Clinical Perspectives of ERCC1 in Bladder Cancer

ERCC1 is a key regulator of nucleotide excision repair (NER) pathway that repairs bulky DNA adducts, including intrastrand DNA adducts and interstrand crosslinks (ICLs). Overexpression of ERCC1 has been linked to increased DNA repair capacity and platinum resistance in solid tumors. Multiple single nucleotide polymorphisms (SNPs) have been detected in ERCC1 gene that may affect ERCC1 protein expression. Platinum-based treatment remains the cornerstone of urothelial cancer treatment. Given the expanding application of neoadjuvant and adjuvant chemotherapy in locally advanced bladder cancer, there is an emerging need for biomarkers that could distinguish potential responders to cisplatin treatment. Extensive research has been done regarding the prognostic and predictive role of ERCC1 gene expression and polymorphisms in bladder cancer. Moreover, novel compounds have been recently developed to target ERCC1 protein function in order to maximize sensitivity to cisplatin. We aim to review all the existing literature regarding the role of the ERCC1 gene in bladder cancer and address future perspectives for its clinical application.

Clinical states model for biomarkers in bladder cancer

Bladder cancer is a significant healthcare problem in the USA, with a high recurrence rate, the need for expensive continuous surveillance and limited treatment options for patients with advanced disease. Research has contributed to an understanding of the molecular pathways involved in the development and progression of bladder cancer, and that understanding has led to the discovery of potentially diagnostic, predictive and prognostic biomarkers. In this review, a clinical states model of bladder cancer is introduced and integrated into a paradigm for biomarker development. Biomarkers are systematically incorporated with predefined end points to aid in clinical management.

Quality of pathologic response and surgery correlate with survival for patients with completely resected bladder cancer after neoadjuvant chemotherapy

BACKGROUND

In a retrospective study of Southwestern Oncology Group (SWOG)-S8710/INT-0080 (radical cystectomy [RC] alone vs 3 cycles of neoadjuvant chemotherapy [NC] with methotrexate, vinblastine, doxorubicin, and cisplatin before RC for bladder cancer), factors found to be associated with improved overall survival (OS) included pathologic complete response, defined as P0; treatment with NC; completion of RC with negative surgical margins; and >or=10 pelvic lymph nodes (LNs) removed.

METHODS

The authors used stratified Cox regression to retrospectively study the association of quality of pathologic response after RC with OS in the subset of S8710 patients who received NC and RC with negative surgical margins.

RESULTS

Of 154 patients who received NC, 68 (44.2%) were

CONCLUSIONS

NC and RC with negative surgical margins for bladder cancer followed by pathologic P0 and LN- disease were found to correlate with improved OS. A combination of baseline clinical stage and post-RC pathologic stage may better predict OS.

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Key Words

• neoadjuvant chemotherapy
• bladder cancer
• pathologic complete response
• overall survival

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MESH Headings

• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Chemotherapy, Adjuvant
• Cisplatin/therapeutic use
• Cystectomy
• Doxorubicin/therapeutic use
• Humans
• Lymph Node Excision
• Methotrexate/therapeutic use
• Neoadjuvant Therapy
• Prognosis
• Retrospective Studies
• Survival Analysis
• Treatment Outcome
• Urinary Bladder Neoplasms/drug therapy
• Urinary Bladder Neoplasms/mortality
• Urinary Bladder Neoplasms/pathology
• Urinary Bladder Neoplasms/surgery
• Vinblastine/therapeutic use

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Grants

• CA22433 NCI NIH HHS
• U10 CA035192 NCI NIH HHS
• U10 CA021115 NCI NIH HHS
• CA76447 NCI NIH HHS
• U10 CA032102 NCI NIH HHS
• N01 CA038926 NCI NIH HHS
• CA42777 NCI NIH HHS
• U10 CA046368 NCI NIH HHS
• CA21115 NCI NIH HHS
• U10 CA035090 NCI NIH HHS
• U10 CA063844 NCI NIH HHS
• U10 CA022433 NCI NIH HHS
• U10 CA027057 NCI NIH HHS
• CA28862 NCI NIH HHS
• CA46136 NCI NIH HHS
• U10 CA016385 NCI NIH HHS
• CA35261 NCI NIH HHS
• CA35117 NCI NIH HHS
• N01 CA035431 NCI NIH HHS
• U10 CA046113 NCI NIH HHS
• U10 CA045560 NCI NIH HHS
• CA59416 NCI NIH HHS
• CA20319 NCI NIH HHS
• CA58415 NCI NIH HHS
• U10 CA076447 NCI NIH HHS
• U10 CA128567 NCI NIH HHS
• N01 CA032102 NCI NIH HHS
• CA68183 NCI NIH HHS
• CA35281 NCI NIH HHS
• U10 CA032102-32 NCI NIH HHS
• CA128567 NCI NIH HHS
• U10 CA014028 NCI NIH HHS
• U10 CA035421 NCI NIH HHS
• N01 CA046441 NCI NIH HHS
• CA35262 NCI NIH HHS
• CA14028 NCI NIH HHS
• CA58882 NCI NIH HHS
• CA45377 NCI NIH HHS
• CA35084 NCI NIH HHS
• U10 CA035281 NCI NIH HHS
• CA35421 NCI NIH HHS
• CA58861 NCI NIH HHS
• CA35090 NCI NIH HHS
• N01 CA063844 NCI NIH HHS
• CA46282 NCI NIH HHS
• U10 CA035261 NCI NIH HHS
• CA16385 NCI NIH HHS
• U10 CA046282 NCI NIH HHS
• U10 CA035262 NCI NIH HHS
• CA46368 NCI NIH HHS
• N01 CA027057 NCI NIH HHS
• U10 CA058686 NCI NIH HHS
• U10 CA046441 NCI NIH HHS
• U10 CA045377 NCI NIH HHS
• CA35192 NCI NIH HHS
• U10 CA058882 NCI NIH HHS
• U10 CA020319 NCI NIH HHS
• CA46113 NCI NIH HHS
• U10 CA038926 NCI NIH HHS
• CA32734 NCI NIH HHS
• CA58686 NCI NIH HHS
• U10 CA032102-19S1 NCI NIH HHS
• U10 CA042777 NCI NIH HHS
• U10 CA035431 NCI NIH HHS
• U10 CA058861 NCI NIH HHS
• U10 CA068183 NCI NIH HHS
• N01 CA045560 NCI NIH HHS

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Affiliation(s)

Guru Sonpavde Department of Medicine, Section of Medical Oncology, Baylor College of Medicine, Houston, Texas, USA.
Bryan H Goldman
V O Speights
Seth P Lerner
David P Wood
Nicholas J Vogelzang
Donald L Trump
Ronald B Natale
H Barton Grossman
E David Crawford

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Novel therapeutics in metastatic bladder cancer

BACKGROUND

Albeit transitional cell carcinoma of the urinary bladder is a chemosensitive neoplasm, metastatic disease is related with poor prognosis and short-term survival data.

OBJECTIVE

Cisplatin-based combination chemotherapy is recognised as the golden standard therapy for patients with inoperable locally advanced or metastatic bladder cancer. However, owing to treatment-related toxicities and short-response durations, novel treatment options or agents, with both enhanced efficacy and tolerability, have been sought.

METHODS

Reviewing the current status and addressing the future of novel anticancer therapeutics in metastatic urinary bladder cancer.

RESULTS/CONCLUSION

Non-platinum, single agents, such as gemcitabine and taxanes, as well as multidrug regimens in doublet or triplet chemotherapeutic combinations are regarded as promising alternatives. Dose intensification of conventional regimens, dose-dense sequential administration of new agents, the use of molecular markers for predicting chemosensitivity and the integration of biologically targeted agents to enhance chemotherapeutic efficacy are promising approaches.