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Kwon WA, Seo HK. Emerging agents for the treatment of metastatic urothelial cancer. Investig Clin Urol 2021; 62:243-255. [PMID: 33943047 PMCID: PMC8100010 DOI: 10.4111/icu.20200597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/04/2021] [Accepted: 02/14/2021] [Indexed: 12/22/2022] Open
Abstract
Over the past few decades, platinum-based combination chemotherapy (PBCC) has been the preferred initial therapy for metastatic urothelial cancer (mUC). However, despite a response rate of approximately 50%, a small proportion of patients with distant metastases may be cured by cisplatin-based combination chemotherapy (CBCC). In addition, up to 50% of patients are not eligible for CBCC due to age or comorbidities. Furthermore, adverse effects from PBCC are a major concern. The emergence of check-point inhibitors (CPIs), particularly those with antibodies directed against programmed cell death 1 protein (PD-1) or its ligand (PD-L1), advanced the treatment of mUC. Avelumab switch-maintenance therapy is recommended in patients with locally advanced or mUC who did not progress on initial PBCC. With the recent advances in tumor molecular biology and the discovery of actionable therapeutic targets, the clinical application of targeted therapy is now being explored for mUC. Erdafitinib, a tyrosine kinase inhibitor of FGFR1-4, has shown positive outcomes in patients with advanced UC with FGFR alterations. Another recent technological development is antibody-drug conjugates (ADCs), which are complex molecules composed of an antibody linked to a biologically active cytotoxic drug (payload) that targets and kills tumor cells while sparing healthy cells. Enfortumab vedotin, a monoclonal antibody targeting nectin-4 conjugated to monomethyl auristatin E, has demonstrated clinically significant efficacy in patients who do not respond to both cytotoxic chemotherapy and CPIs. In this review, we describe switch-maintenance therapies using CPI, various targeted agents, and ADCs that have been investigated for mUC treatment.
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Affiliation(s)
- Whi An Kwon
- Department of Urology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Ho Kyung Seo
- Department of Urology, Center for Urologic Cancer, Hospital, National Cancer Center, Goyang, Korea
- Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang, Korea.
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Jain P, Kathuria H, Momin M. Clinical therapies and nano drug delivery systems for urinary bladder cancer. Pharmacol Ther 2021; 226:107871. [PMID: 33915179 DOI: 10.1016/j.pharmthera.2021.107871] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 02/07/2023]
Abstract
Bladder cancer is the 10th most commonly occurring malignancy worldwide with a 75% of 5-year survival rate, while it ranks 13th among the deaths occurring due to cancer. The majority of bladder cancer cases are diagnosed at an early stage and 70% are of non-invasive grade. However, 70% of these cases develop chemoresistance and progress to the muscle invasive stage. Conventional chemotherapy treatments are unsuccessful in curbing chemoresistance, bladder cancer progression while having an adverse side effect, which is mainly due to off-target drug distribution. Therefore, new drug delivery strategies, new therapeutics and therapies or their combination are being explored to develop better treatments. In this regard, nanotechnology has shown promise in the targeted delivery of therapeutics to bladder cancer cells. This review discusses the recent discovery of new therapeutics (chemotherapeutics, immunotherapeutic, and gene therapies), recent developments in the delivery of therapeutics using nano drug delivery systems, and the combination treatments with FDA-approved therapies, i.e., hyperthermia and photodynamic therapy. We also discussed the potential of other novel drug delivery systems that are minimally explored in bladder cancer. Lastly, we discussed the clinical status of therapeutics and therapies for bladder cancer. Overall, this review can provide a summary of available treatments for bladder cancer, and also provide opportunities for further development of drug delivery systems for better management of bladder cancer.
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Affiliation(s)
- Pooja Jain
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Mumbai, Maharashtra, India.
| | - Himanshu Kathuria
- Department of Pharmacy, National University of Singapore, Singapore 117543, Republic of Singapore; Nusmetic Pvt Ltd, Makerspace, i4 building, 3 Research Link Singapore, 117602, Republic of Singapore.
| | - Munira Momin
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Mumbai, Maharashtra, India.
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Park I, Lee JL. Systemic treatment for advanced urothelial cancer: an update on recent clinical trials and current treatment options. Korean J Intern Med 2020; 35:834-853. [PMID: 32668516 PMCID: PMC7373963 DOI: 10.3904/kjim.2020.204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023] Open
Abstract
After cisplatin-based chemotherapy became the standard treatment for metastatic urothelial cancer (mUC), very little progress has been made in the treatment landscape of this condition until recently. With increased knowledge about the molecular biology of mUC and advances in the field of cancer immunobiology, there has been an explosion in the number of clinical trials for mUC, and systemic treatment of mUC is rapidly changing. Despite the availability of several novel therapeutic agents, cisplatin-based cytotoxic chemotherapy remains the standard, first-line treatment option. Immune checkpoint inhibitors (ICIs), including programmed death-1 and programmed death ligand-1 inhibitors, are preferred second-line treatment options that are also used in first-line cisplatin-ineligible settings. For patients with actionable fibroblast growth factor receptor 2 (FGFR2) or FGFR3 genomic alterations, erdafitinib can be considered after platinum-based treatment. Enfortumab vedotin, a monoclonal antibody targeting nectin-4 conjugated to monomethyl auristatin E, has been approved for patients who do not respond to both cytotoxic chemotherapy and ICIs. In this review, we address the clinical trial data that have established the current standard treatments and ongoing clinical trials of various agents with different mechanisms as well as provide a brief overview of current practice guidelines and recommendations in patients with mUC.
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Affiliation(s)
- Inkeun Park
- Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Lyun Lee
- Daparatment of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Boubaker NS, Spagnuolo M, Trabelsi N, Said R, Gurtner A, Regazzo G, Ayed H, Blel A, Karray O, Saadi A, Rammeh S, Chebil M, Rizzo MG, Piaggio G, Ouerhani S. miR-143 expression profiles in urinary bladder cancer: correlation with clinical and epidemiological parameters. Mol Biol Rep 2019; 47:1283-1292. [PMID: 31863330 DOI: 10.1007/s11033-019-05228-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/07/2019] [Indexed: 02/07/2023]
Abstract
Hsa-mir-143 and hsa-let-7c have been reported to be deregulated in multiple neoplasms. The main purpose of this study was to investigate the expression of these miRNAs in bladder cancer (BCa) and to analyze the association between their expression profiles and clinical and epidemiological parameters. Ninety BCa specimens were included. Expression patterns of miR-143 and let-7c were assessed by qRT-PCR using Taqman specific probes. Validated and predicted targets of these miRNA's were identified using CSmiRTar and DAVID tools, respectively. miR-143 was downregulated in tumors compared to controls (mean fold-change (FC) = 0.076). Its expression was significantly higher in MIBC compared to NMIBC (p = 0,001). Its value as a potential biomarker discriminating non invasive tumors from the invasive ones was confirmed by ROC curve (AUC = 0.768; p = 0.0001). Also, this down-regulation positively correlates with frequency of tobacco use (p = 0,04) and chronic alcohol consumption (p = 0,04). Let-7c was overexpressed in BCa samples (mean (FC = 9.92) compared to non tumoral ones but was not associated to clinical and epidemiological parameters. A comprehensive overview of miR-143 targets and pathways implicated in BCa initiation, diagnosis or prognosis using bioinformatical analysis, was conducted. While both deregulated miRNAs may contribute to urothelial tumorigenesis, the deregulation of miR-143 was significantly correlated to epidemiological and clinical parameters.
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Affiliation(s)
- Nouha Setti Boubaker
- Laboratory of Proteins Engineering and Bioactive Molecules (LIP-MB), National Institute of Applied Sciences and Technology of Tunis (INSAT), The University of Tunis Carthage, Via Elio Chianesi 53, 00144, Tunis, Tunisia.,Department of Research, Diagnosis and Innovative Technologies, IRCCS-Regina Elena National Cancer Institute, UOSD SAFU, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Manuela Spagnuolo
- Oncogenomic and Epigenetic Unit, Department of Research, Diagnosis and Innovative Technologies, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Nesrine Trabelsi
- Laboratory of Proteins Engineering and Bioactive Molecules (LIP-MB), National Institute of Applied Sciences and Technology of Tunis (INSAT), The University of Tunis Carthage, Via Elio Chianesi 53, 00144, Tunis, Tunisia
| | - Rahma Said
- Laboratory of Proteins Engineering and Bioactive Molecules (LIP-MB), National Institute of Applied Sciences and Technology of Tunis (INSAT), The University of Tunis Carthage, Via Elio Chianesi 53, 00144, Tunis, Tunisia
| | - Aymone Gurtner
- Department of Research, Diagnosis and Innovative Technologies, IRCCS-Regina Elena National Cancer Institute, UOSD SAFU, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giulia Regazzo
- Oncogenomic and Epigenetic Unit, Department of Research, Diagnosis and Innovative Technologies, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Haroun Ayed
- Laboratory of Proteins Engineering and Bioactive Molecules (LIP-MB), National Institute of Applied Sciences and Technology of Tunis (INSAT), The University of Tunis Carthage, Via Elio Chianesi 53, 00144, Tunis, Tunisia.,Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ahlem Blel
- Pathology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Omar Karray
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ahmed Saadi
- Laboratory of Proteins Engineering and Bioactive Molecules (LIP-MB), National Institute of Applied Sciences and Technology of Tunis (INSAT), The University of Tunis Carthage, Via Elio Chianesi 53, 00144, Tunis, Tunisia.,Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Soumaya Rammeh
- Pathology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Chebil
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Maria Giulia Rizzo
- Oncogenomic and Epigenetic Unit, Department of Research, Diagnosis and Innovative Technologies, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Piaggio
- Department of Research, Diagnosis and Innovative Technologies, IRCCS-Regina Elena National Cancer Institute, UOSD SAFU, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Slah Ouerhani
- Laboratory of Proteins Engineering and Bioactive Molecules (LIP-MB), National Institute of Applied Sciences and Technology of Tunis (INSAT), The University of Tunis Carthage, Via Elio Chianesi 53, 00144, Tunis, Tunisia.
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