies suggest targeted therapy combined with immunotherapy has the potential to markedly improve patient outcome. Given the prevalence of FGFR alternations in bladder cancer, here we review recent preclinical and clinical studies on FGFR inhibitors and analyze possible drug resistance mechanisms to these agents. We also discuss FGFR inhibitors in combination with other therapies and its potential to improve outcome.
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Affiliation(s)
- Jin-Fen Xiao
- Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.-F.X.); (A.W.C.)
- Department of Surgery (Urology), Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA;
| | - Andrew W. Caliri
- Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.-F.X.); (A.W.C.)
- Department of Surgery (Urology), Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA;
| | - Jason E. Duex
- Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA;
| | - Dan Theodorescu
- Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.-F.X.); (A.W.C.)
- Department of Surgery (Urology), Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA;
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15
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Liu Y, Lou W, Chen G, Ding B, Kuang J, Zhang Y, Wang C, Duan S, Deng Y, Lu X. Genome-wide screening for the G-protein-coupled receptor (GPCR) pathway-related therapeutic gene RGS19 (regulator of G protein signaling 19) in bladder cancer. Bioengineered 2021; 12:5892-5903. [PMID: 34482807 PMCID: PMC8806424 DOI: 10.1080/21655979.2021.1971035] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Bladder cancer is one of the most severe genitourinary cancers, causing high morbidity worldwide. However, the underlying molecular mechanism is not clear, and it is urgent to find target genes for treatment. G-protein-coupled receptors are currently a target of high interest for drug design. Thus, we aimed to identify a target gene-related to G-protein-coupled receptors for therapy. We used The Cancer Genome Atlas (TCGA) and DepMap databases to obtain the expression and clinical data of RGS19. The results showed that RGS19 was overexpressed in a wide range of tumor, especially bladder cancer. We also explored its effect on various types of cancer. High expression of RGS19 was also shown to be significantly associated with poor prognosis. Cell models were constructed for cell cycle detection. shRGS19 can halt the cell cycle at a polyploid point. RGS19 is a G-protein-coupled receptor signaling pathway-related gene with a significant effect on survival. We chose RGS19 as a therapeutic target gene in bladder cancer. The drug GSK1070916 was found to inhibit the effect of RGS19 via cell rescue experiments in vitro.
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Affiliation(s)
- Yue Liu
- Queen Mary School, Medical Collage of Nanchang University, Nanchang, China
| | - Weiming Lou
- Institute of Translational Medicine, Nanchang University, Nanchang, China
| | - Guang Chen
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bing Ding
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jin Kuang
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yize Zhang
- The Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Cong Wang
- The First Affiliated Hospital of Nanchang University, Nanchang University, Jiangxi Province, China
| | - Sainan Duan
- The First Affiliated Hospital of Nanchang University, Nanchang University, Jiangxi Province, China
| | - Ying Deng
- The Second Affiliated Hospital of Nanchang University, Nanchang University, Jiangxi Province, China
| | - Xiongbing Lu
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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16
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Patel A, Bisno DI, Patel HV, Ghodoussipour S, Saraiya B, Mayer T, Singer EA. Immune Checkpoint Inhibitors in the Management of Urothelial Carcinoma. J Cancer Immunol (Wilmington) 2021; 3:115-136. [PMID: 34263255 PMCID: PMC8276975 DOI: 10.33696/cancerimmunol.3.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Urothelial carcinoma is one of the most common cancers in the United States, yet outcomes are historically suboptimal. Since 2016, the approval of five programmed cell death 1 and programmed death-ligand 1 immune checkpoint inhibitors for locally advanced and metastatic urothelial carcinoma has led to improved oncologic outcomes for many patients in the second-line setting. Two checkpoint inhibitors, pembrolizumab and atezolizumab subsequently earned approval for first-fine therapy with restricted indications. More recently, pembrolizumab was approved for bacillus Calmette-Guérin-unresponsive high-risk non-muscle invasive bladder cancer, opening the door for other immune checkpoint inhibitors to be integrated into treatment in earlier disease stages. Recent bacillus Calmette-Guérin shortages have highlighted the need for alternative treatment options for patients with non-muscle invasive bladder cancer. Currently, there are no FDA-approved checkpoint inhibitors for non-metastatic muscle-invasive bladder cancer. Furthermore, many patients are ineligible for standard cisplatin-based chemotherapy regimens. Numerous ongoing clinical trials are employing immune checkpoint inhibitors for muscle-invasive bladder cancer patients in the neoadjuvant, adjuvant, perioperative, and bladder-sparing setting. Although up to 10% of urothelial carcinoma tumors arise in the upper urinary tract, few studies are designed for this population. We highlight the need for more trials designed for patients with upper tract disease. Overall, there are numerous clinical trials investigating the safety and efficacy of immune checkpoint inhibitors in all stages of disease as single-agents and combined with dual-immune checkpoint inhibition, chemotherapy, radiotherapy, and other pharmacologic agents. As the field continues to evolve rapidly, we aim to provide an overview of recent and ongoing immunotherapy clinical trials in urothelial carcinoma.
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Affiliation(s)
- Aakash Patel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Daniel I Bisno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Hiren V Patel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Saum Ghodoussipour
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Biren Saraiya
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Tina Mayer
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Eric A Singer
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
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17
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Huddart R, Hafeez S, Lewis R, McNair H, Syndikus I, Henry A, Staffurth J, Dewan M, Vassallo-Bonner C, Moinuddin SA, Birtle A, Horan G, Rimmer Y, Venkitaraman R, Khoo V, Mitra A, Hughes S, Gibbs S, Kapur G, Baker A, Hansen VN, Patel E, Hall E. Clinical Outcomes of a Randomized Trial of Adaptive Plan-of-the-Day Treatment in Patients Receiving Ultra-hypofractionated Weekly Radiation Therapy for Bladder Cancer. Int J Radiat Oncol Biol Phys 2021; 110:412-424. [PMID: 33316362 PMCID: PMC8114997 DOI: 10.1016/j.ijrobp.2020.11.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Hypofractionated radiation therapy can be used to treat patients with muscle-invasive bladder cancer unable to have radical therapy. Toxicity is a key concern, but adaptive plan-of the day (POD) image-guided radiation therapy delivery could improve outcomes by minimizing the volume of normal tissue irradiated. The HYBRID trial assessed the multicenter implementation, safety, and efficacy of this strategy. METHODS HYBRID is a Phase II randomized trial that was conducted at 14 UK hospitals. Patients with T2-T4aN0M0 muscle-invasive bladder cancer unsuitable for radical therapy received 36 Gy in 6 weekly fractions, randomized (1:1) to standard planning (SP) or adaptive planning (AP) using a minimization algorithm. For AP, a pretreatment cone beam computed tomography (CT) was used to select the POD from 3 plans (small, medium, and large). Follow-up included standard cystoscopic, radiologic, and clinical assessments. The primary endpoint was nongenitourinary Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 3 (≥G3) toxicity within 3 months of radiation therapy. A noncomparative single stage design aimed to exclude ≥30% toxicity rate in each planning group in patients who received ≥1 fraction of radiation therapy. Local control at 3-months (both groups combined) was a key secondary endpoint. RESULTS Between April 15, 2014, and August 10, 2016, 65 patients were enrolled (SP, n = 32; AP, n = 33). The median follow-up time was 38.8 months (interquartile range [IQR], 36.8-51.3). The median age was 85 years (IQR, 81-89); 68% of participants (44 of 65) were male; and 98% of participants had grade 3 urothelial cancer. In 63 evaluable participants, CTCAE ≥G3 nongenitourinary toxicity rates were 6% (2 of 33; 95% confidence interval [CI], 0.7%-20.2%) for the AP group and 13% (4 of 30; 95% CI, 3.8%-30.7%) for the SP group. Disease was present in 9/48 participants assessed at 3 months, giving a local control rate of 81.3% (95% CI, 67.4%-91.1%). CONCLUSIONS POD adaptive radiation therapy was successfully implemented across multiple centers. Weekly ultrahypofractionated 36 Gy/6 fraction radiation therapy is safe and provides good local control rates in this older patient population.
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Affiliation(s)
- Robert Huddart
- The Institute of Cancer Research, London, United Kingdom; Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Shaista Hafeez
- The Institute of Cancer Research, London, United Kingdom; Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Rebecca Lewis
- The Institute of Cancer Research, London, United Kingdom
| | - Helen McNair
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Isabelle Syndikus
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ann Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Monisha Dewan
- The Institute of Cancer Research, London, United Kingdom
| | | | - Syed Ali Moinuddin
- Academic unit of Oncology, Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Alison Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Gail Horan
- Queen Elizabeth Hospital Kings Lynn NHS Trust, Kings Lynn, United Kingdom
| | - Yvonne Rimmer
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Vincent Khoo
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anita Mitra
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Simon Hughes
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Stephanie Gibbs
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, United Kingdom
| | - Gaurav Kapur
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Angela Baker
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Emma Patel
- Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
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18
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Elshabrawy A, Wang H, Satsangi A, Wheeler K, Ramamurthy C, Pruthi D, Kaushik D, Liss M, Gelfond J, Fernandez R, Gore J, Svatek R, Mansour AM. Correlates of refusal of radical cystectomy in patients with muscle-invasive bladder cancer. Urol Oncol 2021; 39:236.e9-236.e20. [PMID: 33423936 DOI: 10.1016/j.urolonc.2020.11.023] [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] [Received: 05/28/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate factors associated with radical cystectomy (RC) refusal, subsequent treatment decisions, and their influence on overall survival (OS). MATERIALS AND METHODS We queried the National Cancer Database for patients with non-metastatic muscle-invasive bladder cancer (MIBC), cT2-T4M0. Patients who refused recommended RC were further stratified by treatment into chemotherapy, radiation therapy, chemoradiotherapy, and no treatment groups. Patients were excluded from the analysis if surgery was not planned, not recommended; or if survival data were unknown. Multivariate logistic regression modeling was utilized to identify independent predictors of refusing RC. Cox proportional hazards model with propensity score overlap weighting was utilized to identify survival predictors. Kaplan-Meier analysis was utilized to evaluate survival according to treatment. RESULTS A total of 74,159 MIBC patients were identified. Among patients with documented reasons for no surgery, 5.4% refused RC despite physician recommendation. Predictors of refusal on multivariate analysis included female gender (P = 0.016), advancing age ≥80 (vs. <60, P < 0.001), African American race (vs. white, P < 0.001) Medicaid (vs. private insurance, P < 0.001) and advancing T stage (T4 vs. T2, P < 0.001). Patients treated at academic centers were less likely to decline RC (vs. community centers, P < 0.001). Median survival after RC was 40.44 months vs. 12.52 months in refusal group. Undergoing chemoradiation had significantly improved survival in those patients compared to monotherapy or no treatment (hazard ratio 0.25, P < 0.001). Overlap weighted model Identified RC refusal as an independent predictor of poor OS (P < 0.001). CONCLUSIONS Several sociodemographic and clinical factors are associated with refusing radical cystectomy. Such refusal is associated with poor survival outcomes.
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Affiliation(s)
| | - Hanzhang Wang
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Arpan Satsangi
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Karen Wheeler
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | | | - Deepak Pruthi
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Dharam Kaushik
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Michael Liss
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Jonathan Gelfond
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - Roman Fernandez
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - John Gore
- Department of Urology, University of Washington, Seattle, WA
| | - Robert Svatek
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Ahmed M Mansour
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX; Urology and Nephrology Center, Mansoura University, Egypt.
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19
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de Vere White R, Dall'Era M. Re: Quality Indicators for Bladder Cancer Services: A Collaborative Review. Eur Urol 2020; 79:700. [PMID: 33288273 DOI: 10.1016/j.eururo.2020.11.031] [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] [Received: 10/21/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Affiliation(s)
| | - Marc Dall'Era
- UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
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20
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Abstract
IMPORTANCE Bladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality. OBSERVATIONS Advanced age, male sex, and cigarette smoking contribute to the development of bladder cancer. Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy. Non-muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification. Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence. Patients with high-risk non-muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage and many alternative therapies are being studied. For patients with muscle-invasive disease, more aggressive therapy with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation is warranted to curb the risk of metastasis and disease-specific mortality. Treatment of patients with advanced disease is undergoing rapid changes as immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease. CONCLUSIONS AND RELEVANCE Improved understanding of the molecular biology and genetics of bladder cancer has evolved the way localized and advanced disease is diagnosed and treated. While intravesical BCG has remained the mainstay of therapy for intermediate and high-risk non-muscle-invasive bladder cancer, the therapeutic options for muscle-invasive and advanced disease has expanded to include immunotherapy with checkpoint inhibition, targeted therapies, and antibody-drug conjugates.
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Affiliation(s)
- Andrew T Lenis
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | - Patrick M Lec
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | | | - M D Mshs
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
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Mortezavi A, Crippa A, Edeling S, Pokupic S, Dell'Oglio P, Montorsi F, D'Hondt F, Mottrie A, Decaestecker K, Wijburg CJ, Collins J, Kelly JD, Tan WS, Sridhar A, John H, Canda AE, Schwentner C, Rönmark EP, Wiklund P, Hosseini A. Morbidity and mortality after robot-assisted radical cystectomy with intracorporeal urinary diversion in octogenarians: results from the European Association of Urology Robotic Urology Section Scientific Working Group. BJU Int 2020; 127:585-595. [PMID: 33058469 PMCID: PMC8246851 DOI: 10.1111/bju.15274] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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
Objectives To evaluate the postoperative complication and mortality rate following laparoscopic radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in octogenarians. Patients and Methods We conducted a retrospective analysis comparing postoperative complication and mortality rates depending on age in a consecutive series of 1890 patients who underwent RARC with ICUD for bladder cancer between 2004 and 2018 in 10 European centres. Outcomes of patients aged <80 years and those aged ≥80 years were compared with regard to postoperative complications (Clavien–Dindo grading) and mortality rate. Cancer‐specific mortality (CSM) and other‐cause mortality (OCM) after surgery were calculated using the non‐parametric Aalen‐Johansen estimator. Results A total of 1726 patients aged <80 years and 164 aged ≥80 years were included in the analysis. The 30‐ and 90‐day rate for high‐grade (Clavien–Dindo grades III–V) complications were 15% and 21% for patients aged <80 years compared to 11% and 13% for patients aged ≥80 years (P = 0.2 and P = 0.03), respectively. In a multivariable logistic regression analysis adjusting for pre‐ and postoperative variables, age ≥80 years was not an independent predictor of high‐grade complications (odds ratio 0.6, 95% confidence interval 0.3–1.1; P = 0.12). The non‐cancer‐related 90‐day mortality was 2.3% for patients aged ≥80 years and 1.8% for those aged <80 years, respectively (P = 0.7). The estimated 12‐month CSM and OCM rates for those aged <80 years were 8% and 3%, and for those aged ≥80 years, 15% and 8%, respectively (P = 0.009 and P < 0.001). Conclusions The minimally invasive approach to RARC with ICUD for bladder cancer in well‐selected elderly patients (aged ≥80 years) achieved a tolerable high‐grade complication rate; the 90‐day postoperative mortality rate was driven by cancer progression and the non‐cancer‐related rate was equivalent to that of patients aged <80 years. However, an increased OCM rate in this elderly group after the first year should be taken into account. These results will support clinicians and patients when balancing cancer‐related vs treatment‐related risks and benefits.
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Affiliation(s)
- Ashkan Mortezavi
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, University Hospital Zurich, Zurich, Switzerland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Edeling
- Department of Urology, Vinzenzkrankenhaus Hannover, Hannover, Germany
| | - Sasa Pokupic
- Department of Urology, Vinzenzkrankenhaus Hannover, Hannover, Germany
| | - Paolo Dell'Oglio
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Francesco Montorsi
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Alexandre Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | | | - Carl J Wijburg
- Department of Urology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Justin Collins
- Department of Urology, University College London Hospital, London, UK
| | - John D Kelly
- Department of Urology, University College London Hospital, London, UK
| | - Wei Shen Tan
- Department of Urology, University College London Hospital, London, UK
| | - Ashwin Sridhar
- Department of Urology, University College London Hospital, London, UK
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | | | - Erik Peder Rönmark
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abolfazl Hosseini
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
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22
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Washington SL, Gregorich SE, Meng MV, Suskind AM, Porten SP. Race modifies survival benefit of guideline-based treatment: Implications for reducing disparities in muscle invasive bladder cancer. Cancer Med 2020; 9:8310-8317. [PMID: 32869516 PMCID: PMC7666728 DOI: 10.1002/cam4.3429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Black individuals with muscle-invasive bladder cancer (MIBC) experienced 21% lower odds of guideline-based treatment (GBT) and differences in treatment explain 35% of observed Black-White differences in survival. Yet little is known of how interactions between race/ethnicity and receipt of GBT drive within- and between-race survival differences. METHODS Black, White, and Latino individuals diagnosed with nonmetastatic, locally advanced MIBC from 2004 to 2013 within the National Cancer Database were included. Guideline-based treatment was defined as the receipt including one or more of the following treatment modalities: radical cystectomy (RC), neoadjuvant chemotherapy with RC, RC with adjuvant chemotherapy, and/or chemoradiation based on American Urological Association guidelines. Cox proportional hazards model of mortality estimated effects of GBT status, race/ethnicity, and the GBT-by-race/ethnicity interaction, adjusting for covariates. RESULTS Of the 54 910 MIBC individuals with 125 821 person-years of posttreatment observation (max = 11 years), 6.9% were Black, and 3.0% were Latino. Overall, 51.4%, 45.3%, and 48.5% of White, Black, and Latino individuals received GBT. Latino individuals had lower hazard of death compared to Black (HR 0.81, 95% CI 0.75-0.87) and White individuals (HR 0.92, 95% 0.86-0.98). With GBT, Latino and White individuals had similar outcomes (HR = 1.00, 95% 0.91-1.10) and both fared better than Black individuals (HR = 0.88, 95% 0.79-0.99 and HR = 0.88, 95% 0.83-0.94, respectively). Without GBT, Latino individuals fared better than White (HR = 0.85, 95% 0.77-0.93) and Black individuals (HR = 0.74, 95% 0.67-0.82) while White individuals fared better than Black individuals (HR = 0.87, 95% 0.83-0.92). Black individuals with GBT fared worse than Latinos without GBT (HR = 1.02, 95% 0.92-1.14), although not statistically significant. CONCLUSION Low GBT levels demonstrated an "under-allocation" of GBT to those who needed it most-Black individuals. Interventions to improve GBT allocation may mitigate race-based survival differences observed in MIBC.
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Affiliation(s)
| | | | - Maxwell V. Meng
- Department of UrologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Anne M. Suskind
- Department of UrologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Sima P. Porten
- Department of UrologyUniversity of CaliforniaSan FranciscoCAUSA
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23
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Abstract
There is an underutilization of potentially curative treatments for patients with muscle-invasive bladder cancer. Contemporary trimodality bladder-preservation therapy - which includes a maximally safe transurethral resection of the bladder tumor followed by concurrent chemoradiation and close cystoscopic surveillance with salvage cystectomy reserved for invasive tumor recurrence - can help fulfill this unmet need. Over the past few decades, cumulative published data from prospective clinical trials and large institutional series have established trimodality therapy (TMT) for select patients as a safe and effective alternative to upfront cystectomy. Indeed, TMT is now supported as an accepted option for muscle-invasive bladder cancer patients by numerous clinical guidelines. Following TMT, the vast majority of long-term survivors maintain their native bladders, which tend to function well with relatively low rates of long-term toxicity and good long-term quality of life. There is the potential to further improve outcomes by optimizing systemic therapy integration and by validating predictive biomarkers for improved patient and treatment selection. TMT offers a unique opportunity for urologic surgeons, radiation oncologists and medical oncologists to work hand-in-hand in a multidisciplinary effort to deliver such therapy optimally, to support its research, to promote informed decision-making and ultimately to preserve the autonomy of patients with bladder cancer. The third annual meeting of the Johns Hopkins Greenberg Bladder Cancer Institute/American Urological Association Translational Research Collaboration allowed bladder cancer experts to meet and advance this mission.
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Affiliation(s)
- Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
| | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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24
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Jiang DM, North SA, Canil C, Kolinsky M, Wood LA, Gray S, Eigl BJ, Basappa NS, Blais N, Winquist E, Mukherjee SD, Booth CM, Alimohamed NS, Czaykowski P, Kulkarni GS, Black PC, Chung PW, Kassouf W, van der Kwast T, Sridhar SS. Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada. Bladder Cancer 2020. [DOI: 10.3233/blc-200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott A. North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kolinsky
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A. Wood
- Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Samantha Gray
- Department of Oncology, Saint John Regional Hospital, Department of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Bernhard J. Eigl
- Department of Medicine, Division of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Naveen S. Basappa
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Normand Blais
- Department of Medicine, Division of Medical Oncology and Hematology, Centre Hospitalier de l’Université de Montréal; Université de Montréal, Montreal, QC, Canada
| | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Som D. Mukherjee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Nimira S. Alimohamed
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Girish S. Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter W. Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Srikala S. Sridhar
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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25
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Osterman CK, Deal AM, McCloskey H, Nyrop KA, Bjurlin MA, Tan HJ, Nielsen ME, Milowsky MI, Muss HB, Smith AB. Impairment and Longitudinal Recovery of Older Adults Treated with Radical Cystectomy for Muscle Invasive Bladder Cancer. J Urol 2021; 205:94-9. [PMID: 32716672 DOI: 10.1097/JU.0000000000001323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Treatment for muscle invasive bladder cancer includes radical cystectomy, a major surgery that can be associated with significant toxicity. Limited data exist related to changes in patient global health status and recovery following radical cystectomy. We used geriatric assessment to longitudinally compare health related impairments in older and younger patients with muscle invasive bladder cancer who undergo radical cystectomy. MATERIALS AND METHODS Older and younger patients (70 or older and younger than 70 years) with muscle invasive bladder cancer undergoing radical cystectomy at an academic institution were enrolled between 2012 and 2019. Patients completed the geriatric assessment before radical cystectomy, and 1, 3 and 12 months after radical cystectomy. For each geriatric assessment measure the Wilcoxon rank sum test was used to compare score distribution between age groups at each time point. The Wilcoxon signed rank test was used to compare distributions between time points within each age group. RESULTS A total of 80 patients (42 younger and 38 older) were enrolled. Before radical cystectomy 78% of patients were impaired on at least 1 geriatric assessment measure. Both age groups had worsening physical function and nutrition at 1 month after radical cystectomy, with older patients having a greater decline in function than younger patients. Both groups recovered to baseline at 3 months after radical cystectomy and maintained this status at 1 year. CONCLUSIONS High rates of impairments were found across age groups in the short term after radical cystectomy, followed by recovery to baseline.
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26
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de Vere White R, Lara PN, Black PC, Evans CP, Dall’Era M. Framing Pragmatic Strategies to Reduce Mortality From Bladder Cancer: An Endorsement From the Society of Urologic Oncology. J Clin Oncol 2020; 38:1760-1762. [DOI: 10.1200/jco.19.01731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ralph de Vere White
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
- Department of Urology, University of California Davis, Sacramento, CA
| | - Primo N. Lara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
- Department Hematology/Oncology, University of California Davis, Sacramento, CA
| | - Peter C. Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher P. Evans
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
- Department of Urology, University of California Davis, Sacramento, CA
| | - Marc Dall’Era
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
- Department of Urology, University of California Davis, Sacramento, CA
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27
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Abstract
PURPOSE OF REVIEW A review of the impact of several key patient characteristics on oncologic outcomes in bladder cancer (BC) summarized and analyzed in a narrative fashion. RECENT FINDINGS The bulk of the published literature suggests that females and blacks have poorer cancer-specific outcomes. Both groups tend to present with worse disease, which may be driven by differences in access to timely and quality care. Attempts to assess the association between smoking status and history and BC outcomes have been hindered by the quality and heterogeneity of the data, although several studies have linked smoking with higher rates of recurrence and poorer survival. Being married, particularly in men, may improve survival after radical cystectomy (RC). Limited data suggests that socioeconomic and education levels may be associated with poorer survival; however, the data is limited. A growing body of investigation suggests that there are significant differences in oncologic outcomes in BC patients based on race, gender, smoking status, socioeconomic status, and others. Further focus and investigation is needed to validate these findings, investigate the root cause of these differences, and offer solutions to mitigate them.
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Affiliation(s)
- Wesley Yip
- USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90033, USA
| | - Giovanni Cacciamani
- USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90033, USA
| | - Sumeet K Bhanvadia
- USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90033, USA.
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28
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John JB, Varughese MA, Cooper N, Wong K, Hounsome L, Treece S, McGrath JS, Harden S. Treatment Allocation and Survival in Patients Diagnosed with Nonmetastatic Muscle-invasive Bladder Cancer: An Analysis of a National Patient Cohort in England. Eur Urol Focus 2021; 7:359-65. [PMID: 32088138 DOI: 10.1016/j.euf.2020.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/19/2020] [Accepted: 01/31/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND UK Bladder cancer survival remains low. Nonmetastatic muscle-invasive bladder cancer (MIBC) is potentially curable. It is unclear how many patients receive nonradical treatment owing to advanced age, comorbidities, or alternative factors. OBJECTIVE To describe treatments and assess survival by disease stage and sex for all newly diagnosed nonmetastatic MIBC in England in 2016, and to observe associations between comorbidities and treatments. DESIGN, SETTING, AND PARTICIPANTS All new nonmetastatic MIBC diagnoses in England in 2016 were identified retrospectively using National Cancer Registration and Analysis Service, Radiotherapy Datasets, Systemic Anti-Cancer Therapy, and Hospital Episode Statistics databases. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Age, Charlson Comorbidity Index (CCI), and treatments were ascertained, and 1-yr survival was estimated using Pohar-Perme and Kaplan-Meier methods. RESULTS AND LIMITATIONS Nonmetastatic MIBC diagnoses were registered for 2519 patients (median age 76 yr). Radical cystectomy was performed in 24%, 37% of whom received neoadjuvant chemotherapy (NAC). Radical radiotherapy was performed in 29%, 48% of whom received NAC. NAC alongside radical treatment was associated with higher 1-yr overall survival (OS)-91% (88-93%) with NAC and 83% (80-85%) without (p = 0.05). Nonradical treatments occurred for 47%, with corresponding lower OS. Females with stage II and III disease had significantly lower net survival (NS). Radically treated patients had lower CCIs. CONCLUSIONS This analysis provides an overview of all nonmetastatic MIBC diagnosed in England in 2016. Just over half of the patients received curative-intent treatment. Of them, only 43% received NAC. One-year OS was disparate, correlating with treatment intensity. Those receiving NAC and radical therapy demonstrated highest OS. Female patients had significantly inferior NS. The data highlight a prescient unmet research need to understand the patient demographic and reasons behind treatment allocation, to address the poor survival observed in those treated nonradically, and the low NAC utilisation. The significantly aged population requires specific future focus. PATIENT SUMMARY We looked at all patients in England in 2016 who were diagnosed with bladder cancer invading the bladder muscle. Many patients were elderly, and the most intensive treatments aiming for cure were frequently not used. Survival in women was found to be considerably worse, as was survival for less intensively treated patients.
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29
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Gadzinski AJ, Psutka SP. Risk stratification metrics for bladder cancer: Comprehensive Geriatric Assessments. Urol Oncol 2020; 38:725-733. [PMID: 32037198 DOI: 10.1016/j.urolonc.2020.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/09/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 12/26/2022]
Abstract
Despite advances in surgical technique and perioperative care pathways, complication rates following radical cystectomy for bladder cancer remain high and perioperative outcomes for elderly patients are suboptimal. Furthermore, subjective risk assessments of patients with bladder cancer, with a high prevalence of complex comorbidity burden and risk of frailty, may result in undertreatment of patients assumed to be poor operative candidates. A critical component of preoperative patient counseling and treatment selection is accurate and objective preoperative risk appraisal. Comprehensive Geriatric Assessments are multi-domain evaluations of the medical, functional, and psychosocial aspects of health designed specifically for use in elderly patients with the objective of identifying vulnerabilities that may be targeted with interventions for improvement. While currently recommended by multiple guideline bodies for use in the preoperative evaluation of elderly patients with bladder cancer there is a paucity of data describing their use in contemporary clinical practice. Herein, then, we will describe the components of a Comprehensive Geriatric Assessments and propose strategies for their integration into the preoperative surgical workflow.
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Affiliation(s)
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA.
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30
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Abstract
PURPOSE OF REVIEW Bladder-sparing trimodality therapy (TMT) has become an accepted alternative to cystectomy for selected muscle invasive bladder cancer (MIBC) patients unfit for cystectomy or opting for bladder preservation. This review will summarize recent advances in TMT for MIBC. RECENT FINDINGS A growing body of literature has emerged which supports the use of TMT. However, its delivery is yet to be standardized. The role of chemotherapy and predictive biomarkers remain to be elucidated. Novel bladder-sparing approaches, drug combinations including immunotherapy and targeted therapies are under investigation in clinical trials, with the goal of ultimately enhancing survival and quality of life outcomes. Recent advances in TMT have made bladder preservation possible for MIBC patients seeking an alternative local therapy to cystectomy. With careful patient selection, TMT offers comparable survival outcomes to cystectomy, and improved quality of life as patients are able to successfully retain their bladder.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Canada, 700 University Avenue, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, University of Toronto, Canada, 700 University Ave, Toronto, ON, Canada
| | - Girish S Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Canada, 6-824, 700 University Avenue, Toronto, ON, Canada
| | - Srikala S Sridhar
- Department of Medicine, Division of Medical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Canada, 700 University Avenue, Toronto, ON, Canada.
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31
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Clinton TN, Wiseman M, Walasek A, Pietzak E. Commentary: underutilization of curative-intent therapy for patients with muscle-invasive bladder cancer in Sweden mimics the United States. Transl Androl Urol 2019; 8:S542-S545. [PMID: 32042642 PMCID: PMC6989840 DOI: 10.21037/tau.2019.12.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Timothy N Clinton
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michal Wiseman
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aleksandra Walasek
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eugene Pietzak
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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