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Weickhardt A, Foroudi F, Lawrentschuk N, Xie J, Sidhom M, Pal A, Grimison P, Zhang A, Ng S, Tang C, Hovey E, Chen C, Hruby G, Guminski A, McJannett M, Conduit C, Tran B, Davis ID, Hayne D. Pembrolizumab with Chemoradiation as Treatment for Muscle-invasive Bladder Cancer: Analysis of Safety and Efficacy of the PCR-MIB Phase 2 Clinical Trial (ANZUP 1502). Eur Urol Oncol 2024; 7:469-477. [PMID: 37806844 DOI: 10.1016/j.euo.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Radiation may improve the efficacy of immune checkpoint inhibition. This study investigates the combination of pembrolizumab and chemoradiation (CRT) for muscle-invasive bladder cancer (MIBC). OBJECTIVE To assess the feasibility and safety of pembrolizumab combined with CRT for MIBC. DESIGN, SETTING, AND PARTICIPANTS A single-arm phase 2 trial was performed with 28 participants having cT2-T4aN0M0 MIBC (Eastern Cooperative Oncology Group performance status 0-1; estimated glomerular filtration rate ≥40 ml/min; no contraindications to pembrolizumab) suitable for CRT. INTERVENTION Whole bladder radiation therapy (RT; 64 Gy in 32 daily fractions, over 6.5 wk, combined with cisplatin (35 mg/m2 intravenously [IV] weekly, six doses) and pembrolizumab (200 mg IV q3 weeks, seven doses), both starting with RT. Surveillance cystoscopy/biopsy and computerised tomography scans performed 12 and 24 wk after CRT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was feasibility, determined by a prespecified satisfactory low rate of grade 3 or worse nonurinary toxicity or completion of planned CRT according to defined parameters. Secondary endpoints were complete cystoscopic response, locoregional progression-free survival (LRPFS), distant metastasis-free survival (DMFS), and overall survival (OS). RESULTS AND LIMITATIONS Twenty-eight patients were enrolled with a 31-mo median follow-up. Six had Grade >3 nonurinary adverse events during/within 12 wk after treatment; three had more than one cisplatin dose reduction. The 24-wk post-CRT complete response (CR) rate was 88%. Eight patients developed metastatic disease, and three had nonmetastatic progression. The DMFS at 2 yr is 78% (95% confidence interval [CI] 54-90%), with LRPFS at 2 yr of 87% (95% CI 64-96%) and median OS of 39 mo (95% CI 17.1-not evaluable). Limitations are the single-arm design and sample size. CONCLUSIONS Combining pembrolizumab with CRT for MIBC was feasible, with manageable toxicity and promising CR rates. PATIENT SUMMARY Immunotherapy treats nonmetastatic/metastatic bladder cancer effectively. We combined pembrolizumab with chemotherapy and radiation to assess its safety and impact on treatment delivery. The combination was feasible with encouraging early activity. Further larger trials are warranted.
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Affiliation(s)
- Andrew Weickhardt
- Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, Melbourne, Australia.
| | - Farshad Foroudi
- Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, Melbourne, Australia
| | - Nathan Lawrentschuk
- Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Jing Xie
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | | | | | | | | | - Siobhan Ng
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Colin Tang
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Elizabeth Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - Colin Chen
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | | | | | - Margaret McJannett
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, Australia
| | - Ciara Conduit
- Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia; Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, Australia
| | - Ben Tran
- Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Ian D Davis
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, Australia; Monash University, Melbourne, Australia; Eastern Health, Melbourne, Australia
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Sarkis J, Vannier E, Mjaess G, Pochet C, Albisinni S, Quackels T, Roumeguère T. Neoadjuvant immunochemotherapy in the treatment of nonmetastatic muscle-invasive bladder cancer: a systematic review. Immunotherapy 2022; 14:1407-1417. [PMID: 36448639 DOI: 10.2217/imt-2022-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Multiple trials are currently studying the additional effect of immunotherapy on neoadjuvant chemotherapy (NAC) in nonmetastatic muscle-invasive bladder cancer. Methods: We performed a systematic review of the literature that summarizes all ongoing trials, with their results when available. Results: From an initial 269 trials identified, 17 were included. Pathological response and pathological complete response rates of the immunotherapy + NAC combination in the cisplatin-eligible population varied between 56.6-75% and 34.0-66.7%, respectively. Two studies published their results in the cisplatin-ineligible population, with pathological complete response rates of 18 and 45.2%. Conclusion: Neoadjuvant immunochemotherapy in platinum-eligible patients results in response rates higher than those reported for NAC alone. Strong preliminary results are still lacking in the platinum-ineligible population.
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Affiliation(s)
- Julien Sarkis
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Enguerrand Vannier
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Corentin Pochet
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Surgical Sciences, Urology Unit, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Thierry Quackels
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Petricevic B, Kabiljo J, Zirnbauer R, Walczak H, Laengle J, Bergmann M. Neoadjuvant Immunotherapy in Gastrointestinal Cancers - The New Standard of Care? Semin Cancer Biol 2022; 86:834-850. [PMID: 35671877 DOI: 10.1016/j.semcancer.2022.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
The development of immune checkpoint inhibitors (ICI) offers novel treatment possibilities for solid cancers, with the crucial benefit of providing higher cure rates. These agents have become part of standard treatments in the metastatic and adjuvant setting for select cancers, such as melanoma, non-small cell lung cancer (NSCLC) or urological malignancies. Currently, there is ample clinical interest in employing ICI in a neoadjuvant setting with a curative intent. This approach is especially supported by the scientific rationale that ICI primarily stimulate the host immune system to eradicate tumor cells, rather than being inherently cytotoxic. Aside from tumor downstaging, neoadjuvant immunotherapy offers the potential of an in situ cancer vaccination, leading to a systemic adjuvant immunological effect after tumor resection. Moreover, preclinical data clearly demonstrate a synergistic effect of ICI with radiotherapy (RT), chemoradiotherapy (CRT) or chemotherapy (ChT). This review harmonizes preclinical concepts with real world data (RWD) in the field of neoadjuvant ICI in gastrointestinal (GI) cancers and discusses their limitations. We believe this is a crucial approach, since up to now, neoadjuvant strategies have been primarily developed by clinicians, whereas the advances in immunotherapy primarily originate from preclinical research. Currently there is limited published data on neoadjuvant ICI in GI cancers, even though neoadjuvant treatments including RT, CRT or ChT are frequently employed in locally advanced/oligometastatic GI cancers (i.e. rectal, pancreatic, esophagus, stomach, etc.). Utilizing established therapies in combination with ICI provides an abundance of opportunities for innovative treatment regimens to further improve survival rates.
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Affiliation(s)
- Branka Petricevic
- Division of Visceral Surgery, Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Julijan Kabiljo
- Division of Visceral Surgery, Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; Ludwig Boltzmann Institute Applied Diagnostics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Rebecca Zirnbauer
- Division of Visceral Surgery, Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Henning Walczak
- Institute for Biochemistry I, Medical Faculty, University of Cologne, Cologne, Germany; Centre for Cell Death, Cancer, and Inflammation (CCCI), UCL Cancer Institute, University College, London, WC1E 6BT UK
| | - Johannes Laengle
- Division of Visceral Surgery, Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; Ludwig Boltzmann Institute Applied Diagnostics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | - Michael Bergmann
- Division of Visceral Surgery, Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; Ludwig Boltzmann Institute Applied Diagnostics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Alevizakos M, Bellmunt J. Adjuvant immunotherapy for muscle-invasive urothelial carcinoma of the bladder. Expert Rev Anticancer Ther 2022; 22:259-267. [PMID: 35142248 DOI: 10.1080/14737140.2022.2038565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION There are substantial unmet needs with regards to adjuvant therapy for muscle-invasive urothelial carcinoma (UC) of the bladder, including patients with persistent disease histologically following neoadjuvant platinum-based therapy and radical resection, as well as patients who are not eligible for or refuse cytotoxic chemotherapy. As such, increased interest has been developed in advancing the use of systemic immunotherapy in the postoperative setting. AREAS COVERED We begin by examining current uses of systemic immunotherapy in the treatment of advanced UC. We also review emerging neoadjuvant data and describe current adjuvant approaches. We then report and analyze data on adjuvant immunotherapy, including the recent randomized trials on adjuvant nivolumab and atezolizumab, and conclude with a discussion on the available evidence and likely directions of the field. EXPERT OPINION Systemic immunotherapy can serve to enhance postoperative therapies for muscle-invasive bladder UC, as exemplified by the recent approval of nivolumab. Further research will serve to define optimal immunotherapy timing and combinations with other systemic therapies, as well as identify predictive biomarkers to allow effective tailoring of therapy for each patient.
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Affiliation(s)
- Michail Alevizakos
- Hematology/Oncology Division, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joaquim Bellmunt
- Hematology/Oncology Division, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Cost-Effectiveness of Immune Checkpoint Inhibitors in Urothelial Carcinoma-A Review. Cancers (Basel) 2021; 14:cancers14010073. [PMID: 35008237 PMCID: PMC8750958 DOI: 10.3390/cancers14010073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Urothelial carcinoma is a malignancy that originates in the genitourinary tract. It is a heterogeneous disease that can present at different stages, and the treatment options vary in efficacy. Advances in immunotherapy stimulated adoption in urothelial carcinoma, and published trials have shown promising results when compared to conventional therapies. However, oncologic drugs are historically costly, and immunotherapy is no exception. A cost-effectiveness analysis is a standardized method of weighing the clinical benefits of an intervention against the financial burden to obtain a composite proposed value. Multiple investigators have assessed immunotherapy in urothelial carcinoma, but no consensus has been reached. Here, we aim to review the literature of the available cost-effectiveness studies to summarize the results and determine the current value of systemic immunotherapy compared to standard treatment. Positive findings will support continued efforts to adopt immunotherapy, whereas negative findings will identify potential gaps for improvement in cost-effectiveness. Abstract Over the last decade, an increasing number of immune checkpoint inhibitors (ICIs) have been assessed for therapeutic efficacy in urothelial carcinoma (UC). The high cost has prompted multiple cost-effectiveness analyses for the various disease stages, with no established consensus. We reviewed the literature to assess the available cost-effectiveness studies and summarize their findings. Studies were filtered for a calculated incremental cost-effectiveness ratio (ICER) to standardize comparison. Over 2600 articles were narrowed to eight primary investigations: one for BCG-refractory non-muscle invasive (NMI), one for neoadjuvant therapy in muscle-invasive (MI), and six for advanced disease. Cost-effectiveness was not achieved for NMI disease. Atezolizumab met the willingness-to-pay (WTP) threshold as neoadjuvant therapy for MI disease compared to chemotherapy, but with multiple limitations on the interpretation. Of the six studies on advanced disease, the results were mixed. This was at least partially attributable to varied methodologies including extrapolated time horizons, inconsistent cost inputs, and different WTP thresholds. Overall, the aggregate results were not compelling enough to establish ICIs as cost-effective compared to conventional chemotherapy. Value may improve with continued investigation into long-term outcomes, refined patient selection, and pricing discounts.
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Perioperative Systemic Treatment for Muscle-Invasive Bladder Cancer: Current Evidence and Future Perspectives. Int J Mol Sci 2021; 22:ijms22137201. [PMID: 34281253 PMCID: PMC8268978 DOI: 10.3390/ijms22137201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
Radical cystectomy is the primary treatment for muscle-invasive bladder cancer; however, approximately 50% of patients develop metastatic disease within 2 years of diagnosis, which results in dismal prognosis. Therefore, systemic treatment is important to improve the prognosis of muscle-invasive bladder cancer. Currently, several guidelines recommend cisplatin-based neoadjuvant chemotherapy before radical cystectomy, and adjuvant chemotherapy is recommended in patients who have not received neoadjuvant chemotherapy. Immune checkpoint inhibitors have recently become the standard treatment option for metastatic urothelial carcinoma. Owing to their clinical benefits, several immune checkpoint inhibitors, with or without other agents (including other immunotherapy, cytotoxic chemotherapy, and emerging agents such as antibody drug conjugates), are being extensively investigated in perioperative settings. Several studies for perioperative immunotherapy have shown that immune checkpoint inhibitors have promising efficacy with relatively low toxicity, and have explored the predictive molecular biomarkers. Herein, we review the current evidence and discuss the future perspectives of perioperative systemic treatment for muscle-invasive bladder cancer.
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El Gharib K, Lilly E, Chebel R. Checkpoint inhibitors in BCG-unresponsive nonmuscle invasive bladder cancer: can they help spare the bladder? Immunotherapy 2021; 13:1105-1111. [PMID: 34184569 DOI: 10.2217/imt-2021-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Intravesical BCG therapy has been for years, the standard of care in nonmuscle-invasive bladder cancer. But upon recurrence/relapse, radical cystectomy is imposed, due to the paucity of other therapeutic options. Immunotherapy has been revolutionizing cancer treatment, and its indications continue to broaden. It has been approved for the treatment of advanced urothelial cancer of the bladder, mainly as a second-line therapy. Its activity is being studied in nonmuscle-invasive bladder cancer that is not responsive to BCG; we herein report the trials investigating these checkpoint inhibitors (pembrolizumab, nivolumab, atezolizumab, durvalumab and avelumab) in this particular setting.
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Affiliation(s)
- Khalil El Gharib
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Eddy Lilly
- Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Roy Chebel
- Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Chung DY, Kang DH, Kim JW, Ha JS, Kim DK, Cho KS. Comparison of Oncologic Outcomes of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13112770. [PMID: 34199565 PMCID: PMC8199668 DOI: 10.3390/cancers13112770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 01/11/2023] Open
Abstract
Simple Summary Currently, platinum-based neoadjuvant chemotherapy (NAC) is becoming a standard treatment for use in patients with muscle-invasive bladder cancer. However, comparisons of oncologic outcomes for the two most commonly used NAC regimens, ddMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) and GC (gemcitabine and cisplatin), are controversial. We sought to compare the oncologic outcomes of these two regimens via a systematic review and meta-analysis of all the available studies published to date. Through this, we aimed to provide evidence on the optimal NAC regimen for use in muscle-invasive bladder cancer. Abstract Platinum-based neoadjuvant chemotherapy (NAC) is widely used for treating muscle-invasive bladder cancer (MIBC). A systematic review was performed following PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched up to December 2020. We conducted a meta-analysis to compare the oncologic outcomes of ddMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) and GC (gemcitabine and cisplatin), which are the most widely used NAC regimens. Endpoints included pathologic complete response (pCR), pathologic downstaging (pDS), overall survival (OS), and cancer-specific survival (CSS). Five studies, with a total of 1206 patients, were included for meta-analysis. pCR was observed in 35.2% of the ddMVAC arm and in 25.1% of the GC arm, and pCR was significantly higher in ddMVAC than in GC (odds ratio (OR), 1.45; 95% confidence interval (CI), 1.11–1.89; p = 0.006). There was no significant difference in pDS (OR, 1.37; CI, 0.84–2.21; p = 0.20). OS was significantly higher in ddMVAC than in GC (hazard ratio, 2.16; CI, 1.42–3.29; p = 0.0004). Only one study reported CSS outcomes. The results of this analysis indicate that ddMVAC is superior to GC in terms of pCR and OS, suggesting that ddMVAC is more effective than GC in NAC for MIBC. However, this should be interpreted with caution because of the inherent limitations of retrospective studies.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Inha University School of Medicine, Incheon 22212, Korea; (D.Y.C.); (D.H.K.); (J.W.K.)
| | - Dong Hyuk Kang
- Department of Urology, Inha University School of Medicine, Incheon 22212, Korea; (D.Y.C.); (D.H.K.); (J.W.K.)
| | - Jong Won Kim
- Department of Urology, Inha University School of Medicine, Incheon 22212, Korea; (D.Y.C.); (D.H.K.); (J.W.K.)
| | - Jee Soo Ha
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Do Kyung Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul 04401, Korea;
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
- Correspondence:
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Narain TA, Tosh JM, Gautam G, Talwar HS, Panwar VK, Mittal A, Mandal AK. Neoadjuvant Therapy for Cisplatin Ineligible Muscle Invasive Bladder Cancer Patients: A Review of Available Evidence. Urology 2021; 154:8-15. [PMID: 33775784 DOI: 10.1016/j.urology.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
Neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for muscle invasive non-metastatic bladder cancer patients. While cisplatin based neoadjuvant chemotherapy has been recommended, systemic therapy in a neoadjuvant setting for cisplatin ineligible patients still needs to be addressed. Various strategies like split dosing cisplatin chemotherapy, carboplatin based chemotherapy and taxanes based chemotherapy have been tried as neoadjuvant therapy for cisplatin ineligible patients. Immunotherapy is a promising tool in this regard with a need for the development of predictive and prognostic biomarkers which can bring out the true potential of these immunotherapeutic agents.
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Affiliation(s)
- Tushar Aditya Narain
- Robotic Pelvic Oncology, Department of Urology, University College London Hospital, London
| | | | - Gagan Gautam
- Urological Oncology and Robotic Surgery, Max Institute of Cancer Care, Saket, New Delhi.
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Pinato DJ, Cortellini A, Sukumaran A, Cole T, Pai M, Habib N, Spalding D, Sodergren MH, Martinez M, Dhillon T, Tait P, Thomas R, Ward C, Kocher H, Yip V, Slater S, Sharma R. PRIME-HCC: phase Ib study of neoadjuvant ipilimumab and nivolumab prior to liver resection for hepatocellular carcinoma. BMC Cancer 2021; 21:301. [PMID: 33757459 PMCID: PMC7988931 DOI: 10.1186/s12885-021-08033-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/15/2021] [Indexed: 12/17/2022] Open
Abstract
Background After liver resection (LR), patients with hepatocellular cancer (HCC) are at high risk of recurrence. There are no approved anti-cancer therapies known to affect such risk, highlighting the acute need for novel systemic therapies to control the probability of disease relapse. Immunotherapy is expanding as a novel treatment option for HCC. Emerging data from cohort 4 of the CA209–040 study, which investigated the safety and preliminary efficacy of nivolumab/ipilimumab co-administration in advanced HCC, suggest that the combination can be delivered safely with an acceptable proportion of reversible grade 3–4 toxicities (27.1%) and a low discontinuation rate (2%) in patients with HCC. Here, we describe the design and rationale of PRIME-HCC, a two-part, multi-centre, phase Ib study to assess safety and bioactivity of the nivolumab/ipilimumab combination prior to LR in early-stage HCC. Methods The study involves an initial safety run-in phase (Part 1) to allow for preliminary safety characterisation within the first 6 patients enrolled and a subsequent expansion (Part 2). Ipilimumab will be administered once only on Day 1. Nivolumab will be administered on Day 1 and Day 22 (± 3 days) for a total of two 21-day cycles (i.e. 6 weeks of treatment). The primary objective of the study is to determine the safety and tolerability of the nivolumab/ipilimumab combination prior to LR. The secondary objective is to preliminarily characterize the efficacy of the combination prior to LR, including objective response rate (ORR) and pathologic response rates. Additional exploratory objectives include preliminary evidence of long-term disease control and to identify predictive correlates of response to the nivolumab/ipilimumab combination in HCC. Discussion The results of this study will help define the positioning of neoadjuvant nivolumab/ipilimumab combination in the perioperative management of HCC, with potential to improve survival outcomes in this patient population. Trial registration EudraCT Number: 2018–000987-27 Clinical trial registry & ID: ClinicalTrials.gov: NCT03682276. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08033-x.
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Affiliation(s)
- David J Pinato
- Division of Cancer, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W120HS, London, UK. .,Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", Via Paolo Solaroli, 17, 28100, Novara, NO, Italy.
| | - Alessio Cortellini
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - Ajithkumar Sukumaran
- NIHR Imperial CRF, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Tom Cole
- NIHR Imperial CRF, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Madhava Pai
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Nagy Habib
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Duncan Spalding
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Mikael H Sodergren
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Maria Martinez
- Division of Cancer, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W120HS, London, UK
| | - Tony Dhillon
- Faculty of Health and Medical Sciences, University of Surrey and Department of Oncology, The Royal Surrey Hospital, Egerton Rd, Guildford, GU2 7XX, UK
| | - Paul Tait
- Department of Radiology, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Robert Thomas
- Department of Radiology, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Caroline Ward
- Division of Cancer, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W120HS, London, UK
| | - Hemant Kocher
- Barts and The London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Vincent Yip
- Barts and The London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Sarah Slater
- Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | - Rohini Sharma
- Division of Cancer, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W120HS, London, UK
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Gutiérrez Calderón V, Cantero González A, Gálvez Carvajal L, Aguilar Lizarralde Y, Rueda Domínguez A. Neoadjuvant immunotherapy in resectable head and neck cancer: oral cavity carcinoma as a potential research model. Ther Adv Med Oncol 2021; 13:1758835920984061. [PMID: 33747147 PMCID: PMC7905482 DOI: 10.1177/1758835920984061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/01/2020] [Indexed: 12/11/2022] Open
Abstract
Squamous cell carcinoma of oral cavity (OCSCC) accounts for approximately 25% of
cases of head and neck squamous cell carcinoma (HNSCC). Tobacco and alcohol
consumption are the main risk factors for both cancers. Surgical resection,
combined with adjuvant radiotherapy or radiochemotherapy in patients with high
risk of relapse, is the key element in management in the initial stages.
However, despite the availability of aggressive multidisciplinary treatments,
advanced resectable OCSCC carries poor prognosis; only half of the patients are
disease-free 5 years after the surgery. Immunotherapy based on the use of immune
checkpoint inhibitors has been proven to be effective in a wide variety of
tumours, including recurrent and metastatic HNSCC. These positive results
resulted in investigations into its effectiveness in earlier stages of the
disease with OCSCC emerging as an interesting research model because of the
accessible location of the tumours. This article reviews the potential
advantages of emerging immunotherapeutic agents [mainly monoclonal antibodies
against programmed cell death-1 (PD-1) immune checkpoint
inhibitors] as neoadjuvant treatment for OCSCC at locoregional stages as well as
the ongoing clinical trials, challenges in evaluating tumour response, and
possible predictive biomarkers of response with highlights regarding the role of
oral microbiota as modulators of immune response. The efficacy and safety of
anti-PD-1 drugs in these patients have been proven in
preliminary trials. If there is a decrease in the relapse rate and an
improvement in the overall survival after surgical resection in ongoing trials,
preoperative immunotherapy may be established as a treatment option for patients
with early stages of the disease.
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Affiliation(s)
- Vanesa Gutiérrez Calderón
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Alexandra Cantero González
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Laura Gálvez Carvajal
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | | | - Antonio Rueda Domínguez
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Carlos Haya Avenue, s/n, Málaga, Spain
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12
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Challapalli A, Masson S, White P, Dailami N, Pearson S, Rowe E, Koupparis A, Oxley J, Abdelaziz A, Ash-Miles J, Bravo A, Foulstone E, Perks C, Holly J, Persad R, Bahl A. A Single-arm Phase II Trial of Neoadjuvant Cabazitaxel and Cisplatin Chemotherapy for Muscle-Invasive Transitional Cell Carcinoma of the Urinary Bladder. Clin Genitourin Cancer 2021; 19:325-332. [PMID: 33727028 DOI: 10.1016/j.clgc.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle-invasive bladder cancer. However, response rates and survival remain suboptimal. We evaluated the efficacy, safety, and tolerability of cisplatin plus cabazitaxel. METHODS A phase II single-arm trial was designed to recruit at least 26 evaluable patients. This would give 80% power to detect the primary endpoint, an objective response rate defined as a pathologic complete response plus partial response (pathologic downstaging), measured by pathologic staging at cystectomy (p0 = 0.35 and p1 = 0.60, α = 0.05). RESULTS Objective response was seen in 15 of 26 evaluable patients (57.7%) and more than one- third of patients achieved a pathologic complete response (9/26; 34.6%). Seventy-eight percent of the patients (21/27) completed all cycles of treatment, with only 6.7% of the reported adverse events being graded 3 or 4. There were 6 treatment-related serious adverse event reported, but no suspected unexpected serious adverse reactions. In the patients who achieved an objective response, the median progression-free survival and overall survival were not reached (median follow-up of 41.5 months). In contrast, the median progression-free survival (7.2 months) and overall survival (16.9 months) were significantly worse (P = .001, log-rank) in patients who did not achieve an objective response. CONCLUSION Cabazitaxel plus cisplatin for neoadjuvant treatment of muscle-invasive bladder cancer can be considered a well-tolerated and effective regimen before definitive therapy with higher rates (57.7%) of objective response, comparing favorably to that with of cisplatin/gemcitabine (23%-26%). These results warrant further evaluation in a phase III study.
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Affiliation(s)
| | - Susan Masson
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Paul White
- Department of Statistics, University of the West of England, Bristol, UK
| | - Narges Dailami
- Department of Statistics, University of the West of England, Bristol, UK
| | - Sylvia Pearson
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Edward Rowe
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Anthony Koupparis
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Jon Oxley
- Department of Pathology, North Bristol NHS Trust, Bristol, UK
| | - Ahmed Abdelaziz
- Department of Oncology, Ain Shams University Hospitals, Egypt
| | | | - Alicia Bravo
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Emily Foulstone
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Claire Perks
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeff Holly
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Raj Persad
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Amit Bahl
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK.
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13
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Jiang DM, Gupta S, Kitchlu A, Meraz-Munoz A, North SA, Alimohamed NS, Blais N, Sridhar SS. Defining cisplatin eligibility in patients with muscle-invasive bladder cancer. Nat Rev Urol 2021; 18:104-114. [PMID: 33432181 DOI: 10.1038/s41585-020-00404-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/29/2023]
Abstract
The current treatment paradigm for muscle-invasive bladder cancer (MIBC) consists of cisplatin-based neoadjuvant chemotherapy followed by local definitive therapy, or local definitive therapy alone for cisplatin-ineligible patients. Given that MIBC has a high propensity for distant relapse and is a chemotherapy-sensitive disease, under-utilization of chemotherapy is associated with suboptimal cure rates. Cisplatin eligibility criteria are defined for patients with metastatic bladder cancer by the Galsky criteria, which include creatinine clearance ≥60 ml/min. However, consensus is still lacking regarding cisplatin eligibility criteria in the neoadjuvant, curative MIBC setting, which continues to represent a substantial barrier to the standardization of patient care and clinical trial design. Jiang and colleagues accordingly suggest an algorithm for assessing cisplatin eligibility in patients with MIBC. Instead of relying on an absolute renal function threshold, their algorithm emphasizes a multidisciplinary and patient-centred approach. They also propose mitigation strategies to minimize the risk of cisplatin-induced nephrotoxicity in selected patients with impaired renal function. This new framework is aimed at reducing the inappropriate exclusion of some patients from cisplatin-based neoadjuvant chemotherapy (which leads to under-treatment) and harmonizing clinical trial design, which could lead to improved overall outcomes in patients with MIBC.
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Affiliation(s)
- Di Maria Jiang
- Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shilpa Gupta
- Department of Hematologic and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Abhijat Kitchlu
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Meraz-Munoz
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Scott A North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Nimira S Alimohamed
- Department of Medicine, Division of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Normand Blais
- Division of Medical Oncology and Hematology, Department of Medicine, Centre Hospitalier de l'Université de Montréal; Université de Montréal, Montreal, Quebec, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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14
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Rey-Cárdenas M, Guerrero-Ramos F, Gómez de Liaño Lista A, Carretero-González A, Bote H, Herrera-Juárez M, Carril-Ajuria L, Martín-Soberón M, Sepulveda JM, Billalabeitia EG, Castellano D, de Velasco G. Recent advances in neoadjuvant immunotherapy for urothelial bladder cancer: What to expect in the near future. Cancer Treat Rev 2021; 93:102142. [PMID: 33453566 DOI: 10.1016/j.ctrv.2020.102142] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
Urothelial bladder cancer (UC) is the most common malignancy involving the urinary system and represents a significant health problem. Immunotherapy has been used for decades for UC with intravesical bacillus Calmette-Guérin (BCG) set as the standard of care for non-muscle-invasive bladder cancer (NMIBC). The advent of immune checkpoint inhibitors (ICIs) has completely transformed the treatment landscape of bladder cancer enabling to expand the treatment strategies. Novel ICIs have successfully shown improved outcomes on metastatic disease to such an extent that the standard of care paradigm has changed leading to the development of different trials with the aim of determining whether ICIs may have a role in early disease. The localized muscle-invasive bladder cancer (MIBC) scenario remains challenging since the recurrence rate continues to be high despite all therapeutic efforts. This article will review the current experience of ICIs in the neoadjuvant setting of UC, the clinical trials landscape and finally, an insight of what to expect in the immediate and mid-term future.
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Affiliation(s)
- M Rey-Cárdenas
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - F Guerrero-Ramos
- Urology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - A Gómez de Liaño Lista
- Medical Oncology Department, Complejo Hospitalario Universitario Insular-Materno Infantil, Canary Islands, Avda. Marítima del Sur, s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - A Carretero-González
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - H Bote
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - M Herrera-Juárez
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - L Carril-Ajuria
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - M Martín-Soberón
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - J M Sepulveda
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - E G Billalabeitia
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - D Castellano
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - G de Velasco
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
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15
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Lopez-Beltran A, Cimadamore A, Blanca A, Massari F, Vau N, Scarpelli M, Cheng L, Montironi R. Immune Checkpoint Inhibitors for the Treatment of Bladder Cancer. Cancers (Basel) 2021; 13:E131. [PMID: 33401585 PMCID: PMC7795541 DOI: 10.3390/cancers13010131] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
A number of immune checkpoint inhibitors (ICIs) have been approved as first-line therapy in case of cisplatin-ineligible patients or as second-line therapy for patients with metastatic urothelial carcinoma (mUC) of the bladder. About 30% of patients with mUC will respond to ICIs immunotherapy. Programmed death-ligand 1 (PD-L1) expression detected by immunohistochemistry seems to predict response to immune checkpoint inhibitors in patients with mUC as supported by the objective response rate (ORR) and overall survival (OS) associated with the response observed in most clinical trials. Pembrolizumab, an anti-PD-1 antibody, demonstrated better OS respective to chemotherapy in a randomized phase 3 study for second-line treatment of mUC. Nivolumab, a PD-1 antibody, also demonstrated an OS benefit when compared to controls. Atezolizumab, Durvalumab, and Avelumab antibodies targeting PD-L1 have also received approval as second-line treatments for mUC with durable response for more than 1 year in selected patients. Atezolizumab and Pembrolizumab also received approval for first-line treatment of patients that are ineligible for cisplatin. A focus on the utility of ICIs in the adjuvant or neoadjuvant setting, or as combination with chemotherapy, is the basis of some ongoing trials. The identification of a clinically useful biomarker, single or in association, to determine the optimal ICIs treatment for patients with mUC is very much needed as emphasized by the current literature. In this review, we examined relevant clinical trial results with ICIs in patients with mUC alone or as part of drug combinations; emphasis is also placed on the adjuvant and neoadjuvant setting. The current landscape of selected biomarkers of response to ICIs including anti-PD-L1 immunohistochemistry is also briefly reviewed.
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Affiliation(s)
- Antonio Lopez-Beltran
- Unit of Anatomic Pathology, Department of Morphological Sciences, Cordoba University Medical School, 14004 Cordoba, Spain
| | - Alessia Cimadamore
- Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, 60126 Ancona, Italy; (A.C.); (M.S.)
| | - Ana Blanca
- Maimonides Biomedical Research Institute of Cordoba, Department of Urology, University Hospital of Reina Sofia, 14004 Cordoba, Spain;
| | - Francesco Massari
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Nuno Vau
- Medical Oncology, Champalimaud Clinical Center, 1400-038 Lisbon, Portugal;
| | - Marina Scarpelli
- Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, 60126 Ancona, Italy; (A.C.); (M.S.)
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, USA;
| | - Rodolfo Montironi
- Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, 60126 Ancona, Italy; (A.C.); (M.S.)
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16
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Adorno Febles VR, Balar AV. Immunotherapy for Metastatic Urothelial Carcinoma. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Abstract
PURPOSE OF REVIEW Systemic treatment of advanced urogenital malignancies has changed significantly in recent years and it will continue to change rapidly in upcoming years. It is the scope of this review article to providing the reader with the most recently approved treatment strategies to be used in daily routine for the individualized and most optimal treatment of our patients. RECENT FINDINGS Immunooncological therapy (IOT) has emerged as the treatment of choice in metastatic renal cell carcinoma and we describe the most relevant clinical trials and we will give some differential therapeutic recommendation who might be best treated with which combination therapy considering both oncological efficacy and treatment-related toxicity. New neoadjuvant treatment options for muscle-invasive bladder cancer are reported. With regard to metastatic prostate cancer, the landscape of medical therapy is continuously evolving and the new, and most relevant therapeutic strategies for metastatic hormone-naive and castration-resistant PCA are described. Last, but not least, we highlight latest developments in the management of advanced testis cancer. SUMMARY The novel treatment options reported in this article are ready for use in daily routine and already represent or will shortly represent new guideline-recommended therapies.
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18
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Current status and future directions of the use of novel immunotherapeutic agents in bladder cancer. Curr Opin Urol 2020; 30:428-440. [PMID: 32141936 DOI: 10.1097/mou.0000000000000740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To report the available information on the current status and future direction of the use of checkpoint inhibitors as novel immunotherapeutic agents in bladder cancer. RECENT FINDINGS In the past 3 years, five immunotherapies targeting programmed cell death 1 (Pembrolizumab and Durvalumab) or programmed cell death-ligand 1 (PD-L1) (Atezolizumab, nivolumab and Avelumab) pathways have been approved in second-line setting for patients who progressed during or after cisplatin-based chemotherapy. According to the most recent update, these patients should be PD-L1-positive to be eligible for immunotherapy. The use of novel checkpoint inhibitors was also very promising in other settings: Metastatic urothelial carcinoma without prior systemic treatment (IMvigor-130), as neoadjuvant treatment before radical cystectomy in patients with muscle invasive disease (PURE-01), and in Bacillus Calmette-Guérin (BCG) refractory nonmuscle invasive bladder cancer (KEYNOTE 057). SUMMARY Ongoing trials on the role of checkpoint inhibitors in bladder cancer may change our approach to different stages of bladder cancer. For metastatic urothelial carcinoma, the role of combined immune and chemotherapy may improve survival. For localized bladder cancer, immunotherapy as neoadjuvant therapy may be associated with less toxicity and better tolerability. Finally, in the setting of a BCG-refractory or BCG-naïve nonmuscle invasive disease checkpoint inhibitors may reduce/delay the risk of progression and subsequent cystectomy.
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19
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Sardana R, Mishra SK, Williamson SR, Mohanty A, Mohanty SK. Immune checkpoints and their inhibitors: Reappraisal of a novel diagnostic and therapeutic dimension in the urologic malignancies. Semin Oncol 2020; 47:367-379. [PMID: 33160642 DOI: 10.1053/j.seminoncol.2020.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Abstract
Advances in molecular immunology have unveiled some of the complexity of the mechanisms regulating cellular immune responses and led to the successful targeting of immune checkpoints in attempts to enhance antitumor T cell responses. Surgery, chemotherapy, and radiation therapy have been the mainstay of treatment in urologic malignancies. Immune checkpoint molecules such as cytotoxic T-lymphocyte associated protein-4, programmed cell death protein-1, and programmed death-ligand 1 have been shown to play central roles in evading cancer immunity. Thus these molecules have been targeted by inhibitors for the management of cancers forming the basis of immunotherapy. Immunotherapy is now among the first line therapeutic options for metastatic renal cell carcinomas. In advanced bladder cancer, immunotherapy is the standard of care in the second line and the first line for cisplatin ineligible patients. There continues to be ongoing research to identify the role if any of immunotherapy in testicular, prostatic, and penile cancers. The ideal biomarker for response to immunotherapy is still elusive. Although programmed death-ligand 1 immunohistochemical testing has been widely used across the globe as a biomarker for immunotherapy, companion diagnostic tests have inherent issues with testing and reporting and cannot have universal applicability. Additional biomarkers including, tumor mutational burden, deficient mismatch repair, high microsatellite instability, and immune gene expression profiling are being evaluated in various clinical trials. This review appraises the data of immunotherapy in the management of urologic malignancies.
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Affiliation(s)
- Rohan Sardana
- Department of Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Sourav K Mishra
- Department of Medical Oncology, Advanced Medical Research Institute, Bhubaneswar, India
| | - Sean R Williamson
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Abhishek Mohanty
- Principal Research Officer Head of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India.
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20
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Poon DMC. Immunotherapy for urothelial carcinoma: Metastatic disease and beyond. Asia Pac J Clin Oncol 2020; 16 Suppl 3:18-23. [PMID: 32852900 DOI: 10.1111/ajco.13312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
For advanced and metastatic urothelial carcinomas (UCs), platinum (preferably cisplatin)-based chemotherapy has been the standard treatment for many years. However, many patients are ineligible for cisplatin-based chemotherapy because of poor performance status and/or other age-related conditions. At the other end of the spectrum, patients with localized non-muscle-invasive bladder cancer who are unresponsive to intravesical Bacillus Calmette-Guérin (BCG) treatment often face radical cystectomy as the only option. In recent years, the application of immunotherapy in the form of immune-checkpoint inhibitors has provided viable alternatives in the second-line postplatinum and first-line cisplatin-ineligible settings. Recent and ongoing clinical trials are also assessing the safety and efficacy of immunotherapy for neoadjuvant and adjuvant uses before/after cystectomy, for BCG-unresponsive cases, and for combination treatments that include the newer indoleamine 2,3-dioxygenase-1 inhibitors and/or BCG. This review summarizes recent developments in immunotherapy for UCs.
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Affiliation(s)
- Darren Ming-Chun Poon
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Society of Uro-Oncology (HKSUO), Hong Kong
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21
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van Wilpe S, Gerretsen ECF, van der Heijden AG, de Vries IJM, Gerritsen WR, Mehra N. Prognostic and Predictive Value of Tumor-Infiltrating Immune Cells in Urothelial Cancer of the Bladder. Cancers (Basel) 2020; 12:E2692. [PMID: 32967190 PMCID: PMC7565173 DOI: 10.3390/cancers12092692] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 12/23/2022] Open
Abstract
The prognosis and responsiveness to chemotherapy and checkpoint inhibitors differs substantially among patients with bladder cancer (BC). There is an unmet need for biomarkers that can accurately predict prognosis and treatment outcome. Here, we describe the available literature on the prognostic and predictive value of tumor-infiltrating immune cells in BC. Current evidence indicates that a high density of tumor-infiltrating CD8+ T cells is a favorable prognostic factor, whereas PD-L1 expression and tumor-associated macrophages are unfavorable prognostic features. While PD-L1 expression appears unsuccessful as a biomarker for the response to checkpoint inhibitors, there are some indications that high CD8+ T cell infiltration, low transforming growth factor-beta signaling and low densities of myeloid-derived suppressor cells are associated with response. Future studies should focus on combinations of biomarkers to accurately predict survival and response to treatment.
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Affiliation(s)
- Sandra van Wilpe
- Department of Medical Oncology, the Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.v.W.); (W.R.G.)
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (E.C.F.G.); (I.J.M.d.V.)
| | - Eveline C. F. Gerretsen
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (E.C.F.G.); (I.J.M.d.V.)
| | - Antoine G. van der Heijden
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - I. Jolanda M. de Vries
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (E.C.F.G.); (I.J.M.d.V.)
| | - Winald R. Gerritsen
- Department of Medical Oncology, the Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.v.W.); (W.R.G.)
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (E.C.F.G.); (I.J.M.d.V.)
| | - Niven Mehra
- Department of Medical Oncology, the Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.v.W.); (W.R.G.)
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (E.C.F.G.); (I.J.M.d.V.)
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22
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Basu A, Sadeghi S. Neoadjuvant Therapies for Bladder Cancer in Cisplatin-ineligible Patients: What Options Do We Have? Eur Urol Focus 2020; 6:623-626. [PMID: 31753690 DOI: 10.1016/j.euf.2019.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/07/2019] [Accepted: 10/24/2019] [Indexed: 11/25/2022]
Abstract
Neoadjuvant chemotherapy has proven clinical benefit in muscle- invasive bladder cancer. Cisplatin is the likely driver of this benefit. Textbook definitions of cisplatin ineligibility may restrict almost 50% of patients from therapy. Checkpoint inhibitors (anti- PD-1 antibodies and anti- CTLA-4 antibodies) are currently in clinical trials for neoadjuvant use. Initial data from these studies appear promising.
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Affiliation(s)
- Arnab Basu
- Department of Hematology & Medical Oncology, University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, AL, USA.
| | - Sarmad Sadeghi
- Department of Medical Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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23
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Spectrum and Clinical Activity of PD-1/PD-L1 Inhibitors: Regulatory Approval and Under Development. Curr Oncol Rep 2020; 22:70. [DOI: 10.1007/s11912-020-00928-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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24
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Thibault C, Gross-Goupil M. Innovations dans les traitements systémiques du carcinome urothélial infiltrant. Bull Cancer 2020; 107:S6-S16. [DOI: 10.1016/s0007-4551(20)30273-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Latest progress in molecular biology and treatment in genitourinary tumours. Clin Transl Oncol 2020; 22:2175-2195. [PMID: 32440915 DOI: 10.1007/s12094-020-02373-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022]
Abstract
The management of genitourinary cancer, including bladder, prostate, renal and testicular cancer, has evolved dramatically in recent years due to a better understanding of tumour genetic mutations, alterations in molecular pathways, and to the development of new kinds of drugs such as targeted therapies and immunotherapies. In the field of immunotherapy, new drugs focused on stimulating, enhancing and modulating the immune system to detect and destroy cancer, have been recently discovered. Research in oncology moves quickly and new data of great relevance for clinical practice are communicated every year. For this reason, a group of experts, focused exclusively on the treatment of genitourinary tumours and who get together every year in the BestGU conference to assess the latest progress in this field have summarized the most important advances in a single review, along with a critical assessment of whether these results should alter daily clinical practice.
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Briganti A, Gandaglia G, Scuderi S, Gallina A, Colombo R, Fossati N, Barletta F, Pellegrino A, Nocera L, Montorsi F, Necchi A. Surgical Safety of Radical Cystectomy and Pelvic Lymph Node Dissection Following Neoadjuvant Pembrolizumab in Patients with Bladder Cancer: Prospective Assessment of Perioperative Outcomes from the PURE-01 Trial. Eur Urol 2020; 77:576-580. [DOI: 10.1016/j.eururo.2019.12.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/23/2019] [Indexed: 12/20/2022]
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Tafuri A, Smith DD, Cacciamani GE, Cole S, Shakir A, Sadeghi S, Vogelzang NJ, Quinn D, Gill PS, Gill IS. Programmed Death 1 and Programmed Death Ligand 1 Inhibitors in Advanced and Recurrent Urothelial Carcinoma: Meta-analysis of Single-Agent Studies. Clin Genitourin Cancer 2020; 18:351-360.e3. [PMID: 32146152 DOI: 10.1016/j.clgc.2020.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 01/06/2020] [Accepted: 01/22/2020] [Indexed: 01/13/2023]
Abstract
We performed a systematic review and meta-analysis on the response rates of patients with treatment-refractory urothelial carcinoma treated with programmed cell death 1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors. We reviewed the literature for prospective studies evaluating PD-1/PD-L1 inhibitors in refractory urothelial carcinoma patients, which formed the basis for US Food and Drug Administration approval of 5 different antagonistic antibodies targeting PD-1 or PD-L1 (atezolizumab, durvalumab, avelumab, nivolumab, and pembrolizumab). We considered studies examining PD-1/PD-L1-treated patients, which we identified using the following key terms in the Pubmed, Scopus, Web of Science, ClinicalTrial.gov, and Cochrane Library databases. Eligible studies had ≥ 20 patients each and reported response rates, duration of response, and overall survival (OS). We performed fixed and random-effects meta-analyses to model the point estimates for objective response rate and complete response. The median progression-free survival (PFS) and OS for studies reporting these statistics were evaluated. We found 10 eligible studies that met our inclusion criteria, providing extractable numerators and denominators for response rates, PFS, and OS for 1934 patients with metastatic urothelial carcinoma. The objective response rate was 18% (95% confidence interval, 15-22) for second-line or later therapies. The random-effects estimate for complete response was 4% (95% confidence interval, 3-5), including all disease locations and all PD-1 and PD-L1 inhibitors. Median OS and PFS were < 13 months and 3 months, respectively, across all studies, irrespective of PD-L1 expression. We found that the estimated response rates of agents included in this meta-analysis seem to be more favorable than other salvage therapies.
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Affiliation(s)
- Alessandro Tafuri
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - David D Smith
- Biostatistics Division, Mercy Lab Foundation, Irvine, CA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Sarah Cole
- Department of Medicine, Division of Oncology, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Aliasger Shakir
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Sarmad Sadeghi
- Department of Medicine, Division of Oncology, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | | | - David Quinn
- Department of Medicine, Division of Oncology, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Parkash S Gill
- Department of Medicine, Pathology and Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Inderbir S Gill
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA.
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Font A, Luque R, Villa JC, Domenech M, Vázquez S, Gallardo E, Virizuela JA, Beato C, Morales-Barrera R, Gelabert A, Maciá S, Puente J, Rubio G, Maldonado X, Perez-Valderrama B, Pinto A, Fernández Calvo O, Grande E, Garde-Noguera J, Fernández-Parra E, Arranz JÁ. The Challenge of Managing Bladder Cancer and Upper Tract Urothelial Carcinoma: A Review with Treatment Recommendations from the Spanish Oncology Genitourinary Group (SOGUG). Target Oncol 2020; 14:15-32. [PMID: 30694442 DOI: 10.1007/s11523-019-00619-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bladder cancer is the fourth most common cancer in men and the ninth most common in women in the Western world. The management of bladder carcinoma requires a multidisciplinary approach. Optimal treatment depends on several factors, including histology, stage, patient status, and possible comorbidities. Here we review recent findings on the treatment of muscle-invasive bladder carcinoma, advanced urothelial carcinoma, upper tract urothelial carcinoma, non-urothelial carcinoma, and urologic complications arising from the disease or treatment. In addition, we present the recommendations of the Spanish Oncology Genitourinary Group for the treatment of these diseases, based on a focused analysis of clinical management and the potential of current research, including recent findings on the potential benefit of immunotherapy. In recent years, whole-genome approaches have provided new predictive biomarkers and promising molecular targets that could lead to precision medicine in bladder cancer. Moreover, the involvement of other specialists in addition to urologists will ensure not only appropriate therapeutic decisions but also adequate follow-up for response evaluation and management of complications. It is crucial, however, to apply recent molecular findings and implement clinical guidelines as soon as possible in order to maximize therapeutic gains and improve patient prognosis.
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Affiliation(s)
- Albert Font
- Medical Oncology Service, B-ARGO Group, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona, Spain.
| | - Raquel Luque
- Medical Oncology Service, H.U. Virgen de las Nieves, Granada, Spain
| | - José Carlos Villa
- Medical Oncology Service, Hospital General Universitario Ciudad Real, Ciudad Real, Spain
| | - Montse Domenech
- Medical Oncology Service, Hospital Fundació Althaia, Manresa, Spain
| | - Sergio Vázquez
- Medical Oncology Service, Hospital Universitario Lucus Augusti, EOXI de Lugo, Cervo e Monforte, Spain
| | - Enrique Gallardo
- Oncology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | - Carmen Beato
- Medical Oncology Service, Hospital Virgen de la Macarena, Seville, Spain
| | - Rafael Morales-Barrera
- Medical Oncology Service, Hospital Universitario Vall d'Hebron, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Sonia Maciá
- Medical Oncology Department, CRO Pivotal, Madrid, Spain
| | - Javier Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Gustavo Rubio
- Medical Oncology Service, Hospital Universitario Fundación Jimenez Diaz, Madrid, Spain
| | - Xavier Maldonado
- Radiation Oncology Service, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Alvaro Pinto
- Medical Oncology Service, Hospital Universitario La Paz, Madrid, Spain
| | | | - Enrique Grande
- Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | | | - Eva Fernández-Parra
- Medical Oncology Service, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
| | - José Ángel Arranz
- Medical Oncology Service, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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Schmid SC, Koll FJ, Rödel C, Maisch P, Sauter A, Beckert F, Seitz A, Kübler H, Flentje M, Chun F, Combs SE, Schiller K, Gschwend JE, Retz M. Radiation therapy before radical cystectomy combined with immunotherapy in locally advanced bladder cancer - study protocol of a prospective, single arm, multicenter phase II trial (RACE IT). BMC Cancer 2020; 20:8. [PMID: 31900121 PMCID: PMC6942254 DOI: 10.1186/s12885-019-6503-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/26/2019] [Indexed: 01/27/2023] Open
Abstract
Background Patients with locally advanced bladder cancer (cT3/4 cN0/N+ cM0) have a poor prognosis despite radical surgical therapy and perioperative chemotherapy. Preliminary data suggest that the combination of radiation and immunotherapy does not lead to excess toxicity and may have synergistic (abscopal) anti-tumor effects. We hypothesize that the combined preoperative application of the PD-1 checkpoint-inhibitor Nivolumab with concomitant radiation therapy of the bladder and pelvic region followed by radical cystectomy with standardized lymphadenectomy is safe and feasible and might improve outcome for patients with locally advanced bladder cancer. Methods Study design: “RACE IT” (AUO AB 65/18) is an investigator initiated, prospective, multicenter, open, single arm phase II trial sponsored by Technical University Munich. Study drug and funding are provided by the company Bristol-Myers Squibb. Study treatment: Patients will receive Nivolumab 240 mg i.v. every 2 weeks for 4 cycles preoperatively with concomitant radiation therapy of bladder and pelvic region (max. 50.4 Gy). Radical cystectomy with standardized bilateral pelvic lymphadenectomy will be performed between week 11–15. Primary endpoint: Rate of patients with completed treatment consisting of radio-immunotherapy and radical cystectomy at the end of week 15. Secondary endpoints: Acute and late toxicity, therapy response and survival (1 year follow up). Main inclusion criteria: Patients with histologically confirmed, locally advanced bladder cancer (cT3/4, cN0/N+), who are ineligible for neoadjuvant, cisplatin-based chemotherapy or who refuse neoadjuvant chemotherapy. Main exclusion criteria: Patients with metastatic disease (lymph node metastasis outside pelvis or distant metastasis) or previous chemo-, immune- or radiation therapy. Planned sample size: 33 patients, interim analysis after 11 patients. Discussion This trial aims to evaluate the safety and feasibility of the combined approach of preoperative PD-1 checkpoint-inhibitor therapy with concomitant radiation of bladder and pelvic region followed by radical cystectomy. The secondary objectives of therapy response and survival are thought to provide preliminary data for further clinical evaluation after successful completion of this trial. Recruitment has started in February 2019. Trial registration Protocol Code RACE IT: AB 65/18; EudraCT: 2018–001823-38; Clinicaltrials.gov: NCT03529890; Date of registration: 27 June 2018.
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Affiliation(s)
- Sebastian C Schmid
- Department of Urology, School of Medicine, Rechts der Isar Medical Center, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Florestan J Koll
- Department of Urology, School of Medicine, Rechts der Isar Medical Center, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Claus Rödel
- Department of Radiation Oncology, University of Frankfurt, Frankfurt, Germany
| | - Philipp Maisch
- Department of Urology, School of Medicine, Rechts der Isar Medical Center, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Franziska Beckert
- Department of Urology, School of Medicine, Rechts der Isar Medical Center, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Anna Seitz
- Department of Urology, University of Würzburg, Würzburg, Germany
| | - Hubert Kübler
- Department of Urology, University of Würzburg, Würzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Felix Chun
- Department of Urology, University of Frankfurt, Frankfurt, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, School of Medicine, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany.,Helmholtz Zentrum München (HMGU), Institute of Radiation Medicine (IRM), Deutsches Konsortium für Translationale Krebsforschung (NeoDKTK) Partner Site Munich, Oberschleißheim, Germany
| | - Kilian Schiller
- Department of Radiation Oncology, School of Medicine, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany.,Helmholtz Zentrum München (HMGU), Institute of Radiation Medicine (IRM), Deutsches Konsortium für Translationale Krebsforschung (NeoDKTK) Partner Site Munich, Oberschleißheim, Germany
| | - Jürgen E Gschwend
- Department of Urology, School of Medicine, Rechts der Isar Medical Center, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Margitta Retz
- Department of Urology, School of Medicine, Rechts der Isar Medical Center, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Adjuvant Therapy for Urothelial and Renal Cell Carcinoma. Eur Urol Focus 2020; 6:3-6. [DOI: 10.1016/j.euf.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/25/2019] [Accepted: 04/10/2019] [Indexed: 12/12/2022]
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Pierantoni F, Maruzzo M, Gardi M, Bezzon E, Gardiman MP, Porreca A, Basso U, Zagonel V. Immunotherapy and urothelial carcinoma: An overview and future prospectives. Crit Rev Oncol Hematol 2019; 143:46-55. [PMID: 31476551 DOI: 10.1016/j.critrevonc.2019.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/06/2019] [Accepted: 08/22/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Urothelial carcinoma (UC) is a common malignancy with a high mortality rate when metastatic. Traditionally, systemic therapy consisted in platinum-based regimens as first-line, with Taxanes or Vinflunine as further lines. Recently, checkpoint inhibitors (CPIs) immunotherapy has emerged as a new therapeutic option. METHODS We searched in Medline, Pubmed and ClinicalTrial.gov databases for the relevant literature, reviewing the results of published trials and the design of ongoing studies involving CPIs in UC. RESULT Strong evidence supports the use of CPIs after failure of Cisplatin-based chemotherapy, although no predictive parameter is available so far. Expression of Programmed-Death-1-Ligand has given conflicting results, and is currently indicated only for the selection of Cisplatin-ineligible patients who should receive CPIs. CONCLUSION The therapeutic landscape of UC is rapidly changing due to the availability of CPIs. Neoadjuvant trials with CPIs and trials combining two CPIs are promising and will further expand the use of immunotherapy.
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Affiliation(s)
- Francesco Pierantoni
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCSS, Padua, Italy.
| | - Marco Maruzzo
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCSS, Padua, Italy
| | - Mario Gardi
- Urology Unit, Department of Surgery, Sant'Antonio Hospital, Padua, Italy
| | - Elisabetta Bezzon
- Radiology Unit, Department of Imaging and Medical Physics, Istituto Oncologico Veneto IOV IRCSS, Padua, Italy
| | - Marina Paola Gardiman
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University Hospital of Padua, Italy
| | - Angelo Porreca
- Urology Unit, Policlinico Abano Terme, Abano Terme, Italy
| | - Umberto Basso
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCSS, Padua, Italy
| | - Vittorina Zagonel
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCSS, Padua, Italy
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Tu MM, Ng TL, De Jong FC, Zuiverloon TC, Fazzari FG, Theodorescu D. Molecular Biomarkers of Response to PD-1/ PD-L1 Immune Checkpoint Blockade in Advanced Bladder Cancer. Bladder Cancer 2019; 5:131-145. [PMID: 33365377 PMCID: PMC7747768 DOI: 10.3233/blc-190218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The activity of PD-1/PD-L1 inhibitors in the treatment of advanced bladder cancer (BC) is promising for many patients. However, a subset of patients do not benefit from treatment, thus leading to an effort to better identify predictive molecular biomarkers of response. OBJECTIVE To conduct a systematic review of the literature on predictive molecular biomarkers associated with response to PD-1 and PD-L1 inhibitors in advanced bladder cancer, defined as locally-advanced, unresectable, or metastatic (mBC) disease. METHODS A search of the literature was performed using Embase (1947 - January 2019), Medline (1946 - January 2019), and EBM Reviews for Cochrane Central Register of Controlled Trials (as of December 2018). Studies examining the association of molecular biomarkers with clinical outcome in BC treated with PD-1 or PD-L1 monotherapy were included. Outcomes of interest were overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), duration of response, and objective response rate (ORR). RESULTS Using the study search criteria, 899 unique abstract citations were found, of which 834 did not meet the eligibility criteria. Full text of the remaining 65 citations were screened, and 50 studies excluded, including 18 review articles. Eight additional studies from the bibliography of the review papers were included, making a total of 23 studies. Five PD-1 / PD-L1 antibodies have been tested in BC immunohistochemistry (IHC). These studies used different expression scoring criteria and generally had poor ability to discriminate likelihood for response. Overall, the data suggests CD8+ T cell infiltration is necessary to mediate an antitumor immune response, but other immune cell populations, such as neutrophils may suppress T cell-mediated immunity and efficacy of PD-1/PD-L1 blockade. An IFNγ signature is a promising predictor, but there needs to be consensus on the optimal gene panel composition, and prospective validation. Tumor mutation burden (TMB) is a promising predictor in six studies reporting on 1200 patients, but there is not a consensus on the optimal definition of "high TMB". Detection of T cell receptor (TCR) clonal expansion has only been conducted in small studies and so its predictive value remains inconclusive. Epithelial-mesenchymal transformation (EMT) and transforming growth factor β (TGFβ) are associated with poor prognosis and possibly intrinsic resistance to PD-1/PD-L1 checkpoint blockade, but more work needs to be done to build upon and confirm the initial findings. CONCLUSIONS Currently no molecular biomarker is sufficiently mature for routine clinical use, while some candidates, or a combination show great promise and need further study.
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Affiliation(s)
- Megan M. Tu
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Terry L. Ng
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Florus C. De Jong
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tahlita C.M. Zuiverloon
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Dan Theodorescu
- Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA,Correspondence to: Dan Theodorescu, Cedars-Sinai Health System, 8700 Beverly Blvd., OCC Mezz C2002, Los Angeles, CA 90048, USA. Tel.: +1 310 423 8431; E-mail:
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Molecular and histopathology directed therapy for advanced bladder cancer. Nat Rev Urol 2019; 16:465-483. [PMID: 31289379 DOI: 10.1038/s41585-019-0208-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 12/29/2022]
Abstract
Bladder cancer is a heterogeneous group of tumours with at least 40 histological subgroups. Patients with localized disease can be cured with surgical resection or radiotherapy, but such curative options are limited in the setting of recurrent disease or distant spread, in which case systemic therapy is used to control disease and palliate symptoms. Cytotoxic chemotherapy has been the mainstay of treatment for advanced bladder cancer, but high-quality evidence is lacking to inform the management of rare subgroups that are often excluded from studies. Advances in molecular pathology, the development of targeted therapies and the resurgence of immunotherapy have led to the reclassification of bladder cancer subgroups and rigorous efforts to define predictive biomarkers for cancer therapies. In this Review, we present the current evidence for the management of conventional, variant and divergent urothelial cancer subtypes, as well as non-urothelial bladder cancers, and discuss how the integration of genomic, transcriptomic and proteomic characterization of bladder cancer could guide future therapies.
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Couey MA, Bell RB, Patel AA, Romba MC, Crittenden MR, Curti BD, Urba WJ, Leidner RS. Delayed immune-related events (DIRE) after discontinuation of immunotherapy: diagnostic hazard of autoimmunity at a distance. J Immunother Cancer 2019; 7:165. [PMID: 31269983 PMCID: PMC6609357 DOI: 10.1186/s40425-019-0645-6] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The risk of delayed autoimmunity occurring months or years after discontinuation of immunotherapy is frequently asserted in the literature. However, specific cases were rarely described until 2018, when a wave of reports surfaced. With expanding I-O indications in the adjuvant/neoadjuvant curative setting, growing numbers of patients will receive limited courses of immunotherapy before entering routine surveillance. In this context, under-recognition of DIRE could pose a growing clinical hazard. METHODS The aim of this study was to characterize DIRE through identification of existing reports of delayed post-treatment irAE in cancer patients treated with immunotherapy. We performed a PubMed literature review from 2008 through 2018 to determine the median data safety reporting window from existing I-O clinical trials, which we then applied to define the DIRE cutoff, and collated all qualifying reports over the same time span. DIRE was defined as new immune-related adverse events (irAE) manifesting ≥90 days after discontinuation of immunotherapy. RESULTS Median duration of I-O clinical trials data safety reporting was 90 days (82% ≤ 90 days). DIRE cutoff was thus set as ≥90 days post-immunotherapy. We identified 23 qualifying cases; 21 by literature review and 2 from our institution. Median off-treatment interval to DIRE was 6 months (range: 3 to 28). Median cumulative immunotherapy exposure was 4 doses (range: 3 to 42). Involvement included endocrine, neurologic, GI, pulmonary, cardiac, rheumatologic and dermatologic irAE. CONCLUSIONS As immunotherapy indications expand into the curative setting, often with brief exposure and potentially sequenced with multimodality treatments, it will be necessary to recognize an emerging diagnostic complex, which we have termed delayed immune-related events (DIRE). Clinical vigilance has the potential to reduce morbidity from diagnostic delay, as irAE are generally manageable with prompt initiation of treatment - or from misdiagnosis - as misattribution can lead to unnecessary or harmful interventions as we describe. DIRE should therefore figure prominently in the differential diagnosis of patients presenting with illnesses of unclear etiology, irrespective of intervening treatments or interval post-immunotherapy, both of which can confound diagnosis. Increased recognition will rest on delineation of DIRE as a clinical diagnostic entity.
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Affiliation(s)
- Marcus A. Couey
- Robert W. Franz Cancer Center, Providence Portland Medical Center, 2N35 North Pavilion, 4805 N.E. Glisan St, Portland, OR 97213 USA
| | - R. Bryan Bell
- Robert W. Franz Cancer Center, Providence Portland Medical Center, 2N35 North Pavilion, 4805 N.E. Glisan St, Portland, OR 97213 USA
| | - Ashish A. Patel
- Robert W. Franz Cancer Center, Providence Portland Medical Center, 2N35 North Pavilion, 4805 N.E. Glisan St, Portland, OR 97213 USA
| | - Meghan C. Romba
- Providence Neurological Specialties-West, Providence St. Vincent Medical Center, 9135 Southwest Barnes Road, Suite 461, Portland, OR 97225 USA
| | - Marka R. Crittenden
- The Oregon Clinic, Radiation Oncology, 4805 NE Glisan St. Garden Level, Portland, OR 97213 USA
| | - Brendan D. Curti
- Robert W. Franz Cancer Center, Providence Portland Medical Center, 2N35 North Pavilion, 4805 N.E. Glisan St, Portland, OR 97213 USA
| | - Walter J. Urba
- Robert W. Franz Cancer Center, Providence Portland Medical Center, 2N35 North Pavilion, 4805 N.E. Glisan St, Portland, OR 97213 USA
| | - Rom S. Leidner
- Robert W. Franz Cancer Center, Providence Portland Medical Center, 2N35 North Pavilion, 4805 N.E. Glisan St, Portland, OR 97213 USA
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Li R, Spiess PE, Gilbert SM, Necchi A. Towards Personalized Neoadjuvant Therapy for Muscle-invasive Bladder Cancer. Eur Urol 2019; 76:4-6. [DOI: 10.1016/j.eururo.2019.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/20/2019] [Indexed: 01/18/2023]
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Aragon-Ching JB, Choudhury A, Margulis V, Yu EY. Formidable Scenarios in Urothelial and Variant Cancers of the Urinary Tract. Am Soc Clin Oncol Educ Book 2019; 39:262-275. [PMID: 31099661 DOI: 10.1200/edbk_237451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Diagnostic and therapeutic challenges in the field of bladder and upper tract cancers provide opportunities for multidisciplinary care. Urothelial cancers make up the majority of the histologic subtype of bladder and upper tract cancers. Although the existence of variant histology, nonurothelial cancers, and urethral cancers is rare, these cancers pose a challenging clinical dilemma given the lack of well-defined consensus treatment guidelines. This review focuses on key issues of treatment: cisplatin ineligibility with emphasis on the definition, nuances of chemotherapy and frontline immune checkpoint inhibitor therapy, use of radiation in bladder-preservation strategies, upper tract urothelial cancer management, and highlights of urothelial variants and nonurothelial tumors and management.
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Affiliation(s)
| | - Ananya Choudhury
- 2 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Vitaly Margulis
- 3 The Univeristy of Texas Southwestern Medical Center, Dallas, TX
| | - Evan Y Yu
- 4 University of Washington, Seattle, WA
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Soria F, Mosca A, Gontero P. Drug strategies for bladder cancer in the elderly: is there promise for the future? Expert Opin Pharmacother 2019; 20:1387-1396. [PMID: 31081702 DOI: 10.1080/14656566.2019.1615055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Bladder cancer (BCa) is a disease that predominantly affects adult and elderly populations. As people live longer, it will become even more frequent and consequently represents a big health problem for health-care providers and is a challenging clinical dilemma. In the elderly, the treatment of BCa presents some peculiarities due to its more aggressive behavior and reduced patient reserves, impacting their response to medical and surgical therapies. AREAS COVERED The authors provide a non-systematic review of the literature using PubMed to obtain an overview of the therapeutic options for BCa in the elderly, from the low-risk non-muscle-invasive setting to muscle-invasive and advanced/metastatic disease. EXPERT OPINION The main challenge in the treatment of BCa in the elderly is represented by the need to find a compromise between the risk of under- and overtreatment. The wide spectrum of disease prognoses between low-risk non-muscle invasive BCa and invasive metastatic disease represents a perfect setting for a personalized approach. To pursue this aim, older patients need a multidisciplinary approach and clinical management, in order to optimize oncological outcomes as well as to face and support their frailty during cancer therapies.
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Affiliation(s)
- Francesco Soria
- a Department of Urology and Comprehensive Cancer Center , Medical University of Vienna , Vienna , Austria.,b Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital , University of Studies of Torino , Turin , Italy
| | - Alessandra Mosca
- c Medical Oncology , Maggiore della Carità University Hospital , Novara , Italy
| | - Paolo Gontero
- b Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital , University of Studies of Torino , Turin , Italy
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Meleis L, Moore R, Inman BA, Harrison MR. Retrospective analysis of the efficacy and safety of neoadjuvant gemcitabine and cisplatin in muscle-invasive bladder cancer. J Oncol Pharm Pract 2019; 26:330-337. [DOI: 10.1177/1078155219845434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Neoadjuvant cisplatin-based combination chemotherapy for muscle-invasive bladder cancer (MIBC) improves overall and disease-free survival. However, there is much debate over the optimal neoadjuvant regimen. Gemcitabine plus cisplatin (GC) has been the neoadjuvant regimen of choice for many institutions for patients with MIBC based on data extrapolated from the metastatic setting. Based on recent data, many institutions are transitioning to variations of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) as the neoadjuvant regimen of choice. Objective To assess the effectiveness and safety of neoadjuvant chemotherapy with gemcitabine plus cisplatin in patients with muscle-invasive bladder cancer prior to cystectomy. Methods This is a single-center, retrospective, cohort study at Duke University Hospital (DUH). Patients included had MIBC and received gemcitabine plus cisplatin chemotherapy prior to a cystectomy. The primary endpoint was to assess the pathologic complete response (pCR) rate in MIBC after treatment with gemcitabine and cisplatin. Patients were split into two groups, those who received their chemotherapy at DUH, and those who received their chemotherapy at an outside facility. Results Overall pCR rate for all patients (n = 36) was 14%. The pCR rates for patients in the Duke Chemotherapy Group (n = 17) and in the Community Chemotherapy Group (n = 19) were 24% and 5%, respectively. GC was overall well tolerated in most patients with few adverse events ≥ grade 3. Conclusions This retrospective study demonstrates a consistent pCR rate (24% in Duke Chemotherapy Group) for neoadjuvant GC in MIBC compared with other literature. The overall pCR rate for all patients was 14%.
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Affiliation(s)
- Laura Meleis
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Russell Moore
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Brant A Inman
- Urology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Michael R Harrison
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Martinez Chanza N, Tripathi A, Harshman LC. Adjuvant Therapy Options in Renal Cell Carcinoma: Where Do We Stand? Curr Treat Options Oncol 2019; 20:44. [DOI: 10.1007/s11864-019-0639-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Osterman CK, Babu DS, Geynisman DM, Lewis B, Somer RA, Balar AV, Zibelman MR, Guancial EA, Antinori G, Yu S, Narayan V, Guzzo TJ, Plimack ER, Vaughn DJ, Fung C, Mamtani R. Efficacy of Split Schedule Versus Conventional Schedule Neoadjuvant Cisplatin-Based Chemotherapy for Muscle-Invasive Bladder Cancer. Oncologist 2019; 24:688-690. [PMID: 30728277 PMCID: PMC6516116 DOI: 10.1634/theoncologist.2018-0561] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022] Open
Abstract
Neoadjuvant cisplatin-based chemotherapy (NAC; 70 mg/m2) is standard of care for muscle-invasive bladder carcinoma (MIBC). Many patients (pts) cannot receive cisplatin because of renal impairment, and administration of cisplatin 35 mg/m2 on day 1 + 8 or 1 + 2 (i.e., split schedule) is a commonly used alternative. In this retrospective analysis, we compared complete (pT0) and partial (
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Affiliation(s)
- Chelsea K Osterman
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Dilip S Babu
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Bianca Lewis
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Robert A Somer
- MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA
| | - Arjun V Balar
- Langone Medical Center, New York University, New York City, New York, USA
| | | | | | - Gianna Antinori
- MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA
| | - Shun Yu
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vivek Narayan
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas J Guzzo
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - David J Vaughn
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chunkit Fung
- University of Rochester Medical Center, Rochester, New York, USA
| | - Ronac Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Necchi A, Montorsi F. Reply to S. Zhang. J Clin Oncol 2019; 37:940-941. [PMID: 30811283 DOI: 10.1200/jco.18.02448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrea Necchi
- Andrea Necchi, MD, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; and Francesco Montorsi, MD, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy
| | - Francesco Montorsi
- Andrea Necchi, MD, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; and Francesco Montorsi, MD, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy
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Gust KM, Shariat SF. Re: Pembrolizumab as Neoadjuvant Therapy Before Radical Cystectomy in Patients with Muscle-invasive Urothelial Bladder Carcinoma (PURE-01): An Open-label, Single-arm, Phase II Study. Eur Urol 2019; 75:695-696. [DOI: 10.1016/j.eururo.2018.12.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
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Schiff JP, Barata PC, Yu EY, Grivas P. Precision therapy in advanced urothelial cancer. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2019. [DOI: 10.1080/23808993.2019.1582298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Joshua P. Schiff
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Pedro C. Barata
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Evan Y. Yu
- Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
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Lattanzi M, Balar AV. Current Status and Future Direction of Immunotherapy in Urothelial Carcinoma. Curr Oncol Rep 2019; 21:24. [PMID: 30806823 DOI: 10.1007/s11912-019-0775-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Since 2016, five new programmed cell death protein 1/ligand 1 (PD-1/L1) checkpoint inhibitors have been approved for metastatic urothelial carcinoma. This review will summarize the data supporting the widespread use of these agents and highlight areas of ongoing clinical development. RECENT FINDINGS PD-1/L1 axis inhibition has demonstrated clear superiority to chemotherapy for the treatment of metastatic urothelial cancer in the second-line setting. A multitude of ongoing studies are investigating the feasibility and efficacy of incorporating established and novel immunotherapies into earlier lines of therapy, including non-metastatic muscle-invasive bladder cancer and even non-muscle-invasive disease. Early-phase clinical trials have begun to explore the safety and activity of novel immune-oncology combinations across a range of clinical settings. Immunotherapy has a clearly defined role in the treatment of metastatic urothelial cancer both in the platinum-refractory setting and in the first-line cisplatin-ineligible setting. Ongoing clinical trials will dictate how to best incorporate immunotherapy into earlier lines of therapy and define the safety and activity of novel immunotherapy agents and combinations.
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Affiliation(s)
- Michael Lattanzi
- Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Arjun V Balar
- Department of Medicine, NYU School of Medicine, New York, NY, USA. .,Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA. .,NYU School of Medicine, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, 160 East 34th Street, 10th Floor, New York, NY, 10016, USA.
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Treatment Approaches for Cisplatin-Ineligible Patients with Invasive Bladder Cancer. Curr Treat Options Oncol 2019; 20:12. [DOI: 10.1007/s11864-019-0609-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Grivas P, Drakaki A, Friedlander TW, Sonpavde G. Conceptual Framework for Therapeutic Development Beyond Anti-PD-1/PD-L1 in Urothelial Cancer. Am Soc Clin Oncol Educ Book 2019; 39:284-300. [PMID: 31099684 DOI: 10.1200/edbk_237449] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Platinum-based chemotherapy has been the standard of care in advanced urothelial cancer, but long-term outcomes have remained poor. Immune checkpoint inhibitors, with their favorable toxicity profiles and noteworthy efficacy, have steered a new era in advanced urothelial cancer, with five agents targeting the PD-1/PD-L1 pathway approved by the U.S. Food and Drug Administration (FDA). However, most patients do not achieve response, whereas immunotherapy-related adverse events may cause morbidity, increased health care use, and-rarely-mortality. Therefore, there is an urgent need for additional therapeutic modalities across the disease spectrum. A plethora of clinical trials are ongoing in various disease settings, including chemotherapy regimens, radiotherapy, antibody-drug conjugates, agents targeting additional immune checkpoint pathways, vaccine, cytokines, adoptive cell therapies, as well as targeted and anti-angiogenic agents. Two agents, enfortumab vedotin and erdafitinib, have breakthrough designation by the FDA but are not approved yet (at the time of this paper's preparation). Novel combinations with various treatment modalities and optimal sequencing of active therapies are being investigated in prospective clinical trials. Evaluation of new treatments has met with substantial challenges for many reasons, for example, molecular heterogeneity, clonal evolution, and genomic instability. In the era of precision molecular medicine, and because patients do not respond uniformly to current therapies, there is a growing need for identification and validation of biomarkers that can accurately predict treatment response and assist in patient selection. Here, we review current updates and future directions of experimental therapeutics in urothelial cancer, including examples (but not an exhaustive list) of ongoing clinical trials.
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Affiliation(s)
- Petros Grivas
- 1 From the University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Alexandra Drakaki
- 2 David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Terence W Friedlander
- 3 Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Guru Sonpavde
- 4 Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
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Jain RK, Snyders T, Nandgoapal L, Garje R, Zakharia Y, Gupta S. Immunotherapy Advances in Urothelial Carcinoma. Curr Treat Options Oncol 2018; 19:79. [DOI: 10.1007/s11864-018-0598-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Tripathi A, Plimack ER. Immunotherapy for Urothelial Carcinoma: Current Evidence and Future Directions. Curr Urol Rep 2018; 19:109. [PMID: 30406502 DOI: 10.1007/s11934-018-0851-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Until recently, effective treatment options for patients with advanced urothelial carcinoma were limited to platinum-based chemotherapy. In the post-platinum setting and for patients ineligible for cisplatin, minimally effective second-line chemotherapy was used and outcomes were poor. The approval of immune checkpoint inhibitors has significantly changed the treatment landscape of urothelial carcinoma. Here, we review current data demonstrating their efficacy in advanced disease and ongoing trials investigating novel combination strategies. RECENT FINDINGS Since May 2016, five agents targeting the programmed cell death 1 (PD-1) pathways have been approved for use after progression on platinum-based chemotherapy. Further, atezolizumab and pembrolizumab are approved for use in cisplatin-ineligible patients with high programmed death-ligand 1 (PD-L1) expression. Preliminary studies have shown their safety and efficacy as neoadjuvant therapy in muscle-invasive bladder cancer. Several ongoing trials are investigating these agents in combination with radiation therapy, platinum-based chemotherapy, other immune checkpoint inhibitors, and targeted agents. Immune checkpoint inhibitors have demonstrated durable efficacy in patients with advanced urothelial carcinoma as first- and second-line therapy. Ongoing studies will help define the optimal sequence, combination strategies, and predictive biomarkers of response.
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Affiliation(s)
- Abhishek Tripathi
- Hematology Oncology, University of Oklahoma Stephenson Cancer Center, 800 NE 10th Street, 6th floor, Oklahoma City, OK, USA
| | - Elizabeth R Plimack
- Division of Genitourinary Medical Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111-2497, USA.
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