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Bührer E, D'Haese D, Daugaard G, de Wit R, Albany C, Tryakin A, Fizazi K, Stahl O, Gietema JA, De Giorgi U, Cafferty FH, Hansen AR, Tandstad T, Huddart RA, Necchi A, Sweeney CJ, Garcia-Del-Muro X, Heng DYC, Lorch A, Chovanec M, Winquist E, Grimison P, Feldman DR, Terbuch A, Hentrich M, Bokemeyer C, Negaard H, Fankhauser C, Shamash J, Vaughn DJ, Sternberg CN, Heidenreich A, Collette L, Gillessen S, Beyer J. Impact of teratoma on survival probabilities of patients with metastatic non-seminomatous germ cell cancer: Results from the IGCCCG Update Consortium. Eur J Cancer 2024; 202:114042. [PMID: 38564927 DOI: 10.1016/j.ejca.2024.114042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
AIMS To resolve the ongoing controversy surrounding the impact of teratoma (TER) in the primary among patients with metastatic testicular non-seminomatous germ-cell tumours (NSGCT). PATIENTS AND METHODS Using the International Germ Cell Cancer Collaborative Group (IGCCCG) Update Consortium database, we compared the survival probabilities of patients with metastatic testicular GCT with TER (TER) or without TER (NTER) in their primaries corrected for known prognostic factors. Progression-free survival (5y-PFS) and overall survival at 5 years (5y-OS) were estimated by the Kaplan-Meier method. RESULTS Among 6792 patients with metastatic testicular NSGCT, 3224 (47%) had TER in their primary, and 3568 (53%) did not. In the IGCCCG good prognosis group, the 5y-PFS was 87.8% in TER versus 92.0% in NTER patients (p = 0.0001), the respective 5y-OS were 94.5% versus 96.5% (p = 0.0032). The corresponding figures in the intermediate prognosis group were 5y-PFS 76.9% versus 81.6% (p = 0.0432) in TER and NTER and 5y-OS 90.4% versus 90.9% (p = 0.8514), respectively. In the poor prognosis group, there was no difference, neither in 5y-PFS [54.3% in TER patients versus 55.4% (p = 0.7472) in NTER], nor in 5y-OS [69.4% versus 67.7% (p = 0.3841)]. NSGCT patients with TER had more residual masses (65.3% versus 51.7%, p < 0.0001), and therefore received post-chemotherapy surgery more frequently than NTER patients (46.8% versus 32.0%, p < 0.0001). CONCLUSION Teratoma in the primary tumour of patients with metastatic NSGCT negatively impacts on survival in the good and intermediate, but not in the poor IGCCCG prognostic groups.
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Affiliation(s)
- Emanuel Bührer
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - David D'Haese
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Gedske Daugaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ronald de Wit
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Costantine Albany
- Horizon Oncology Research, 1345 Unity PI Ste 345, Lafayette, IN, United States of America
| | - Alexey Tryakin
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Olof Stahl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | | | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy and the Italian Germ Cell Cancer Group (IGG), Italy
| | - Fay H Cafferty
- Medical Research Council Clinical Trials Unit, University College London (UCL), London, United Kingdom; Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, United Kingdom
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Torgrim Tandstad
- The Cancer Clinic, St Olavs University Hospital and Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Andrea Necchi
- Vita-Salute San Raffaele University, Milan, Italy; Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Christopher J Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
| | - Xavier Garcia-Del-Muro
- Catalan Institute of Oncology, IDIBELL Institute of Research, University of Barcelona, Barcelona, Spain
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland; Department of Urology, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia; Cancer Research Institute, Biomedical Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Eric Winquist
- Division of Medical Oncology, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Peter Grimison
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, Australia
| | - Darren R Feldman
- Memorial Sloan Kettering Cancer Centre, New York, NY, United States of America; Weill Medical College of Cornell University, New York, NY, United States of America
| | - Angelika Terbuch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT with Section Pneumology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Helene Negaard
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | | | - David J Vaughn
- University of Pennsylvania, Philadelphia, PA, United States of America
| | | | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Austria
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland; Universita della Svizzera Italiana (USI), Lugano, Switzerland
| | - Jörg Beyer
- University Department of Medical Oncology, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
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Kastner L, Rieger C, Pfister D, Schmautz M, Storz E, Heidenreich A. HIVEC as an alternative option in non-muscle-invasive bladder cancer: Experiences from a high-volume center. Urol Oncol 2024:S1078-1439(24)00340-5. [PMID: 38653592 DOI: 10.1016/j.urolonc.2024.01.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND High risk non-muscle invasive bladder cancer (NMIBC) is usually treated with intravesical BCG-therapy. In case of BCG failure radical cystectomy (RC) is the treatment of choice. Nevertheless, many patients are unfit for or unwilling to undergo RC. Hyperthermic intravesical chemotherapy (HIVEC) is a promising bladder sparing therapy in such cases. It was the purpose of the study to evaluate the efficacy of HIVEC in patients with BCG failure as well as in BCG naïve patients in case of BCG shortage or given contra-indications for BCG. METHODS We analyzed the first 60 patients who received hyperthermic intravesical chemotherapy (HIVEC) at our department. The therapy regimen consisted of an induction course of 6 weekly sessions, followed by a maintenance course with 6 monthly sessions. Fluorescence cystoscopy with urine cytology and bladder mapping was performed after completion of induction and maintenance therapy at 3 and 12 months. About 68.6 % had received a recurrence after or during BCG treatment, 55% of the subjects were BCG-unresponsive NMIBC according to EAU guidelines. RESULTS The median follow up was 12 months with 12 cycles of HIVEC therapy being administered on average, representing completion of induction and maintenance therapy with 6 cycles each. The 1- and 2-year recurrence-free-survival (RFS) was 67% and 40% respectively. Only one out of 60 patients developed progression to muscle invasion with progression-free-survival (PFS) of 98% at 2 years. No statistical differences were found in RFS for patients failure to BCG compared to patients that were BCG-naïve (BCG unresponsive vs. BCG-naïve) and patients that carried carcinoma in situ (CIS) compared to patients without CIS (CIS vs. no CIS). CONCLUSION Chemohyperthermia using HIVEC results in high recurrence-free survival and a 2-year progression-free survival rate of 98% with a bladder preservation rate of almost 80%. Comparing our data, HIVEC shows better oncological results together with better tolerability and safety making HIVEC a good alternative for patients who refuse radical cystectomy or who are ineligible for radical cystectomy.
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Affiliation(s)
- Lucas Kastner
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Constantin Rieger
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany.
| | - David Pfister
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Max Schmautz
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Enno Storz
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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Rieger C, Pfister D, Kastner L, Eich ML, Quaas A, Tolkach Y, Heidenreich A. Cystic Pelvic Masses in Men: A Presentation of Uncommon Cases and a Literature Review. Clin Genitourin Cancer 2024; 22:523-534. [PMID: 38281876 DOI: 10.1016/j.clgc.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
Unclear cystic masses in the pelvis in male patients are a rare situation and could be of benign or malignant origin. The underlying diseases demand for specific diagnostic and therapeutic approaches. We present a case series of 3 male patients with different clinical symptoms (perineal pain, urinary retention and a large scrotal cyst) related to cystic lesions in the pelvic region. On all patients initial histopathological workup was unclear. All patients underwent surgery with complete resection of the tumor which revealed a broad spectrum of histopathological findings: unusual form of cystic adenocarcinoma of the prostate, malignant transformation of a dysontogenetic cyst, and finally a very rare diagnosis of a malignant tumor of the Cowper gland. This case series and literature review provide clues for a possible diagnostic and therapeutic approach in the case of unclear pelvic cystic masses and could support urologists during the therapy selection in the future.
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Affiliation(s)
- Constantin Rieger
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany.
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Lucas Kastner
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Marie-Lisa Eich
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Yuri Tolkach
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
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Heidenreich A. Significant Survival Differences for Grade Group 4 and Grade Group 5 Prostate Cancer: Detailed Reporting of Pathohistology and Modern Diagnostic Algorithms Are Needed To Tailor Treatment. Eur Urol Oncol 2024; 7:211-212. [PMID: 38000933 DOI: 10.1016/j.euo.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria.
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Seelemeyer F, Pfister D, Pappesch R, Merkelbach-Bruse S, Paffenholz P, Heidenreich A. Reply to Fumihiko Urabe, Takashi Yoshioka, and Takahiro Kimura's Letter to the Editor re: Felix Seelemeyer, David Pfister, Robert Pappesch, Sabine Merkelbach-Bruse, Pia Paffenholz and Axel Heidenreich. Evaluation of a miRNA-371a-3p Assay for Predicting Final Histopathology in Patients Undergoing Primary Nerve-sparing Retroperitoneal Lymphadenectomy for Stage IIA/B Seminoma or Nonseminoma. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2023.10.021. Eur Urol Oncol 2024; 7:306. [PMID: 38238223 DOI: 10.1016/j.euo.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Felix Seelemeyer
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Robert Pappesch
- Department of Pathology and Molecular Pathology, University Hospital Cologne, Germany
| | | | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria.
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Pongratanakul P, Bremmer F, Pauls S, Poschmann G, Kresbach C, Parmaksiz F, Skowron MA, Fuß J, Stephan A, Paffenholz P, Stühler K, Schüller U, Ströbel P, Heidenreich A, Che Y, Albers P, Nettersheim D. Assessing the risk to develop a growing teratoma syndrome based on molecular and epigenetic subtyping as well as novel secreted biomarkers. Cancer Lett 2024; 585:216673. [PMID: 38296184 DOI: 10.1016/j.canlet.2024.216673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
In germ cell tumors (GCT), a growing teratoma during chemotherapy with decreasing tumor markers was defined as 'growing teratoma syndrome' (GTS) by Logothetis et al. in 1982. So far, its pathogenesis and specific treatment options remain elusive. We aimed at updating the GTS definition based on molecular and epigenetic features as well as identifying circulating biomarkers. We selected 50 GTS patients for clinical characterization and subsequently 12 samples were molecularly analyzed. We further included 7 longitudinal samples of 2 GTS patients. Teratomas (TER) showing no features of GTS served as controls. GTS were stratified based on growth rates into a slow (<0.5 cm/month), medium (0.5-1.5) and rapid (>1.5) group. By analyzing DNA methylation, microRNA expression and the secretome, we identified putative epigenetic and secreted biomarkers for the GTS subgroups. We found that proteins enriched in the GTS groups compared to TER were involved in proliferation, DNA replication and the cell cycle, while proteins interacting with the immune system were depleted. Additionally, GTSrapid seem to interact more strongly with the surrounding microenvironment than GTSslow. Expression of pluripotency- and yolk-sac tumor-associated genes in GTS and formation of a yolk-sac tumor or somatic-type malignancy in the longitudinal GTS samples, pointed at an additional occult non-seminomatous component after chemotherapy. Thus, updating the Logothetis GTS definition is necessary, which we propose as follows: The GTS describes a continuously growing teratoma that might harbor occult non-seminomatous components considerably reduced during therapy but outgrowing over time again.
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Affiliation(s)
- Pailin Pongratanakul
- Department of Urology, Urological Research Laboratory, Translational UroOncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Urology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felix Bremmer
- Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Stella Pauls
- Molecular Proteomics Laboratory (MPL), Biological and Medical Research Center (BMFZ), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Gereon Poschmann
- Molecular Proteomics Laboratory (MPL), Biological and Medical Research Center (BMFZ), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Catena Kresbach
- Institute of Neuropathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fatma Parmaksiz
- Department of Urology, Urological Research Laboratory, Translational UroOncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Margaretha A Skowron
- Department of Urology, Urological Research Laboratory, Translational UroOncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Janina Fuß
- Competence Centre for Genomic Analysis, Kiel, Germany
| | - Alexa Stephan
- Department of Urology, Urological Research Laboratory, Translational UroOncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kai Stühler
- Molecular Proteomics Laboratory (MPL), Biological and Medical Research Center (BMFZ), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ulrich Schüller
- Institute of Neuropathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Yue Che
- Department of Urology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Albers
- Department of Urology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Nettersheim
- Department of Urology, Urological Research Laboratory, Translational UroOncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Lighthouse Project Germ Cell Tumors, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Germany.
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Rieger C, Schlüchtermann J, Storz E, Kastner L, Pfister D, Heidenreich A. Cost-effectiveness analysis of different treatment modalities in BCG-unresponsive NMIBC. BJU Int 2024. [PMID: 38491799 DOI: 10.1111/bju.16332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Radical cystectomy (RC) is the standard of care (SOC) in BCG-unresponsive NMIBC and is associated with a significant health-related quality-of-life burden. Recently, promising results have been published on Gemcitabine/Docetaxel, Pembrolizumab, and Hyperthermic Intravesical Chemotherapy (HIVEC) as salvage therapy options trying to increase the rate of bladder preservation. Here, we performed a Cost-Effectiveness-Analysis of those treatment modalities. PATIENTS AND METHODS We developed a Markov model from a payer's perspective drawing on clinical data of single-arm trials testing intravesical gemcitabine/docetaxel and pembrolizumab in BCG-unresponsive NMIBC, as well as clinical data from patients receiving hyperthermic intravesical chemotherapy HIVEC (n = 29) as intravesical salvage chemotherapy at our uro-oncological centre in Cologne. Costs were simulated utilising a non-commercial diagnosis-related groups grouper, utilities were derived from comparable cost-effectiveness studies. We used a Monte Carlo simulation to identify the optimal treatment, comparing the incremental cost effectiveness ratios (ICERs) at a willingness-to-pay threshold of €50 000 (euro)/quality-adjusted life year (QALY). RESULTS Over a horizon of 10 years, gemcitabine/docetaxel, HIVEC, and pembrolizumab were associated with costs of €48 353, €64 438, and €204 580, as well as a gain of QALYs of 6.16, 6.48, and 6.00, resulting in an ICER of €26 482, €42 567, and €184 533 respectively, in comparison to RC with total costs of €21 871 and a gain of QALYs of 5.01. Monte Carlo simulation identified HIVEC as the treatment of choice under assumption of a WTP of <€50 000. CONCLUSION Considering a WTP of <€50 000/QALY, gemcitabine/docetaxel and HIVEC are highly cost-effective therapeutic options in BCG-refractory NMIBC, while RC remains the cheapest option. At its current price, pembrolizumab would only be cost-effective assuming a price reduction of at least 70%.
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Affiliation(s)
- Constantin Rieger
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Jörg Schlüchtermann
- Faculty of Law, Business and Economics, University of Bayreuth, Bayreuth, Germany
| | - Enno Storz
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Lucas Kastner
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
- Department of Urology, Medical University Vienna, Vienna, Austria
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Nestler T, Paffenholz P, Pfister D, Schoch J, Nini A, Hiester A, Albers P, Heidenreich A. Reply by Authors. J Urol 2024; 211:435. [PMID: 38329048 DOI: 10.1097/ju.0000000000003812.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/30/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Tim Nestler
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Pia Paffenholz
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
| | - Justine Schoch
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Alessandro Nini
- Department of Urology, Azienda ULSS 7 Pedemontana, Bassano del Grappa, Italy
| | - Andreas Hiester
- Department of Urology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Peter Albers
- Department of Urology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Axel Heidenreich
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
- Department of Urology, Medical University, Vienna, Austria
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Heidenreich A, Bach C, Pfister D. [Palliative surgery for metastatic prostate cancer]. Urologie 2024; 63:241-253. [PMID: 38418597 DOI: 10.1007/s00120-024-02285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/01/2024]
Abstract
Androgen deprivation in combination with novel hormonal agents, docetaxel, or in combination with abiraterone/prednisone plus docetaxel or darolutamid plus docetaxel represent the standard therapeutic approach in metastatic hormone-sensitive prostate cancer (mHSPC). Patients with low-risk prostate cancer also benefit from additional radiation therapy or radical prostatectomy in terms of progression-free and overall survival. Despite favorable response rates, basically all patients will develop castration resistant prostate cancer (CRPC) within 2.5 to 4 years. In addition to systemic chemotherapy, second-line hormonal treatment of systemic application of radionuclides such as radium223 or 177Lu-PSMA represent salvage management options. However, nowadays about 50-65% of patients will develop symptoms due to local progression of prostate cancer which is the result of improved oncological outcomes with significantly prolonged survival times due to the new medical treatment options. Management of such symptomatic local progression will become more important in upcoming years so that all uro-oncologists need to be aware of the various surgical management options. Complications of the lower urogenital tract such as recurrent gross hematuria ± bladder clotting and with the necessity for red blood cell transfusions, subvesical obstruction and acute urinary retention, rectourethral or rectovesical fistulas might be managed by palliative surgery such as palliative transurethral resection of the prostate (TURP), radical cystectomy, radical cystoprostatectomy with urinary diversion, and pelvic exenteration. Symptomatic or asymptomatic obstruction of the upper urinary tract might be managed by endoluminal or percutaneous urinary diversion, ureteral reimplantation, ileal ureter replacement, or implantation of the Detour® system (Coloplast GmbH, Hamburg, Germany).
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Affiliation(s)
- Axel Heidenreich
- Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
- Klinik für Urologie, Medizinische Universität Wien, Wien, Österreich.
| | - Christian Bach
- Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - David Pfister
- Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Nestler T, Paffenholz P, Pfister D, Schoch J, Nini A, Hiester A, Albers P, Heidenreich A. Adjunctive Surgery Is Often Without Oncological Benefit at Time of Postchemotherapy Retroperitoneal Lymph Node Dissection. J Urol 2024; 211:426-435. [PMID: 38085711 DOI: 10.1097/ju.0000000000003812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/30/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for advanced nonseminomatous germ cell tumors (GCTs) aims to resect all remaining metastatic tissue. Resection of adjacent visceral or vascular organs is commonly performed for complete resection. Resection of organs harboring only necrosis results in relevant overtreatment. The study aimed to describe the frequency of metastatic involvement of resected organs with teratoma or viable cancer and to analyze perioperative complications and relapse-free survival. MATERIALS AND METHODS In a 2-center study, we reviewed a cohort of 1204 patients who underwent PC-RPLND between 2008 and 2021 and identified 242 (20%) cases of adjunctive surgery during PC-RPLND. We analyzed the removed adjacent structures and the pathohistological presence of GCT elements in the resected organs: viable GCT, teratoma, or necrosis/fibrosis. Surgery-associated complications were reported according to the Clavien-Dindo classification. RESULTS Viable GCT, teratoma, and necrosis were present in 54 (22%), 94 (39%), and 94 (39%), respectively, of all patients with adjunctive resection of adjacent organs. Vascular resections or reconstructions (n = 112; viable: 23%, teratoma: 41%, necrosis: 36%) were performed most frequently, followed by nephrectomies (n = 77; viable: 29%, teratoma: 39%, necrosis: 33%). Perioperative complications of grade ≥ IIIa occurred in 6.6% of all patients, with no difference between the viable GCT and teratoma/necrosis groups (P = .1). A total of 76 patients have been followed without a relapse for at least 36 months. Median follow-up of the whole cohort was 22 months (quartile 7 and 48). Patients with viable GCT/teratoma in the resected specimens had a significantly increased risk of recurrence by 5 years compared to patients with only necrosis (19% vs 59% vs 81%, P < .001). CONCLUSIONS This study shows that 33% to 40% of all resections of adjacent organs do not harbor teratoma or viable GCT. This highlights the need for better patient selection for these complex patients.
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Affiliation(s)
- Tim Nestler
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Pia Paffenholz
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
| | - Justine Schoch
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Alessandro Nini
- Department of Urology, Azienda ULSS 7 Pedemontana, Bassano del Grappa, Italy
| | - Andreas Hiester
- Department of Urology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Peter Albers
- Department of Urology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Axel Heidenreich
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
- Department of Urology, Medical University, Vienna, Austria
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11
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Giesen A, Van den Broeck T, Develtere D, Raskin Y, Wymer K, Eden C, Claessens M, Hente R, Rans K, Berghen C, De Meerleer G, Langley S, Karnes RJ, Heidenreich A, Pfister D, Joniau S. Salvage vesiculectomy for local prostate cancer recurrence: surgical technique and early post-operative outcomes. World J Urol 2024; 42:81. [PMID: 38358521 DOI: 10.1007/s00345-024-04771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/17/2023] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Isolated recurrence in remnants of the seminal vesicles (SV) after treatment of primary prostate cancer (PCa) has become a more frequent entity with the widespread use of more sensitive next-generation imaging modalities. Salvage vesiculectomy is hypothesized to be a worthwhile management option in these patients. The primary goal of this study is to describe the surgical technique of this new treatment option. Secondary outcomes are peri- and post-operative complications and early oncological outcomes. METHODS Retrospective multicenter study, including 108 patients with solitary recurrence in the SV treated between January 2009 and June 2022, was performed. Patients with local recurrences outside the SVs or with metastatic disease were excluded. Both SVs were resected using a robot-assisted or an open approach. In selected cases, a concomitant lymphadenectomy was performed. RESULTS Overall, 31 patients (29%) reported complications, all but one grade 1 to 3 on the Clavien-Dindo Scale. A median PSA decrease of 2.07 ng/ml (IQR: 0.80-4.33, p < 0.001), translating into a median PSA reduction of 92% (IQR: 59-98%) was observed. At a median follow-up of 14 months, freedom from secondary treatment was 54%. Lymphadenectomy had a significant influence on PSA reduction (p = 0.018). CONCLUSION Salvage vesiculectomy for PCa recurrence limited to the SV is a safe procedure with excellent PSA response and is a potential curative treatment in a subset of patients. A concomitant lymphadenectomy can best be performed in all patients that did not underwent one at primary treatment.
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Affiliation(s)
- Alexander Giesen
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Thomas Van den Broeck
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Dries Develtere
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Yannic Raskin
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Urology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Kevin Wymer
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Robert Hente
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Kato Rans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stephen Langley
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Urology, AZ Klina, Brasschaat, Belgium.
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12
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Heidenreich A, Paffenholz P, Hartmann F, Seelemeyer F, Pfister D. Retroperitoneal Lymph Node Dissection in Clinical Stage IIA/B Metastatic Seminoma: Results of the COlogne Trial of Retroperitoneal Lymphadenectomy In Metastatic Seminoma (COTRIMS). Eur Urol Oncol 2024; 7:122-127. [PMID: 37438222 DOI: 10.1016/j.euo.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/06/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Radiation therapy and systemic chemotherapy are recommended treatment options in marker-negative clinical stage (CS) IIA/B seminoma. Despite high cure rates of 82-94%, both therapeutic options are associated with significant long-term toxicities. OBJECTIVE To evaluate the feasibility, oncological efficacy, and treatment-associated morbidity of primary nerve-sparing retroperitoneal lymph node dissection (nsRPLND) in CS IIA/B seminoma. DESIGN, SETTING, AND PARTICIPANTS A prospective, single-arm, clinical phase 2 trial including CS IIA/B seminoma patients was conducted. INTERVENTION Primary nerve-sparing retroperitoneal lymphadenectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Relapse-free and overall survival, surgery-associated complications according to the Clavien-Dindo classification, and Kaplan-Meier methods for survival calculation were assessed. RESULTS AND LIMITATIONS Thirty patients at a mean age of 39.1 (34-52) yr with marker-negative CS IIA and IIB seminomas were recruited. The median follow-up was 22 (8-30) mo. Nineteen (63%) and 11 (36%) patients were diagnosed with stages IIA and B, respectively, at the time of primary diagnosis. Fourteen (47%) and 16 (53%) patients were diagnosed with CS IIA and IIB, respectively, at the time of nsRPLND. Twenty-seven and three patients underwent open and robot-assisted nsRPLND, respectively. The median operating room time was 125 (115-145) min, median blood loss was <150 ml, and median time of hospitalization was 4.5 (3-9) d. Four (13%) patients experienced Clavien-Dindo grade 3a complications. Lymph node histology revealed seminoma in 25 (80%) patients; two and three patients demonstrated embryonal carcinoma and benign disease, respectively. Sixteen patients underwent a serum analysis of miR371 preoperatively, which predicted metastatic disease in 12/13 and benign histology in 3/3 patients. Three of 30 (10%) patients developed an outfield relapse 4, 6, and 9 mo postoperatively and were salvaged by systemic chemotherapy. Limitations are the low patient number and length of follow-up. CONCLUSIONS The nsRPLND approach results in a high cure rate at midterm follow-up and is associated with a low frequency of treatment-associated morbidities, making this approach a feasible alternative to radiation therapy or systemic chemotherapy. PATIENT SUMMARY The standard treatment of clinical stage IIA/B seminomas is radiation therapy or chemotherapy, which results in a significantly increased frequency of long-term toxicity and secondary neoplasms. In this trial, we demonstrate that nerve-sparing retroperitoneal lymph node dissection is a feasible therapeutic approach with low morbidity and high oncological efficacy.
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Affiliation(s)
- Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria.
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Florian Hartmann
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Felix Seelemeyer
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
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13
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Rieger C, Pfister D, Heidenreich A. [Emergencies in cancer therapy: surgical indications under systemic therapy]. Aktuelle Urol 2024; 55:60-64. [PMID: 37607584 DOI: 10.1055/a-2129-7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Emergency surgery due to side-effects of cancer therapy in patients with metastatic disease of the genitourinary tract is rare. Nevertheless, there are a number of emergencies that require rapid intervention and should be recognized by every uro-oncologist. The following review will work out important side-effects requiring surgical treatment, highlighting the main symptoms and the initial management.
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Affiliation(s)
- Constantin Rieger
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Koln, Germany
| | - David Pfister
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Koln, Germany
| | - Axel Heidenreich
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Koln, Germany
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14
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Belge G, Dumlupinar C, Nestler T, Klemke M, Törzsök P, Trenti E, Pichler R, Loidl W, Che Y, Hiester A, Matthies C, Pichler M, Paffenholz P, Kluth L, Wenzel M, Sommer J, Heinzelbecker J, Schriefer P, Winter A, Zengerling F, Kramer MW, Lengert M, Frey J, Heidenreich A, Wülfing C, Radtke A, Dieckmann KP. Detection of Recurrence through microRNA-371a-3p Serum Levels in a Follow-up of Stage I Testicular Germ Cell Tumors in the DRKS-00019223 Study. Clin Cancer Res 2024; 30:404-412. [PMID: 37967143 PMCID: PMC10792362 DOI: 10.1158/1078-0432.ccr-23-0730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Surveillance of clinical stage I (CSI) testicular germ cell tumors (GCT) is hampered by low sensitivity and specificity of current biomarkers for detecting relapses. This study evaluated if serum levels of microRNA371a-3p (M371 test) can: (i) Accurately detect relapses, (ii) detect relapses earlier than conventional technology, and (iii) if elevated postoperative M371 levels may predict relapse. EXPERIMENTAL DESIGN In a multicentric setting, 258 patients with testicular CSI GCT were prospectively followed by surveillance for a median time of 18 months with serial measurements of serum M371 levels, in addition to standard diagnostic techniques. Diagnostic characteristics of M371 for detecting relapses were calculated using ROC curve analysis. RESULTS Thirty-nine patients recurred (15.1%), all with elevated M371 levels; eight without relapse had elevations, too. The test revealed the following characteristics: area under the ROC curve of 0.993, sensitivity 100%, specificity 96.3%, positive predictive value 83%, negative predictive value 100%. Earlier relapse detection with the test was found in 28%, with non-significant median time gain to diagnosis. Postoperative M371 levels did not predict future relapse. CONCLUSIONS The sensitivity and specificity of the M371 test for detecting relapses in CSI GCTs are much superior to those of conventional diagnostics. However, post-orchiectomy M371 levels are not predictive of relapse, and there is no significant earlier relapse detection with the test. In all, there is clear evidence for the utility of the M371 test for relapse detection suggesting it may soon be ready for implementation into routine follow-up schedules for patients with testicular GCT.
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Affiliation(s)
- Gazanfer Belge
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Cansu Dumlupinar
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Tim Nestler
- Department of Urology, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - Markus Klemke
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Peter Törzsök
- Department of Urology and Andrology, Paracelsus Medical University, Salzburg University Hospital, Salzburg, Austria
| | | | - Renate Pichler
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Wolfgang Loidl
- Ordensklinikum Barmherzige Schwestern, Department Urology, Linz, Austria
| | - Yue Che
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Andreas Hiester
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Martin Pichler
- Research Unit of Non-Coding RNA, Division of Oncology, Medical University of Graz, Graz, Austria
| | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Luis Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jörg Sommer
- Department of Urology, St. Franziskus Krankenhaus Lohne, Lohne, Germany
| | - Julia Heinzelbecker
- Saarland University Medical Centre and Saarland University, Department of Urology, Homburg, Germany
| | | | - Alexander Winter
- Department of Urology, University Hospital Oldenburg, Oldenburg, Germany
| | | | - Mario Wolfgang Kramer
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marie Lengert
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Jana Frey
- miRdetect GmbH, Bremerhaven, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
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15
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Heidenreich A, Bach C, Pfister D. [Palliative urologic surgery for metastatic prostate cancer: what needs to be considered in the future?]. Aktuelle Urol 2024. [PMID: 38232756 DOI: 10.1055/a-2226-9243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Androgen deprivation in combination with novel hormonal agents, docetaxel or the combination of abiraterone/prednisone plus docetaxel or darolutamide plus docetaxel represent the standard therapeutic approach in metastatic hormone-sensitive prostate cancer (mHSPC). Patients with low-risk prostate cancer also benefit from additional radiation therapy or radical prostatectomy in terms of progression-free and overall survival. Despite favourable response rates, basically all patients will develop castration-resistant prostate cancer (CRPC) within 2.5 to 4 years. Systemic chemotherapy, second-line hormonal treatment or systemic application of radionuclides such as Radium-223 or 177Lu-PSMA represent salvage management options. As the new medical treatment options have led to an improved oncological outcome with significantly prolonged survival times, about 50% to 65% of patients will develop symptoms due to local progression of prostate cancer. The management of such symptomatic local progression will become more important in upcoming years, which means that all uro-oncologists need to be aware of the various surgical management options. If complications of the lower urogenital tract occur, for example repetitive gross haematuria with or without bladder clotting and with the necessity for red blood cell transfusions, subvesical obstruction, acute urinary retention or rectourethral or rectovesical fistulas, these may be managed by palliative surgery such as palliative TURP, radical cystectomy, radical cystoprostatectomy with urinary diversion, and pelvic exenteration. Symptomatic or asymptomatic obstruction of the upper urinary tract can be managed by endoluminal or percutaneous urinary diversion, ureteral reimplantation, ileal ureter replacement, or implantation of a Detour system. However, an individualised and risk-adapted treatment strategy needs to be developed for each single patient to achieve an optimal therapeutic outcome with improvement of both symptoms and quality of life. In specific clinical situations, best supportive care may be an adequate option.
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Affiliation(s)
- Axel Heidenreich
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und Roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Christian Bach
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und Roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - David Pfister
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und Roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
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16
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Karapanos L, Halbe L, Heidenreich A. Penile urethrostomy for recurrent long-segment strictures of the penile urethra: step-by-step surgical technique. Cent European J Urol 2024; 77:157-158. [PMID: 38645820 PMCID: PMC11032024 DOI: 10.5173/ceju.2023.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/09/2023] [Accepted: 10/26/2023] [Indexed: 04/23/2024] Open
Affiliation(s)
- Leonidas Karapanos
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Surgery, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Luisa Halbe
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Surgery, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Surgery, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
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17
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Fankhauser CD, Tandstad T, Heidenreich A. Editorial Comment. J Urol 2024; 211:87-88. [PMID: 37793059 DOI: 10.1097/ju.0000000000003697.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Christian D Fankhauser
- University of Zurich, Zurich, Switzerland
- Luzerner Kantonsspital, Lucerne, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Torgrim Tandstad
- Department of Oncology, The Cancer Clinic, St Olav's University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, NTNU, Trondheim, Norway
| | - Axel Heidenreich
- Department of Urology, Uniklinik Koln, Cologne, Germany
- Department of Urology, Medical University of Vienna, Vienna, Austria
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18
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Rajwa P, Heidenreich J, Drzezga A, Schmidt M, Shariat SF, Heidenreich A. The diagnostic accuracy of 68 Ga-PSMA-PET/CT in primary staging of patients with high-risk nonmetastatic prostate cancer treated with radical prostatectomy: A single-center cohort analysis. Prostate 2024; 84:74-78. [PMID: 37750292 DOI: 10.1002/pros.24627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND 68 Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) is a recommended imaging modality for patients with recurrent prostate cancer (PCa). Its routine implementation before radical prostatectomy (RP) may allow avoiding undertreatment. We aimed to analyze the diagnostic accuracy of 68 Ga-PSMA-PET/CT for pelvic lymph node metastases in a large cohort of patients treated with RP and extended pelvic lymph node dissection (ePLND) for high-risk PCa. METHODS This is a retrospective analysis of an institutional database of patients who underwent 68 Ga-PSMA-PET/CT before RP and ePLND for high-risk PCa. The diagnostic estimates of 68 Ga-PSMA-PET/CT with 95% confidence intervals (CIs) for lymph node involvement were calculated. RESULTS We included 165 high-risk PCa patients. The median PSA value was 24.5 ng/mL (range: 6.7-185) and all the patients had biopsy Grade Group 4-5. In total, 46 (28%) of patients had clinical lymph node involvement at 68 Ga-PSMA-PET/CT. A mean number of resected lymph nodes per patient was 22 (range: 15-45) and 149 (4.2%) of all resected nodes were positive for lymph node metastasis at final pathology. The diagnostic estimates for the detection of pN+ disease at RP were as follows: sensitivity 63% (95% CI: 51-75), specificity 97% (95% CI: 91-99), positive predictive value 94% (95% CI: 82-99), and negative predictive value 79% (95% CI: 70-86). The total accuracy of PSMA-PET was 83% (95% CI: 76-88). CONCLUSION Our analyses support high specificity and positive predictive value of pretreatment 68 Ga-PSMA PET/CT for the detection of pelvic lymph node metastasis in patients treated with RP for high-risk PCa. While a positive finding should be considered as robust indicator for clinical decision-making, a negative result cannot reliably rule out the presence of lymph node involvement in high-risk PCa; there is a need for advanced risk stratification in those patients.
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Affiliation(s)
- Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Julian Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Matthias Schmidt
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
| | - Axel Heidenreich
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
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19
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Antonelli L, Ardizzone D, Tachibana I, Adra N, Cary C, Hugar L, Sexton WJ, Bagrodia A, Mego M, Daneshmand S, Nicolai N, Nazzani S, Giannatempo P, Franza A, Heidenreich A, Paffenholz P, Saoud R, Eggener S, Ho M, Oswald N, Olson K, Tryakin A, Fedyanin M, Naoun N, Javaud C, Cazzaniga W, Nicol D, Gerdtsson A, Tandstad T, Fizazi K, Fankhauser CD. Risk Factors for Relapse in Nonseminomatous Testicular Cancer After Postchemotherapy Retroperitoneal Lymph Node Dissection With Viable Residual Cancer. J Clin Oncol 2023; 41:5296-5305. [PMID: 37656935 DOI: 10.1200/jco.23.00443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/14/2023] [Accepted: 06/23/2023] [Indexed: 09/03/2023] Open
Abstract
PURPOSE No consensus exists on the management of men with nonseminoma and viable nonteratomatous germ cell tumor in the postchemotherapy retroperitoneal lymph node dissection (pcRPLND) specimen after first-line chemotherapy. We analyzed surveillance versus different adjuvant chemotherapy regimens and the influence of time to pcRPLND on oncologic outcomes. METHODS Data on 117 men treated with cisplatin-based first-line chemotherapy between 1990 and 2018 were collected from 13 institutions. All patients had viable nonteratomatous germ cell tumor in the pcRPLND specimen. Surgery was performed after a median of 57 days, followed by either surveillance (n = 64) or adjuvant chemotherapy (n = 53). Primary end points were progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS After controlling for International Germ Cell Cancer Cooperative Group risk group and percent of viable malignant cells found at RPLND, no difference was observed between men managed with surveillance or adjuvant chemotherapy regarding PFS (hazard ratio [HR], 0.72 [95% CI, 0.32 to 1.6]; P = .4), CSS (HR, 0.69; 95% CI, 0.20 to 2.39; P = .6), and OS (HR, 0.78 [95% CI, 0.25 to 2.44]; P = .7). No statistically significant differences for PFS, CSS, or OS were observed on the basis of chemotherapy regimen or in men treated with pcRPLND ≤57 versus >57 days after first-line chemotherapy. Residual disease with <10% versus ≥10% viable cancer cells were associated with a longer PFS (HR, 3.22 [95% CI, 1.29 to 8]; P = .012). Relapse in the retroperitoneum was observed in 34 (29%) men. CONCLUSION Men with a complete resection at pcRPLND and <10% viable cells have favorable outcomes without further treatment. Complete retroperitoneal resection seems more important than early pcRPLND.
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Affiliation(s)
- Luca Antonelli
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland
- Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | | | - Isamu Tachibana
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Lee Hugar
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Aditya Bagrodia
- Department of Urology, University of California, San Diego, CA
- The University of Texas Southwestern, Dallas, TX
| | - Michal Mego
- Department of Oncology, Comenius University, National Cancer Institute, Bratislava, Slovak Republic
| | - Siamak Daneshmand
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Nicola Nicolai
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sebastiano Nazzani
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Giannatempo
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Franza
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne, Faculty of Medicine and University of Cologne, Cologne, Germany
- Department of Urology, Medical University, Vienna, Austria
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne, Faculty of Medicine and University of Cologne, Cologne, Germany
| | - Ragheed Saoud
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL
| | - Scott Eggener
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL
| | - Matthew Ho
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL
| | | | | | - Alexey Tryakin
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Mikhail Fedyanin
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | | | | | - Walter Cazzaniga
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David Nicol
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Institute of Cancer Research, London, United Kingdom
| | - Axel Gerdtsson
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Torgrim Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Christian Daniel Fankhauser
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland
- University of Lucerne, Lucerne, Switzerland
- University of Zurich, Zurich, Switzerland
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20
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Sibert NT, Kurth T, Breidenbach C, Wesselmann S, Feick G, Carl EG, Dieng S, Albarghouth MH, Aziz A, Baltes S, Bartolf E, Bedke J, Blana A, Brock M, Conrad S, Darr C, Distler F, Drosos K, Duwe G, Gaber A, Giessing M, Harke NN, Heidenreich A, Hijazi S, Hinkel A, Kaftan BT, Kheiderov S, Knoll T, Lümmen G, Peters I, Polat B, Schrodi V, Stolzenburg JU, Varga Z, von Süßkind-Schwendi J, Zugor V, Kowalski C. Prediction models of incontinence and sexual function one year after radical prostatectomy based on data from 20 164 prostate cancer patients. PLoS One 2023; 18:e0295179. [PMID: 38039308 PMCID: PMC10691723 DOI: 10.1371/journal.pone.0295179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool. METHODS Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80-20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models. RESULTS For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/. CONCLUSION The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients.
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Affiliation(s)
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Günther Feick
- Bundesverband Prostatakrebs Selbsthilfe, Bonn, Germany
| | | | | | | | | | - Stefan Baltes
- KRH Klinikum Region Hannover, Klinikum Siloah—Oststadt—Heidehaus, Hannover, Germany
| | | | - Jens Bedke
- University Hospital Tübingen, Tübingen, Germany
| | | | - Marko Brock
- Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | | | | | | | | | | | - Amr Gaber
- Carl-Thiem-Klinikum, Cottbus, Germany
| | | | | | | | | | | | | | | | - Thomas Knoll
- Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany
| | | | - Inga Peters
- Krankenhaus Nordwest, Frankfurt am Main, Germany
| | | | | | | | - Zoltan Varga
- SRH Kliniken Landkreis Sigmaringen, Sigmaringen, Germany
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21
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D'Andrea D, Soria F, Hurle R, Enikeev D, Kotov S, Régnier S, Xylinas E, Lusuardi L, Heidenreich A, Cai C, Frego N, Taraktin M, Ryabov M, Gontero P, Compérat E, Shariat SF. Reply to Francesco Montorsi, Giuseppe Rosiello, Giorgio Gandaglia, Andrea Salonia, and Alberto Briganti's Letter to the Editor re: David D'Andrea, Francesco Soria, Rodolfo Hurle, et al. En Bloc Versus Conventional Resection of Primary Bladder Tumor (eBLOC): A Prospective, Multicenter, Open-label, Phase 3 Randomized Controlled Trial. Eur Urol Oncol 2023;6:508-15. Eur Urol Oncol 2023:S2588-9311(23)00242-0. [PMID: 37978025 DOI: 10.1016/j.euo.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Affiliation(s)
- David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria.
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Sergey Kotov
- Department of Urology and Andrology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Sophie Régnier
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsius Medical University, Salzburg, Austria
| | - Axel Heidenreich
- Department of Urology, Uro-oncology, Robot-Assisted and Specialized Surgery, University of Cologne, Cologne, Germany
| | - Chao Cai
- Department of Urology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nicola Frego
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Mark Taraktin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia
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22
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Seelemeyer F, Pfister D, Pappesch R, Merkelbach-Bruse S, Paffenholz P, Heidenreich A. Evaluation of a miRNA-371a-3p Assay for Predicting Final Histopathology in Patients Undergoing Primary Nerve-sparing Retroperitoneal Lymphadenectomy for Stage IIA/B Seminoma or Nonseminoma. Eur Urol Oncol 2023:S2588-9311(23)00236-5. [PMID: 37932157 DOI: 10.1016/j.euo.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
Patients with marker-negative clinical stage IIA/B seminoma or nonseminoma represent a therapeutic challenge, as 20-30% might harbor nonmalignant histologies. MicroRNA 371a-3p (miR371) may represent a biomarker with diagnostic and predictive properties in testicular germ cell tumors (TGCTs). We evaluated the predictive accuracy of this biomarker in identifying the presence or absence of lymph node metastases (LNMs) in clinical stage IIA/B TGCT. In a cohort of 24 consecutive patients with marker-negative clinical stage IIA/B TGCT (n = 15 seminoma, n = 9 nonseminoma) serum miR371 was assessed 1 d before nerve-sparing retroperitoneal lymphadenectomy. Histology revealed metastatic TGCT in 22/24 patients (91.7%), with positive miR371a findings for 20 of these 22 patients with metastases (90.9%). Histology revealed no malignancy in one patient and lymphoma in another, both of whom had negative miR371a findings. One additional patient with pure teratoma and one with a microscopic seminomatous LNM had false-negative miR371a findings. The miR371 assay had sensitivity of 90.9% and specificity of 50%. The positive predictive value was 100.0% and the negative predictive value was 75.0%. According to the data available, miR371a represents a highly reliable, personalized tumor marker for predicting the presence of low-volume retroperitoneal LNMs in marker-negative TGCT. miR371 has potential for inclusion in the diagnostic armamentarium for men with equivocal lymph nodes to facilitate avoidance of unnecessary treatment and the associated toxicity. PATIENT SUMMARY: Our study demonstrates that blood tests for the biomarker miR371 are highly reliable in predicting the presence of lymph node metastases in patients with stage IIA/B testicular cancer. For patients with equivocal findings, use of this test may help in avoiding unnecessary treatment.
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Affiliation(s)
- Felix Seelemeyer
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Robert Pappesch
- Department of Urology, Medical University Vienna, Vienna, Austria
| | | | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria.
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23
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Lauritsen J, Sauvé N, Tryakin A, Jiang DM, Huddart R, Heng DYC, Terbuch A, Winquist E, Chovanec M, Hentrich M, Fankhauser CD, Shamash J, Del Muro XG, Vaughn D, Heidenreich A, Sternberg CN, Sweeney C, Necchi A, Bokemeyer C, Bandak M, Jandari A, Collette L, Gillessen S, Beyer J, Daugaard G. Outcomes of relapsed clinical stage I versus de novo metastatic testicular cancer patients: an analysis of the IGCCCG Update database. Br J Cancer 2023; 129:1759-1765. [PMID: 37777577 PMCID: PMC10667594 DOI: 10.1038/s41416-023-02443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/07/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Active surveillance after orchiectomy is the preferred management in clinical stage I (CSI) germ-cell tumours (GCT) associated with a 15 to 30% relapse rate. PATIENTS AND METHODS In the IGCCCG Update database, we compared the outcomes of gonadal disseminated GCT relapsing from initial CSI to outcomes of patients with de novo metastatic GCT. RESULTS A total of 1014 seminoma (Sem) [298 (29.4%) relapsed from CSI, 716 (70.6%) de novo] and 3103 non-seminoma (NSem) [626 (20.2%) relapsed from CSI, 2477 (79.8%) de novo] were identified. Among Sem, no statistically significant differences in PFS and OS were found between patients relapsing from CSI and de novo metastatic disease [5-year progression-free survival (5y-PFS) 87.6% versus 88.5%; 5-year overall survival (5y-OS) 93.2% versus 96.1%). Among NSem, PFS and OS were higher overall in relapsing CSI patients (5y-PFS 84.6% versus 80.0%; 5y-OS 93.3% versus 88.7%), but there were no differences within the same IGCCCG prognostic groups (HR = 0.89; 95% CI: 0.70-1.12). Relapses in the intermediate or poor prognostic groups occurred in 11/298 (4%) Sem and 112/626 (18%) NSem. CONCLUSION Relapsing CSI GCT patients expect similar survival compared to de novo metastatic patients of the same ICCCCG prognostic group. Intermediate and poor prognosis relapses from initial CSI expose patients to unnecessary toxicity from more intensive treatments.
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Affiliation(s)
- Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Nicolas Sauvé
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Alexey Tryakin
- Department of Chemotherapy, N.N.Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Di Maria Jiang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Robert Huddart
- Institute of Cancer Research and Royal Marsden Hospital, Downs Road, Sutton, Surrey, UK
| | - Daniel Y C Heng
- Division of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Eric Winquist
- Department of Oncology, University of Western Ontario and London Health Sciences Centre, London, ON, Canada
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, National Cancer Institute, Bratislava, Slovakia
| | - Marcus Hentrich
- Department of Hematology/Oncology, Red Cross Hospital, Munich, Germany
| | | | | | | | - David Vaughn
- Division of Hematology/Oncology, Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA
| | | | - Andrea Necchi
- Vita-Salute San Raffaele University, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT with section Pneumonology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mikkel Bandak
- Department of Consulting and Research, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Abolghassem Jandari
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- University of Southern Switzerland, Lugano, Switzerland
| | - Joerg Beyer
- Department of Medical Onccology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
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24
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Karapanos L, Knorr V, Halbe L, Schmautz M, Ergashev B, Heidenreich A. Comparison of oral morbidity and mid-term efficacy of anterior urethroplasty using an autologous tissue-engineered graft (MukoCell®) versus native oral mucosa graft. Int J Urol 2023; 30:1000-1007. [PMID: 37435860 DOI: 10.1111/iju.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Our study aimed to compare surgical success rate (SR) and oral morbidity of augmentation urethroplasty for anterior urethral strictures using autologous tissue-engineered oral mucosa graft (TEOMG) named MukoCell® versus native oral mucosa graft (NOMG). METHODS We conducted a single-institution observational study on patients undergoing TEOMG and NOMG urethroplasty for anterior urethral strictures >2 cm in length from January 2016 to July 2020. SR, oral morbidity, and potential risk factors of recurrence were compared between groups were analyzed. A decrease of maximum uroflow rate < 15 mL/s or further instrumentation was considered a failure. RESULTS Overall, TEOMG (n = 77) and NOMG (n = 76) groups had comparable SR (68.8% vs. 78.9%, p = 0.155) after a median follow-up of 52 (interquartile range [IQR] 45-60) months for TEOMG and 53.5 (IQR 43-58) months for NOMG. Subgroup analysis revealed comparable SR according to surgical technique, stricture localization, and length. Only following repetitive urethral dilatations, TEOMG achieved lower SR (31.3% vs. 81.3%, p = 0.003). Surgical time was significantly shorter by TEOMG use (median 104 vs. 182 min, p < 0.001). Oral morbidity and the associated "burden" in patients' quality of life were significantly less at 3 weeks following the biopsy required for TEOMG manufacture, compared to NOMG harvesting and totally absent at 6 and 12 months postoperatively. CONCLUSIONS The SR of TEOMG urethroplasty appeared to be comparable to NOMG at a mid-term follow-up but taking into account the uneven distribution of stricture site and the surgical techniques used in both groups. Surgical time was significantly shortened, since no intraoperative mucosa harvesting was required, and oral complications were diminished through the preoperative biopsy for MukoCell® manufacture.
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Affiliation(s)
- Leonidas Karapanos
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vincent Knorr
- Department of Urology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Luisa Halbe
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maximilian Schmautz
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Bobirjon Ergashev
- Department of Urology, Andijan State Medical Institute, Andijan, Uzbekistan
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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25
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D'Andrea D, Soria F, Hurle R, Enikeev D, Kotov S, Régnier S, Xylinas E, Lusuardi L, Heidenreich A, Cai C, Frego N, Taraktin M, Ryabov M, Gontero P, Compérat E, Shariat SF. Reply to Riccardo Lombardo, Sara Riolo, and Cosimo De Nunzio's Letter to the Editor re: David D'Andrea, Francesco Soria, Rodolfo Hurle, et al. En Bloc Versus Conventional Resection of Primary Bladder Tumor (eBLOC): A Prospective, Multicenter, Open-label, Phase 3 Randomized Controlled Trial. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2023.07.010. Eur Urol Oncol 2023:S2588-9311(23)00216-X. [PMID: 37865570 DOI: 10.1016/j.euo.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/23/2023]
Affiliation(s)
- David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria.
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Sergey Kotov
- Department of Urology and Andrology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Sophie Régnier
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsius Medical University, Salzburg, Austria
| | - Axel Heidenreich
- Department of Urology, Uro-oncology, Robot-Assisted and Specialized Surgery, University of Cologne, Cologne, Germany
| | - Chao Cai
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nicola Frego
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Mark Taraktin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia
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Rajwa P, Robesti D, Chaloupka M, Zattoni F, Giesen A, Huebner NA, Krzywon A, Miszczyk M, Moll M, Stando R, Cisero E, Semko S, Checcucci E, Devos G, Apfelbeck M, Gatti C, Marra G, van den Bergh RCN, Goldner G, Rasul S, Ceci F, Dal Moro F, Porpiglia F, Gontero P, Bjartell A, Stief C, Heidenreich A, Joniau S, Briganti A, Shariat SF, Gandaglia G. Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography: Results of a Multicenter European Study. Eur Urol Oncol 2023:S2588-9311(23)00197-9. [PMID: 37845121 DOI: 10.1016/j.euo.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND De novo oligometastatic prostate cancer (omPCa) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a new disease entity and its optimal management remains unknown. OBJECTIVE To analyze the outcomes of patients treated with cytoreductive radical prostatectomy (cRP) for omPCa on PSMA-PET. DESIGN, SETTING, AND PARTICIPANTS Overall, 116 patients treated with cRP at 13 European centers were identified. Oligometastatic PCa was defined as miM1a and/or miM1b with five or fewer osseous metastases and/or miM1c with three or fewer lung lesions on PSMA-PET. INTERVENTION Cytoreductive radical prostatectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Thirty-day complications according to Clavien-Dindo, continence rates, time to castration-resistant PCa (CRPC), and overall survival (OS) were analyzed. RESULTS AND LIMITATIONS Overall, 95 (82%) patients had miM1b, 18 (16%) miM1a, and three (2.6%) miM1c omPCa. The median prebiopsy prostate-specific antigen was 14 ng/ml, and 102 (88%) men had biopsy grade group ≥3 PCa. The median number of metastases on PSMA-PET was 2; 38 (33%), 29 (25%), and 49 (42%) patients had one, two, and three or more distant positive lesions. A total of 70 (60%) men received neoadjuvant systemic therapy, and 37 (32%) underwent metastasis-directed therapy. Any and Clavien-Dindo grade ≥3 complications occurred in 36 (31%) and six (5%) patients, respectively. At a median follow-up of 27 mo, 19 (16%) patients developed CRPC and eight (7%) patients died. The 1-yr urinary continence rate was 82%. The 2-yr CRPC-free survival and OS were 85.8% (95% confidence interval [CI] 78.5-93.7%) and 98.9% (95% CI 96.8-100%), respectively. The limitations include retrospective design and short-term follow-up. CONCLUSIONS Cytoreductive radical prostatectomy is a safe and feasible treatment option in patients with de novo omPCa on PSMA-PET. Despite overall favorable oncologic outcomes, some of these patients have a non-negligible risk of early progression and thus should be considered for multimodal therapy. PATIENT SUMMARY We found that patients treated at expert centers with surgery for prostate cancer, with a limited number of metastases detected using novel molecular imaging, have favorable short-term survival, functional results, and acceptable rates of complications.
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Affiliation(s)
- Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Daniele Robesti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Michael Chaloupka
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University Munich, Munich, Germany
| | - Fabio Zattoni
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Alexander Giesen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Nicolai A Huebner
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Marcin Miszczyk
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Matthias Moll
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Rafał Stando
- Department of Radiotherapy, Holy Cross Cancer Center, Kielce, Poland
| | - Edoardo Cisero
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Sofiya Semko
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Gaëtan Devos
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maria Apfelbeck
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University Munich, Munich, Germany
| | - Cecilia Gatti
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Giancarlo Marra
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Gregor Goldner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Christian Stief
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University Munich, Munich, Germany
| | - Axel Heidenreich
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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D'Andrea D, Soria F, Hurle R, Enikeev D, Kotov S, Régnier S, Xylinas E, Lusuardi L, Heidenreich A, Cai C, Frego N, Taraktin M, Ryabov M, Gontero P, Compérat E, Shariat SF. En Bloc Versus Conventional Resection of Primary Bladder Tumor (eBLOC): A Prospective, Multicenter, Open-label, Phase 3 Randomized Controlled Trial. Eur Urol Oncol 2023; 6:508-515. [PMID: 37543464 DOI: 10.1016/j.euo.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/24/2023] [Accepted: 07/19/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND En bloc transurethral resection of the bladder (eTURB) might improve the surgical management of non-muscle-invasive bladder cancer (NMIBC) in comparison to conventional TURB (cTURB). OBJECTIVE To evaluate whether eTURB is superior to cTURB in resection of NMIBC and specimen retrieval. DESIGN, SETTING, AND PARTICIPANTS This was a randomized, multicenter trial in patients with up to three cTa-T1 NMIBC tumors of 1-3 cm in size, who were enrolled from January 2019 to January 2022. INTERVENTION Participants were randomized 1:1 to undergo eTURB (n = 192) or cTURB (n = 192). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the prevalence of detrusor muscle (DM) in the specimen retrieved. Secondary endpoints included bladder perforation, persistent disease at second-look TURB, positive lateral resection margin, positive deep resection margin, operation time, perforation rate, obturator reflex, conversion from eTURB to cTURB, recurrence-free survival, and disease recurrence at 3 mo. RESULTS AND LIMITATIONS A total of 384 patients were randomized to undergo eTURB or cTURB. A total of 452 tumors were resected and analyzed for the primary outcome. eTURB was superior to cTURB in retrieval of DM (80.7% vs 71.1%; mixed-model p = 0.01). Bladder perforation (5.6% vs 12%; difference -6.4%; 95% confidence interval [CI] -12.2% to -0.6%) and obturator reflex (8.4% vs 16%; difference -7.6%; 95% CI -14.3% to -0.9%) were less frequent in the eTURB arm than in the cTURB arm. Operation time did not differ between the two techniques (26 min, interquartile range [IQR] 20-38 for eTURB vs 25 min, IQR 17-35 for cTURB; difference 1 min, 95% CI -25.9 to 4.99). Second-look TURB was performed in 24 patients in the eTURB arm and 34 in the cTURB arm, with no difference in the rate of residual papillary disease (pTa/pT1: 56% vs 55.9%; difference 0.1%, 95% CI -25.5% to 25.7%). At median follow-up of 13 mo (IQR 7-20), 18.4% of the patients in the eTURB arm and 16.7% in the cTURB arm had experienced bladder cancer recurrence (Cox hazard ratio 0.87, 95% CI 0.49-1.52; p = 0.6). CONCLUSIONS In patients with clinical NMIBC with up to three tumors of 1-3 cm in size, tumor removal via eTURB resulted in a higher rate of DM in the pathologic specimen in comparison to cTURB. Moreover, eTURB was associated with lower frequency of obturator reflex and bladder perforation than cTURB was. While improving on the quality indicators for NMIBC, the long-term differential oncologic benefits of eTURB remain uncertain. PATIENT SUMMARY We compared two techniques for removal of bladder tumors and found that tumor removal in a single piece, called en bloc resection, provides a better-quality specimen for pathology analysis and fewer complications in comparison to the conventional method. This trial is registered at ClinicalTrials.gov as NCT03718754.
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Affiliation(s)
- David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria.
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Sergey Kotov
- Department of Urology and Andrology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Sophie Régnier
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsius Medical University, Salzburg, Austria
| | - Axel Heidenreich
- Department of Urology, Uro-oncology, Robot-Assisted and Specialized Surgery, University of Cologne, Cologne, Germany
| | - Chao Cai
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nicola Frego
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Mark Taraktin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia
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Hugar LA, Peak TC, Naqvi M, Kim Y, Bandini M, Pederzoli F, Marandino L, Albersen M, Roussel E, Zhu Y, Ye DW, Ornellas AA, Catanzaro M, Hakenberg OW, Heidenreich A, Haidl F, Watkin N, Ager M, Briganti A, Salvioni R, Chakiryan NH, Montorsi F, Necchi A, Spiess PE. Predicting Limited Survival Following Inguinal Lymph Node Dissection in Penile Cancer: Should We Revisit the Goals of Care? Urology 2023; 180:176-181. [PMID: 37467807 DOI: 10.1016/j.urology.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/26/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Patients with advanced penile squamous cell cancer have a poor prognosis and can benefit from early palliative care consultation. We built a model to identify those patients most likely to benefit. METHODS Patients with penile squamous cell cancer undergoing inguinal lymph node dissection were identified from the National Cancer Database (NCDB) and a multi-institutional international dataset (INT). A multivariable Cox proportional hazards model for overall survival (OS) was developed using the NCDB and applied to the INT dataset. Parameters were used to make receiver operating characteristic (ROC) curves. ROC-related criteria were optimized to identify a predictive probability cut point and dichotomize patients from INT into risk groups for limited OS of <6 and <12 months. RESULTS NCDB had 860 deaths; 105 (5%) at 6 months and 296 (15%) at 12 months. INT had 257 deaths; 56 (8%) at 6 months and 124 (18%) at 12 months. Limited OS was associated with older age, greater T and N stage, and fewer lymph nodes removed. Optimized ROC criteria using the OS <6 months curve best dichotomized INT patients into high-risk group with median OS of 24 months (95% CI 18-34) and low-risk group with median OS of 174 months (95% CI 120-NE). CONCLUSION We developed a simple model that could be used as a screening tool for early palliative care referral.
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Affiliation(s)
- Lee A Hugar
- Lexington Medical Center, Lexington Urology, Columbia, SC
| | - Taylor C Peak
- H Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, FL.
| | - Mahrukh Naqvi
- H Lee Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, Tampa, FL
| | - Youngchul Kim
- H Lee Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, Tampa, FL
| | - Marco Bandini
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Pederzoli
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Marandino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Yao Zhu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ding-Wei Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Antonio A Ornellas
- Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil
| | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | - Nick Watkin
- St. George's University Hospitals, NHS Foundation Trust, London, UK
| | - Michael Ager
- St. George's University Hospitals, NHS Foundation Trust, London, UK
| | - Alberto Briganti
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Francesco Montorsi
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Philippe E Spiess
- H Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, FL
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29
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Abida W, Campbell D, Patnaik A, Bryce AH, Shapiro J, Bambury RM, Zhang J, Burke JM, Castellano D, Font A, Ganju V, Hardy-Bessard AC, McDermott R, Sautois B, Spaeth D, Voog E, Piulats JM, Pintus E, Ryan CJ, Merseburger AS, Daugaard G, Heidenreich A, Fizazi K, Loehr A, Despain D, Simmons AD, Dowson M, Go J, Watkins SP, Chowdhury S. Rucaparib for the Treatment of Metastatic Castration-resistant Prostate Cancer Associated with a DNA Damage Repair Gene Alteration: Final Results from the Phase 2 TRITON2 Study. Eur Urol 2023; 84:321-330. [PMID: 37277275 PMCID: PMC10527050 DOI: 10.1016/j.eururo.2023.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/20/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Initial TRITON2 (NCT02952534) results demonstrated the efficacy of rucaparib 600 mg BID in patients with metastatic castration-resistant prostate cancer (mCRPC) associated with a BRCA1 or BRCA2 (BRCA) or other DNA damage repair (DDR) gene alteration. OBJECTIVE To present the final data from TRITON2. DESIGN, SETTING, AND PARTICIPANTS TRITON2 enrolled patients with mCRPC who had progressed on one or two lines of next-generation androgen receptor-directed therapy and one taxane-based chemotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was objective response rate (ORR; as per the modified Response Evaluation Criteria in Solid Tumor Version 1.1/Prostate Cancer Clinical Trials Working Group 3 criteria in patients with measurable disease by independent radiology review [IRR]); prostate-specific antigen (PSA) response rate (≥50% decrease from baseline [PSA50]) was a key secondary endpoint. RESULTS AND LIMITATIONS As of July 27, 2021 (study closure), TRITON2 had enrolled 277 patients, grouped by mutated gene: BRCA (n = 172), ATM (n = 59), CDK12 (n = 15), CHEK2 (n = 7), PALB2 (n = 11), or other DDR gene (Other; n = 13). ORR by IRR was 46% (37/81) in the BRCA subgroup (95% confidence interval [CI], 35-57%), 100% (4/4) in the PALB2 subgroup (95% CI, 40-100%), and 25% (3/12) in the Other subgroup (95% CI, 5.5-57%). No patients within the ATM, CDK12, or CHEK2 subgroups had an objective response by IRR. PSA50 response rates (95% CI) in the BRCA, PALB2, ATM, CDK12, CHEK2, and Other subgroups were 53% (46-61%), 55% (23-83%), 3.4% (0.4-12), 6.7% (0.2-32%), 14% (0.4-58%), and 23% (5.0-54%), respectively. CONCLUSIONS The final TRITON2 results confirm the clinical benefit and manageable safety profile of rucaparib in patients with mCRPC, including those with an alteration in BRCA or select non-BRCA DDR gene. PATIENT SUMMARY Almost half of TRITON2 patients with BRCA-mutated metastatic castration-resistant prostate cancer had a complete or partial tumor size reduction with rucaparib; clinical benefits were also observed with other DNA damage repair gene alterations.
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Affiliation(s)
- Wassim Abida
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - David Campbell
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Akash Patnaik
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | | | | | | | | | - John M Burke
- Rocky Mountain Cancer Centers and US Oncology Research, Denver, CO, USA
| | | | - Albert Font
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vinod Ganju
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | | | - Ray McDermott
- Adelaide and Meath Hospital (Incorporating the National Children's Hospital), Dublin, Ireland
| | - Brieuc Sautois
- Medical Oncology, University Hospital of Liège, CHU Sart Tilman, Liège, Belgium
| | | | - Eric Voog
- Clinique Victor Hugo Centre Jean Bernard, Le Mans, France
| | | | - Elias Pintus
- Guy's & St Thomas' NHS Foundation Trust Hospital, London, UK
| | | | - Axel S Merseburger
- University Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Gedske Daugaard
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Axel Heidenreich
- Universitätsklinikum Köln, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Saclay, Villejuif Cedex, France
| | | | | | | | | | - Jowell Go
- Clovis Oncology, Inc., Boulder, CO, USA
| | | | - Simon Chowdhury
- Guy's & St Thomas' NHS Foundation Trust Hospital, London, UK
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Patrikidou A, Cazzaniga W, Berney D, Boormans J, de Angst I, Di Nardo D, Fankhauser C, Fischer S, Gravina C, Gremmels H, Heidenreich A, Janisch F, Leão R, Nicolai N, Oing C, Oldenburg J, Shepherd R, Tandstad T, Nicol D. European Association of Urology Guidelines on Testicular Cancer: 2023 Update. Eur Urol 2023; 84:289-301. [PMID: 37183161 DOI: 10.1016/j.eururo.2023.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023]
Abstract
CONTEXT Each year the European Association of Urology (EAU) produce a document based on the most recent evidence on the diagnosis, therapy, and follow-up of testicular cancer (TC). OBJECTIVE To represent a summarised version of the EAU guidelines on TC for 2023 with a focus on key changes in the 2023 update. EVIDENCE ACQUISITION A multidisciplinary panel of TC experts, comprising urologists, medical and radiation oncologists, and pathologists, reviewed the results from a structured literature search to compile the guidelines document. Each recommendation in the guidelines was assigned a strength rating. EVIDENCE SYNTHESIS For the 2023 EAU guidelines on TC, a review and restructure were undertaken. The key changes incorporated in the 2023 update include: new supporting text regarding venous thromboembolism prophylaxis in males with metastatic germ cell tumours receiving chemotherapy; quality of life after treatment; an update of the histological classifications and inclusion of the World Health Organization 2022 pathological classification; inclusion of the revalidation of the 1997 International Germ Cell Cancer Collaborative Group prognostic risk factors; and a new section covering oncology treatment protocols. CONCLUSIONS The 2023 version of the EAU guidelines on TC include the highest available scientific evidence to standardise the management of TC. Better stratification and optimisation of treatment modalities will continue to improve the high survival rates for patients with TC. PATIENT SUMMARY This article presents a summary of the European Association of Urology guidelines on testicular cancer published in 2023 and includes the latest recommendations for management of this disease. The guidelines are a valuable resource that may help patients in understanding treatment recommendations.
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Affiliation(s)
- Anna Patrikidou
- Department of Oncology, Institut Gustave Roussy, Villejuif, France
| | - Walter Cazzaniga
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel Berney
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Joost Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Isabel de Angst
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Domenico Di Nardo
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Stefanie Fischer
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Carmen Gravina
- Department of Urology, Sant'Andrea Hospital-Sapienza University, Rome, Italy
| | - Hendrik Gremmels
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Florian Janisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ricardo Leão
- Department of Urology, Faculty of Medicine, University of Coimbra, Clinical Academic Center of Coimbra, Coimbra, Portugal
| | - Nicola Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Christoph Oing
- Department of Oncology, Freeman Hospital NHS Foundation Trust, London, UK
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
| | - Robert Shepherd
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Torgrim Tandstad
- Department of Oncology, The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway
| | - David Nicol
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer research, London, UK.
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31
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Terzis R, Reimer RP, Nelles C, Celik E, Caldeira L, Heidenreich A, Storz E, Maintz D, Zopfs D, Große Hokamp N. Deep-Learning-Based Image Denoising in Imaging of Urolithiasis: Assessment of Image Quality and Comparison to State-of-the-Art Iterative Reconstructions. Diagnostics (Basel) 2023; 13:2821. [PMID: 37685359 PMCID: PMC10486912 DOI: 10.3390/diagnostics13172821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
This study aimed to compare the image quality and diagnostic accuracy of deep-learning-based image denoising reconstructions (DLIDs) to established iterative reconstructed algorithms in low-dose computed tomography (LDCT) of patients with suspected urolithiasis. LDCTs (CTDIvol, 2 mGy) of 76 patients (age: 40.3 ± 5.2 years, M/W: 51/25) with suspected urolithiasis were retrospectively included. Filtered-back projection (FBP), hybrid iterative and model-based iterative reconstruction (HIR/MBIR, respectively) were reconstructed. FBP images were processed using a Food and Drug Administration (FDA)-approved DLID. ROIs were placed in renal parenchyma, fat, muscle and urinary bladder. Signal- and contrast-to-noise ratios (SNR/CNR, respectively) were calculated. Two radiologists evaluated image quality on five-point Likert scales and urinary stones. The results showed a progressive decrease in image noise from FBP, HIR and DLID to MBIR with significant differences between each method (p < 0.05). SNR and CNR were comparable between MBIR and DLID, while it was significantly lower in HIR followed by FBP (e.g., SNR: 1.5 ± 0.3; 1.4 ± 0.4; 1.0 ± 0.3; 0.7 ± 0.2, p < 0.05). Subjective analysis confirmed best image quality in MBIR, followed by DLID and HIR, both being superior to FBP (p < 0.05). Diagnostic accuracy for urinary stone detection was best using MBIR (0.94), lowest using FBP (0.84) and comparable between DLID (0.90) and HIR (0.90). Stone size measurements were consistent between all reconstructions and showed excellent correlation (r2 = 0.958-0.975). In conclusion, MBIR yielded the highest image quality and diagnostic accuracy, with DLID producing better results than HIR and FBP in image quality and matching HIR in diagnostic precision.
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Affiliation(s)
- Robert Terzis
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, Germany (D.M.); (D.Z.)
| | - Robert Peter Reimer
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, Germany (D.M.); (D.Z.)
| | - Christian Nelles
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, Germany (D.M.); (D.Z.)
| | - Erkan Celik
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, Germany (D.M.); (D.Z.)
| | - Liliana Caldeira
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, Germany (D.M.); (D.Z.)
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surger, University Hospital Cologne, 50937 Cologne, Germany
| | - Enno Storz
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surger, University Hospital Cologne, 50937 Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, Germany (D.M.); (D.Z.)
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, Germany (D.M.); (D.Z.)
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, Germany (D.M.); (D.Z.)
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Kafka M, Horninger A, di Santo G, Virgolini I, Neuwirt H, Unterrainer LM, Kunte SC, Deiss E, Paffenholz P, Heidenreich A, Rasul S, Einspieler H, Shariat SF, Rajwa P, Dozauer R, Tsaur I, Medlock E, Rölz N, Rausch S, la Fougère C, Trautwein N, Roesch MC, Merseburger AS, Zattoni F, Sepulcri M, Ladurner M, Bektic J, Gandaglia G, Horninger W, Heidegger I. Real-world Outcomes and Predictive Biomarkers for 177Lutetium Prostate-specific Membrane Antigen Ligand Treatment in Metastatic Castration-resistant Prostate Cancer: A European Association of Urology Young Academic Urologists Prostate Cancer Working Group Multi-institutional Observational Study. Eur Urol Oncol 2023:S2588-9311(23)00161-X. [PMID: 37604763 DOI: 10.1016/j.euo.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The European Association of Urology guidelines include the lutetium-177 (177Lu) PSMA-617 prostate-specific membrane antigen (PSMA) ligand as a therapy option for metastatic castration-resistant prostate cancer (mCRPC). A major challenge in clinical practice is to pursue a personalized treatment approach based on robust predictive biomarkers. OBJECTIVE To assess the performance of 177Lu PSMA in real-world practice and to elaborate clinical biomarkers for evaluating treatment responses. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective observational study including 233 patients with mCRPC treated with 177Lu PSMA in eight high-volume European centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline characteristics and clinical parameters during and after 177Lu PSMA treatment were documented. Correlations to treatment response were analyzed using χ2 and log-rank tests, with differences between groups with and without disease progression calculated using a Mann-Whitney U test. Univariate and multivariate-adjusted hazard ratios (HRs) were measured using Cox proportional hazards models. RESULTS AND LIMITATIONS A prostate-specific antigen (PSA) decrease of ≥30% was observed in 41.7%, 63.5%, and 77.8% of patients after the first, second, and third treatment cycle, respectively. Restaging performed via PSMA positron emission tomography-computed tomography revealed that 33.7% of patients had an imaging-based response, including two patients with a complete response, while 13.4% had stable disease. The median time to progression was 5 mo and the median time until the start of a consecutive antineoplastic therapy was 8.5 mo. Of importance, a PSA decrease ≥30% after the first two cycles of 177Lu PSMA (1 cycle: p = 0.0003; 2 cycles: p = 0.004), absolute PSA after the first three cycles (1 cycle: p = 0.011; 2 cycles: p = 0.0005; 3 cycles: p = 0.002), and a PSA doubling time >6 mo (p = 0.009) were significantly correlated to treatment response. Furthermore, gamma-glutamyl transferase ≤31 U/L at the start of 177Lu PSMA therapy was correlated with 1.5 times higher risk of progression for patients without but not with visceral metastases (p = 0.046). CONCLUSIONS 177Lu PSMA is an effective treatment option in mCRPC in the real-world setting. A PSA decrease ≥30% after the first two cycles is an early marker of response that can be easily implemented in clinical practice. PATIENT SUMMARY 177Lu PSMA is a radioactive agent approved for treatment of advanced prostate cancer. We reviewed its use outside of clinical trials for patients treated at eight European centers. We found that 177Lu PSMA is an effective treatment option in real-world practice. A PSA (prostate-specific antigen) decrease of ≥30% after the first two therapy cycles is an early indicator of response to treatment and can be used in personalizing treatments for patients.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Horninger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Gianpaolo di Santo
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Neuwirt
- Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Lena M Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Sophie C Kunte
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Emil Deiss
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Sazan Rasul
- Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Holger Einspieler
- Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Weill Cornell Medicine, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Robert Dozauer
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Ellen Medlock
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Niklas Rölz
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | | | - Nils Trautwein
- Department of Nuclear Medicine University Hospital Tübingen, Tübingen, Germany
| | - Marie C Roesch
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Fabio Zattoni
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padova, Italy
| | - Matteo Sepulcri
- Radiation Oncology Unit, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Michael Ladurner
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Tolkach Y, Ovtcharov V, Pryalukhin A, Eich ML, Gaisa NT, Braun M, Radzhabov A, Quaas A, Hammerer P, Dellmann A, Hulla W, Haffner MC, Reis H, Fahoum I, Samarska I, Borbat A, Pham H, Heidenreich A, Klein S, Netto G, Caie P, Buettner R. An international multi-institutional validation study of the algorithm for prostate cancer detection and Gleason grading. NPJ Precis Oncol 2023; 7:77. [PMID: 37582946 PMCID: PMC10427608 DOI: 10.1038/s41698-023-00424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/24/2023] [Indexed: 08/17/2023] Open
Abstract
Pathologic examination of prostate biopsies is time consuming due to the large number of slides per case. In this retrospective study, we validate a deep learning-based classifier for prostate cancer (PCA) detection and Gleason grading (AI tool) in biopsy samples. Five external cohorts of patients with multifocal prostate biopsy were analyzed from high-volume pathology institutes. A total of 5922 H&E sections representing 7473 biopsy cores from 423 patient cases (digitized using three scanners) were assessed concerning tumor detection. Two tumor-bearing datasets (core n = 227 and 159) were graded by an international group of pathologists including expert urologic pathologists (n = 11) to validate the Gleason grading classifier. The sensitivity, specificity, and NPV for the detection of tumor-bearing biopsies was in a range of 0.971-1.000, 0.875-0.976, and 0.988-1.000, respectively, across the different test cohorts. In several biopsy slides tumor tissue was correctly detected by the AI tool that was initially missed by pathologists. Most false positive misclassifications represented lesions suspicious for carcinoma or cancer mimickers. The quadratically weighted kappa levels for Gleason grading agreement for single pathologists was 0.62-0.80 (0.77 for AI tool) and 0.64-0.76 (0.72 for AI tool) for the two grading datasets, respectively. In cases where consensus for grading was reached among pathologists, kappa levels for AI tool were 0.903 and 0.855. The PCA detection classifier showed high accuracy for PCA detection in biopsy cases during external validation, independent of the institute and scanner used. High levels of agreement for Gleason grading were indistinguishable between experienced genitourinary pathologists and the AI tool.
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Affiliation(s)
- Yuri Tolkach
- Institute of Pathology, University Hospital Cologne, Cologne, Germany.
| | | | - Alexey Pryalukhin
- Institute of Pathology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Marie-Lisa Eich
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | | | - Martin Braun
- Institute of Pathology Troisdorf, Troisdorf, Germany
| | | | - Alexander Quaas
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Peter Hammerer
- Urology Clinic, Municipal Clinic of Brunswick, Brunswick, Germany
| | - Ansgar Dellmann
- Institute of Pathology, Municipal Clinic of Brunswick, Brunswick, Germany
| | - Wolfgang Hulla
- Institute of Pathology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Michael C Haffner
- Divisions of Human Biology and Clinical Research, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Henning Reis
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Fahoum
- Department of Pathology, Sourasky Medical Center, Tel Aviv, Israel
| | - Iryna Samarska
- Department of Pathology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Artem Borbat
- Department of Pathology, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - Hoa Pham
- Department of Pathology, Bach Mai Hospital, Hanoi, Vietnam
- Department of Pathology, University of Nagasaki, Nagasaki, Japan
| | - Axel Heidenreich
- Clinic of Urology, University Hospital Cologne, Cologne, Germany
| | - Sebastian Klein
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - George Netto
- Department of Pathology, University of Alabama, Birmingham, AL, USA
| | | | - Reinhard Buettner
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
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Majewski M, Paffenholz P, Ruf C, Che Y, Seidel C, Heinzelbecker J, Schmelz H, Matthies C, Albers P, Bokemeyer C, Heidenreich A, Pichler M, Nestler T. Misuse of tumor marker levels leads to an insufficient International Germ Cell Consensus Classification (IGCCCG) risk group assignment and impaired treatment. Cancer Med 2023; 12:16829-16836. [PMID: 37392170 PMCID: PMC10501278 DOI: 10.1002/cam4.6304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/04/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Metastatic germ cell tumors of the testis (GCTs) are risk-stratified according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification system. This risk classification is based on anatomical risk factors as well as tumor marker levels of AFP, HCG, and LDH assessed pre-chemotherapy after orchiectomy treatment. An incorrect classification is possible when pre-orchiectomy marker levels are used, possibly resulting in over- or undertreatment of patients. The aim was to investigate the potential frequency and clinical relevance of incorrect risk stratification using pre-orchiectomy tumor marker levels. METHODS A multicenter registry analysis, including patients with metastasized nonseminomatous GCT (NSGCT), was conducted by investigators of the German Testicular Cancer Study Group (GTCSG). Based on the marker levels at different timepoints, IGCCCG risk groups were calculated. The agreement was tested using Cohen's kappa. RESULTS A total of 672 of 1910 (35%) patients were diagnosed with metastatic NSGCTs, and 523 (78%) had sufficient data for 224 follow-up data points. By using pre-orchiectomy tumor marker levels, 106 patients (20%) would have been incorrectly classified. Seventy-two patients (14%) were classified into a higher risk category, and 34 patients (7%) were classified into a lower risk category. Cohen's kappa was 0.69 (p < 0.001), showing a strong agreement between the use of both marker timepoints. The treatment of misclassified patients would have resulted in an overtreatment of 72 patients or undertreatment of 34 patients. CONCLUSIONS The use of pre-orchiectomy tumor marker levels may lead to an incorrect risk classification and might subsequently lead to under- or overtreatment of patients.
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Affiliation(s)
| | - Pia Paffenholz
- Department of UrologyUniversity Hospital of CologneCologneGermany
| | - Christian Ruf
- Department of UrologyFederal Armed Services Hospital UlmUlmGermany
| | - Yue Che
- Department of UrologyUniversity Hospital of DuesseldorfDuesseldorfGermany
| | - Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of PneumologyUniversity Medical Center Hamburg‐Eppendorf, University Hospital of Hamburg‐EppendorfHamburgGermany
| | - Julia Heinzelbecker
- Department of Urology and Pediatric UrologyUniversity Medical Centre Homburg, Saarland University Hospital of HomburgHomburgGermany
| | | | - Cord Matthies
- Department of UrologyFederal Armed Services Hospital HamburgHamburgGermany
| | - Peter Albers
- Department of UrologyUniversity Hospital of DuesseldorfDuesseldorfGermany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of PneumologyUniversity Medical Center Hamburg‐Eppendorf, University Hospital of Hamburg‐EppendorfHamburgGermany
| | - Axel Heidenreich
- Department of UrologyUniversity Hospital of CologneCologneGermany
- Department of UrologyMedical University ViennaViennaAustria
| | | | - Tim Nestler
- Department of UrologyUniversity Hospital of CologneCologneGermany
- Department of UrologyFederal Armed Services Hospital KoblenzKoblenzGermany
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Nohl EK, Behring J, Kameri E, Köditz B, Nestler T, Heidenreich A, VON Brandenstein M. Improved Analysis of Prostate Cancer: VIM3, ATG7 and P53 Form a Complex and Activate miRNA 371a-3p. Anticancer Res 2023; 43:2407-2416. [PMID: 37247912 DOI: 10.21873/anticanres.16408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIM It is not possible to differentiate prostate carcinomas sufficiently to ensure that every patient receives the right therapy. New molecular markers are needed. Our objective was to identify a complex consisting of vimentin variant 3 (VIM3), autophagy-related protein 7 (ATG7) and tumor protein p53 (TP53) in prostate cancer cells and its effect on microRNA (miR)-371a-3p. MATERIALS AND METHODS Prostate cancer cell lines (PC3, DU145, LNCaP) and the benign prostatic hyperplasia cell line BPH-1 were cultured in growth medium for 24 h, then stimulated with endothelin 1 (EDN1) (50 nM) and withaferin A (2 nM) for 24 h. Cell extracts were then analyzed by western blot. The localization of VIM3, ATG7 and TP53 in the nucleus was demonstrated with immunofluorescence staining and complex formation was demonstrated by immunoprecipitation. Cancer cell migration was analyzed with a scratch assay and agarose drop analysis. The binding of the complex to the promoter of pri-miR-371a-3p was analyzed with a non-radioactive electrophoretic mobility shift assay. VIM3 knockdown using small interfering RNA and quantitative real-time polymerase chain reaction for miR-371a-3p were performed. RESULTS The complex was present in the nucleus of prostate cancer cells and in the BPH-1 cell line. EDN1 increased the levels of the complex partners and cell migration, whereas withaferin A reduced the levels of the complex partners and migration. The complex bound to the promoter of pri-miR-371a-3p and might be involved in its transcription. Transfection with miR-371a-3p increased migration of prostate cancer cells. VIM3 knockdown reduced miR-371a-3p expression. CONCLUSION The VIM3-ATG7-P53 complex, with its stimulatory effect on miR-371a-3p, may have the potential to be a marker for improved differentiation between prostate carcinomas, allowing tailored therapy.
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Affiliation(s)
- Elena K Nohl
- Department of Urology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany;
| | - Jasmin Behring
- Department of Urology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Ersen Kameri
- Department of Urology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Barbara Köditz
- Department of Urology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Tim Nestler
- Department of Urology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Department of Urology, Medical University, Vienna, Austria
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Ural Y, Elter T, Yilmaz Y, Hallek M, Datta RR, Kleinert R, Heidenreich A, Pfister D. Validation and implementation of a mobile app decision support system for prostate cancer to improve quality of tumor boards. PLOS Digit Health 2023; 2:e0000054. [PMID: 37285355 DOI: 10.1371/journal.pdig.0000054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/27/2023] [Indexed: 06/09/2023]
Abstract
Certified Cancer Centers must present all patients in multidisciplinary tumor boards (MTB), including standard cases with well-established treatment strategies. Too many standard cases can absorb much of the available time, which can be unfavorable for the discussion of complex cases. In any case, this leads to a high quantity, but not necessarily a high quality of tumor boards. Our aim was to develop a partially algorithm-driven decision support system (DSS) for smart phones to provide evidence-based recommendations for first-line therapy of common urological cancers. To assure quality, we compared each single digital decision with recommendations of an experienced MTB and obtained the concordance.1873 prostate cancer patients presented in the MTB of the urological department of the University Hospital of Cologne from 2014 to 2018 have been evaluated. Patient characteristics included age, disease stage, Gleason Score, PSA and previous therapies. The questions addressed to MTB were again answered using DSS. All blinded pairs of answers were assessed for discrepancies by independent reviewers. Overall concordance rate was 99.1% (1856/1873). Stage specific concordance rates were 97.4% (stage I), 99.2% (stage II), 100% (stage III), and 99.2% (stage IV). Quality of concordance were independent of age and risk profile. The reliability of any DSS is the key feature before implementation in clinical routine. Although our system appears to provide this safety, we are now performing cross-validation with several clinics to further increase decision quality and avoid potential clinic bias.
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Affiliation(s)
- Yasemin Ural
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Urology, Uro-Oncology and robot assisted surgery, Germany
| | - Thomas Elter
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Germany
| | - Yasemin Yilmaz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Urology, Uro-Oncology and robot assisted surgery, Germany
| | - Michael Hallek
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Germany
| | - Rabi Raj Datta
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Germany
| | - Robert Kleinert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Germany
| | - Axel Heidenreich
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Urology, Uro-Oncology and robot assisted surgery, Germany
| | - David Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Urology, Uro-Oncology and robot assisted surgery, Germany
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Aldin A, Besiroglu B, Adams A, Monsef I, Piechotta V, Tomlinson E, Hornbach C, Dressen N, Goldkuhle M, Maisch P, Dahm P, Heidenreich A, Skoetz N. First-line therapy for adults with advanced renal cell carcinoma: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2023; 5:CD013798. [PMID: 37146227 PMCID: PMC10158799 DOI: 10.1002/14651858.cd013798.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Since the approval of tyrosine kinase inhibitors, angiogenesis inhibitors and immune checkpoint inhibitors, the treatment landscape for advanced renal cell carcinoma (RCC) has changed fundamentally. Today, combined therapies from different drug categories have a firm place in a complex first-line therapy. Due to the large number of drugs available, it is necessary to identify the most effective therapies, whilst considering their side effects and impact on quality of life (QoL). OBJECTIVES To evaluate and compare the benefits and harms of first-line therapies for adults with advanced RCC, and to produce a clinically relevant ranking of therapies. Secondary objectives were to maintain the currency of the evidence by conducting continuous update searches, using a living systematic review approach, and to incorporate data from clinical study reports (CSRs). SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, conference proceedings and relevant trial registries up until 9 February 2022. We searched several data platforms to identify CSRs. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating at least one targeted therapy or immunotherapy for first-line treatment of adults with advanced RCC. We excluded trials evaluating only interleukin-2 versus interferon-alpha as well as trials with an adjuvant treatment setting. We also excluded trials with adults who received prior systemic anticancer therapy if more than 10% of participants were previously treated, or if data for untreated participants were not separately extractable. DATA COLLECTION AND ANALYSIS All necessary review steps (i.e. screening and study selection, data extraction, risk of bias and certainty assessments) were conducted independently by at least two review authors. Our outcomes were overall survival (OS), QoL, serious adverse events (SAEs), progression-free survival (PFS), adverse events (AEs), the number of participants who discontinued study treatment due to an AE, and the time to initiation of first subsequent therapy. Where possible, analyses were conducted for the different risk groups (favourable, intermediate, poor) according to the International Metastatic Renal-Cell Carcinoma Database Consortium Score (IMDC) or the Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Our main comparator was sunitinib (SUN). A hazard ratio (HR) or risk ratio (RR) lower than 1.0 is in favour of the experimental arm. MAIN RESULTS We included 36 RCTs and 15,177 participants (11,061 males and 4116 females). Risk of bias was predominantly judged as being 'high' or 'some concerns' across most trials and outcomes. This was mainly due to a lack of information about the randomisation process, the blinding of outcome assessors, and methods for outcome measurements and analyses. Additionally, study protocols and statistical analysis plans were rarely available. Here we present the results for our primary outcomes OS, QoL, and SAEs, and for all risk groups combined for contemporary treatments: pembrolizumab + axitinib (PEM+AXI), avelumab + axitinib (AVE+AXI), nivolumab + cabozantinib (NIV+CAB), lenvatinib + pembrolizumab (LEN+PEM), nivolumab + ipilimumab (NIV+IPI), CAB, and pazopanib (PAZ). Results per risk group and results for our secondary outcomes are reported in the summary of findings tables and in the full text of this review. The evidence on other treatments and comparisons can also be found in the full text. Overall survival (OS) Across risk groups, PEM+AXI (HR 0.73, 95% confidence interval (CI) 0.50 to 1.07, moderate certainty) and NIV+IPI (HR 0.69, 95% CI 0.69 to 1.00, moderate certainty) probably improve OS, compared to SUN, respectively. LEN+PEM may improve OS (HR 0.66, 95% CI 0.42 to 1.03, low certainty), compared to SUN. There is probably little or no difference in OS between PAZ and SUN (HR 0.91, 95% CI 0.64 to 1.32, moderate certainty), and we are uncertain whether CAB improves OS when compared to SUN (HR 0.84, 95% CI 0.43 to 1.64, very low certainty). The median survival is 28 months when treated with SUN. Survival may improve to 43 months with LEN+PEM, and probably improves to: 41 months with NIV+IPI, 39 months with PEM+AXI, and 31 months with PAZ. We are uncertain whether survival improves to 34 months with CAB. Comparison data were not available for AVE+AXI and NIV+CAB. Quality of life (QoL) One RCT measured QoL using FACIT-F (score range 0 to 52; higher scores mean better QoL) and reported that the mean post-score was 9.00 points higher (9.86 lower to 27.86 higher, very low certainty) with PAZ than with SUN. Comparison data were not available for PEM+AXI, AVE+AXI, NIV+CAB, LEN+PEM, NIV+IPI, and CAB. Serious adverse events (SAEs) Across risk groups, PEM+AXI probably increases slightly the risk for SAEs (RR 1.29, 95% CI 0.90 to 1.85, moderate certainty) compared to SUN. LEN+PEM (RR 1.52, 95% CI 1.06 to 2.19, moderate certainty) and NIV+IPI (RR 1.40, 95% CI 1.00 to 1.97, moderate certainty) probably increase the risk for SAEs, compared to SUN, respectively. There is probably little or no difference in the risk for SAEs between PAZ and SUN (RR 0.99, 95% CI 0.75 to 1.31, moderate certainty). We are uncertain whether CAB reduces or increases the risk for SAEs (RR 0.92, 95% CI 0.60 to 1.43, very low certainty) when compared to SUN. People have a mean risk of 40% for experiencing SAEs when treated with SUN. The risk increases probably to: 61% with LEN+PEM, 57% with NIV+IPI, and 52% with PEM+AXI. It probably remains at 40% with PAZ. We are uncertain whether the risk reduces to 37% with CAB. Comparison data were not available for AVE+AXI and NIV+CAB. AUTHORS' CONCLUSIONS Findings concerning the main treatments of interest comes from direct evidence of one trial only, thus results should be interpreted with caution. More trials are needed where these interventions and combinations are compared head-to-head, rather than just to SUN. Moreover, assessing the effect of immunotherapies and targeted therapies on different subgroups is essential and studies should focus on assessing and reporting relevant subgroup data. The evidence in this review mostly applies to advanced clear cell RCC.
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Affiliation(s)
- Angela Aldin
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Burcu Besiroglu
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carolin Hornbach
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nadine Dressen
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marius Goldkuhle
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Axel Heidenreich
- Department of Urology, Uro-oncology, Special Urological and Robot-assisted Surgery, University Hospital of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Schoch J, Haunschild K, Strauch A, Nestler K, Schmelz H, Paffenholz P, Pfister D, Persigehl T, Heidenreich A, Nestler T. German specialists treating testicular cancer follow different guidelines with resulting inconsistency in assessment of retroperitoneal lymph-node metastasis: clinical implications and possible corrective measures. World J Urol 2023; 41:1353-1358. [PMID: 37014392 DOI: 10.1007/s00345-023-04364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Testicular germ cell tumors (GCTs) are aggressive but highly curable tumors. To avoid over/undertreatment, reliable clinical staging of retroperitoneal lymph-node metastasis is necessary. Current clinical guidelines, in their different versions, lack specific recommendations on how to measure lymph-node metastasis. OBJECTIVE We aimed to assess the practice patterns of German institutions frequently treating testicular cancer for measuring retroperitoneal lymph-node size. METHODS An 8-item survey was distributed among German university hospitals and members of the German Testicular Cancer Study Group. RESULTS In the group of urologists, 54.7% assessed retroperitoneal lymph nodes depending on their short-axis diameter (SAD) (33.3% in any plane, 21.4% in the axial plane), while 45.3% used long-axis diameter (LAD) for the assessment (42.9% in any plane, 2.4% in the axial plane). Moreover, the oncologists mainly assessed lymph-node size based on the SAD (71.4%). Specifically, 42.9% of oncologists assessed the SAD in any plane, while 28.5% measured this dimension in the axial plane. Only 28.6% of oncologists considered the LAD (14.3% in any plane, 14.3% in the axial plane). None of the oncologists and 11.9% of the urologists (n = 5) always performed an MRI for the initial assessment, while for follow-up imaging, the use increased to 36.5% of oncologists and 31% of urologists. Furthermore, only 17% of the urologists, and no oncologists, calculated lymph-node volume in their assessment (p = 0.224). CONCLUSION Clear and consistent measurement instructions are urgently needed to be present in all guidelines across different specialistic fields involved in testicular cancer management.
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Affiliation(s)
- Justine Schoch
- Department of Urology, Federal Armed Forces Hospital Koblenz, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - Kathrin Haunschild
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Angelina Strauch
- Department of Urology, Federal Armed Forces Hospital Koblenz, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - Kai Nestler
- Institute of Diagnostic and Interventional Radiology, Federal Armed Forces Hospital Koblenz, Koblenz, Germany
| | - Hans Schmelz
- Department of Urology, Federal Armed Forces Hospital Koblenz, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - Pia Paffenholz
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Tim Nestler
- Department of Urology, Federal Armed Forces Hospital Koblenz, Ruebenacherstrasse 170, 56072, Koblenz, Germany.
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany.
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Braun F, Jaschinski M, Täger P, Marmann V, Brandenstein MV, Köditz B, Fischer T, Muñoz-Vázquez S, Zimmermanns B, Dietlein M, Sudbrock F, Krapf P, Fischer D, Heidenreich A, Drzezga A, Kirsch S, Pietsch M, Schomäcker K. Synthesis and evaluation of radioiodinated estrogens for diagnosis and therapy of male urogenital tumours. Org Biomol Chem 2023; 21:3090-3095. [PMID: 36947011 DOI: 10.1039/d3ob00114h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The preparation of 24 estrogens, their estrogen receptor (ER) affinity and studies of radioiodinated estrogen binding to ER-positive male bladder tumor cells (HTB9) are described. The estrogens with the highest affinity were selected using fluorescence anisotropy assays. A 2,2,2-trifluoroethyl group at the 11β-position caused particularly promising affinity. (Radio)iodination was performed on the 17α-vinyl group. Binding studies on HTB9 cells revealed picomolar affinities of radioconjugates 19 and 31, indicating promising ability for targeting of urogenital tumors.
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Affiliation(s)
- Feodor Braun
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Marcel Jaschinski
- Organic Chemistry, Bergische Universität Wuppertal, 42119 Wuppertal, Germany
| | - Philipp Täger
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Verena Marmann
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Melanie von Brandenstein
- Clinic and Polyclinic for Urology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Barbara Köditz
- Clinic and Polyclinic for Urology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Thomas Fischer
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Sergio Muñoz-Vázquez
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Beate Zimmermanns
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Ferdinand Sudbrock
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Phillip Krapf
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Dietmar Fischer
- Institutes I & II of Pharmacology, Center of Pharmacology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Axel Heidenreich
- Clinic and Polyclinic for Urology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
| | - Stefan Kirsch
- Organic Chemistry, Bergische Universität Wuppertal, 42119 Wuppertal, Germany
| | - Markus Pietsch
- Institutes I & II of Pharmacology, Center of Pharmacology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Klaus Schomäcker
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
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Omlin A, Cathomas R, von Amsberg G, Reuter C, Feyerabend S, Loidl W, Boegemann M, Lorch A, Heidenreich A, Tsaur I, Larcher-Senn J, Buck S, Mathijssen RHJ, Jaehde U, Gillessen S, Joerger M. Randomized phase 2 Cabazitaxel dose individualization and Neutropenia prevention Trial (CAINTA) in patients with metastatic castration-resistant prostate cancer. Clin Cancer Res 2023; 29:1887-1893. [PMID: 36917691 DOI: 10.1158/1078-0432.ccr-22-3360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/13/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE There is ongoing controversy about the recommended dose of cabazitaxel in patients with metastatic castration-resistant prostate cancer (mCRPC). EXPERIMENTAL DESIGN This multicenter phase II open-label, randomized, parallel-group study compared 3-weekly cabazitaxel at 25 mg/m2 (conventional Arm A) with cabazitaxel therapeutic drug monitoring (TDM) (experimental Arm B) in mCRPC. The primary objective was to improve the clinical feasibility rate (CFR) defined as the absence of grade 4 neutropenia or thrombocytopenia, any thrombocytopenia with bleeding, febrile neutropenia, severe non-hematological toxicity, withdrawal for cabazitaxel-related toxicity or death. 60 patients had to be randomized to detect a difference in CFR of 35% (power 80%, 2-sided alpha 10%). RESULTS 40 patients were randomized to Arm A and 33 patients to Arm B. CFR was 69.4% in Arm A and 64.3% in Arm B (p = 0.79). Week-12 PSA response was 38.5% in both arms. A radiological response by RECIST v.1.1 was seen in 3 (9.7%) patients in Arm A versus 6 (23.1%) patients in Arm B (P = 0.28), disease progression was higher in Arm A compared to Arm B (61.3% versus 30.8%, P = 0.05). Median PFS was longer in Arm B compared to Arm A (9.5 versus 4.4 months, HR = 0.46, P = 0.005). Median OS was higher in Arm B compared to Arm A (16.2 versus 7.3 months, HR = 0.33, P <0.0001). CONCLUSIONS Pharmacokinetic-guided dosing of cabazitaxel in patients with mCRPC is feasible and improves clinical outcome due to individual dose escalations in 55% of patients.
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Affiliation(s)
| | | | | | | | | | - Wolfgang Loidl
- Ordensklinikum Linz GmbH Elisabethinen, Linz, Upperaustria, Austria
| | | | - Anja Lorch
- Universtity Hospital Zurich, Zurich, Switzerland
| | | | - Igor Tsaur
- University Medicine Mainz, Mainz, Germany
| | | | - Stefan Buck
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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41
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Antonelli L, Ardizzone D, Ravi P, Bagrodia A, Mego M, Daneshmand S, Nicolai N, Nazzani S, Giannatempo P, Franza A, Heidenreich A, Paffenholz P, Saoud R, Eggener S, Ho M, Oswald N, Olson K, Tryakin A, Fedyanin M, Naoun N, Javaud C, Fizazi K, King JM, Adra N, Douglawi A, Cary C, Sweeney C, Fankhauser CD. Risk of residual cancer after complete response following first-line chemotherapy in men with metastatic non-seminomatous germ cell tumour and International Germ Cell Cancer Cooperative Group intermediate/poor prognosis: A multi-institutional retrospective cohort study. Eur J Cancer 2023; 182:144-154. [PMID: 36787661 DOI: 10.1016/j.ejca.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Current guidelines recommend surveillance in metastatic non-seminomatous germ cell tumour patients treated with first-line-chemotherapy and a complete clinical response (normalisation of serum tumour markers and residual masses <1 cm). However, this recommendation is based on a series including patients with good prognosis according to International Germ Cell Cancer Cooperative Group prognostic group (IGCCCG-PG). The aim of this study was to analyse the proportion of residual teratoma and survival among patients with intermediate/poor IGCCCG-PG and a complete clinical response after first-line-chemotherapy. MATERIAL & METHODS This is a retrospective study of men with intermediate/poor IGCCCG-PG, who had a complete clinical response after first-line chemotherapy. Patients were either followed by surveillance or treated with post-chemotherapy retroperitoneal lymph node dissection (pcRPLND). RESULTS Between 2009 and 2018, 143 men with intermediate (n = 83) or poor (n = 60) IGCCCG-PG were treated at 11 international centres. Among 33 patients treated with pcRPLND, the specimen showed teratoma and viable cancer in 16 (48%) and 4 (12%). During a median a 7-year follow-up, 20/110 (18%) patients managed with surveillance relapsed, of whom seven (6%) had a retroperitoneal-only relapse versus 2/33 patients managed with pcRPLND relapsed. No difference was observed regarding overall survival (OS) among men treated with pcRPLND or surveillance (5-year OS, 93% and 89%, p-value = 0.35). The median time-to-recurrence among men on surveillance was 1.3 years (range: 0.3-9.1), and the most common sites of relapses included retroperitoneum (11%), chest (5%), and bones (4%). CONCLUSIONS While most men with intermediate/poor IGCCCG-PG harbour teratoma/cancer in the retroperitoneum despite a complete response to first-line-chemotherapy, only 6% managed with surveillance relapsed in the retroperitoneum. There was no significant difference in OS between the two groups.
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Affiliation(s)
- Luca Antonelli
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Switzerland; Department of Urology, Policlinico Umberto I, Rome, Italy
| | | | - Praful Ravi
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Aditya Bagrodia
- Department of Urology, The University of Texas Southwestern, Dallas, TX, USA
| | - Michal Mego
- Department of Oncology, Comenius University, National Cancer Institute, Bratislava, Slovak Republic
| | - Siamak Daneshmand
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nicola Nicolai
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sebastiano Nazzani
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Giannatempo
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Franza
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany; Department of Urology, Medical University, Vienna, Austria
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Ragheed Saoud
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Scott Eggener
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Matthew Ho
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | | | | | - Alexey Tryakin
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Mikhail Fedyanin
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | | | | | - Karim Fizazi
- Institut Gustave Roussy, Villejuif Cedex, France
| | - Jennifer M King
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Nabil Adra
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Antoin Douglawi
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Clint Cary
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Christopher Sweeney
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Christian D Fankhauser
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Switzerland; University of Zurich, Zurich, Switzerland.
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Huelster HL, Chang A, Rose KM, Bandini M, Albersen M, Roussel E, Chipollini J, Zhu Y, Ye DW, Ornellas AA, Catanzaro M, Marandino L, Pederzoli F, Hakenberg OW, Heidenreich A, Haidl F, Watkin N, Ager M, Ahmed ME, Karnes JR, Briganti A, Kim Y, Montorsi F, Necchi A, Spiess PE. Concomitant vs Staged Therapeutic Inguinal Lymphadenectomy in Clinically Node Positive Penile Squamous Cell Carcinoma: Does It Make a Difference? J Urol 2023; 209:557-564. [PMID: 36652397 DOI: 10.1097/ju.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Inguinal lymph node dissection within 3 months of primary tumor resection in penile cancer has been associated with longer recurrence-free and cancer-specific survival. However, the optimal timing and effect of lymphadenectomy performed concurrently at the time of primary lesion management on oncologic outcomes in clinically lymph node positive penile squamous cell carcinoma remains unknown. MATERIALS AND METHODS An international, multicenter cohort of 966 penile cancer cases was queried for penile squamous cell carcinoma management after the year 2000, clinically lymph node positive status, and performance of penile surgery and inguinal lymph node dissection. Cohorts were stratified as concomitant if inguinal lymph node dissection and penile surgery occurred on the same date or staged when inguinal lymph node dissection was performed after penile resection. Rates and patterns of penile squamous cell carcinoma recurrence were reported. Distant recurrence-free, cancer-specific, and overall survival were estimated using Kaplan-Meier analyses and groups compared with log-rank testing. RESULTS Of 253 contemporary men with clinically lymph node positive penile squamous cell carcinoma, 96 (38%) underwent concomitant inguinal lymph node dissection and 157 (62%) had inguinal lymph node dissection performed in a staged manner. Penile cancer was most likely to recur distantly (19%) followed by in the groin (14%) or pelvis (5%). There were no differences in distant recurrence-free, cancer-specific, or overall survival between management strategies. Multivariable analysis adjusting for stage, treatment center, and perioperative chemoradiation also demonstrated no recurrence-free, cancer-specific, or overall survival benefit between management strategies. CONCLUSIONS Inguinal lymph node dissection performed concurrently with excision of the penile tumor for clinically node positive penile squamous cell carcinoma is not associated with differences in recurrence-free, cancer-specific, or overall survival compared to staged lymph node dissection.
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Affiliation(s)
| | - Andrew Chang
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kyle M Rose
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marco Bandini
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Juan Chipollini
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Yao Zhu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ding-Wei Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Antonio A Ornellas
- Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil
| | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Laura Marandino
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Filippo Pederzoli
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | | | | | | | - Nick Watkin
- St George's University Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Michael Ager
- St George's University Hospitals, NHS Foundation Trust, London, United Kingdom
| | | | | | - Alberto Briganti
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Youngchul Kim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Francesco Montorsi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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43
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Rajwa P, Pfister D, Rieger C, Heidenreich J, Drzezga A, Persigehl T, Shariat SF, Heidenreich A. Importance of magnetic resonance imaging and prostate-specific membrane antigen PET-CT in patients treated with salvage radical prostatectomy for radiorecurrent prostate cancer. Prostate 2023; 83:385-391. [PMID: 36564936 DOI: 10.1002/pros.24470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/06/2022] [Accepted: 12/02/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Accurate staging and identification of optimal candidates for local salvage therapy, such as salvage radical prostatectomy (SRP), is necessary to ensure optimal care in patients with radiorecurrent prostate cancer (PCa). We aimed to analyze performance of magnetic resonance imaging (MRI) and prostate-specific membrane antigen (PSMA)-positron emission tomography (PET)/computed tomography (CT) for predicting pathologic nonorgan confined disease (pT3) and lymph node involvement (pN+) in patients treated with SRP for radiorecurrent PCa. METHODS We retrospectively reviewed the institutional database to identify patients who underwent MRI or 68 Ga-PSMA-PET/CT before SRP for radiorecurrent PCa. The diagnostic estimates of MRI and PSMA-PET/CT for pT3 and pN+, were calculated. RESULTS We identified 113 patients with radiorecurrent PCa who underwent preoperative MRI followed by SRP; 53 had preoperative 68 Ga-PSMA-PET/CT. For the detection of pT3 disease, the overall accuracy of MRI was 70% (95% confidence interval [CI] 61-78), sensitivity 40% (95% CI 26-55) and specificity 94% (95% CI 85-98); PSMA-PET/CT had slightly higher accuracy of 77% (95% CI 64-88), and higher sensitivity of 90% (95% CI 68-99), but lower specificity of 70% (95% CI 51-84). For pN+ disease, MRI had poor sensitivity of 14% (95% CI 3-36), specificity of 50 (95% CI 39-61) and total accuracy of 43% (95% CI 34-53); PSMA-PET/CT had an accuracy of 85% (95% CI 72-93), sensitivity of 27% (95% CI 6-61), and specificity of 100% (95% CI 92-100). CONCLUSION In patients with radiorecurrent PCa, both, MRI, and 68 Ga-PSMA PET/CT are valuable tools for the pre-SRP staging and should be integrated into the standard workup. For lymph node metastases, 68 Ga-PSMA PET/CT is a strong rule-in test with nearly perfect specificity; in contrast MRI had a low accuracy for lymph node metastases.
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Affiliation(s)
- Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Constantin Rieger
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Julian Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Alexander Drzezga
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
| | - Axel Heidenreich
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
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Heidenreich A, Paffenholz P, Pfister D, Rieger C. Cytoreductive radical prostatectomy: who benefits from the surgical approach? Curr Opin Urol 2023; 33:168-171. [PMID: 36633132 DOI: 10.1097/mou.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Local treatment in oligometastatic prostate cancer patients is associated with improved survival. Nevertheless, in term of surgery, cytoreductive radical prostatectomy has no level of evidence 1 and is an individual treatment approach. We reviewed the recent literature to highlight parameters for selecting patients for a surgical approach. RECENT FINDINGS Retrospective data on oncologic outcome for cytoreductive prostatectomy are confirmed. We identified several parameters that help to select patients for surgery. Patients with a favorable prostate-specific antigen (PSA) decline after androgen deprivation therapy (ADT) have excellent oncologic long-term control. Circulating tumor cells (CTC's) are frequently analyzed in more advanced prostate cancer. In case of C-reactive protein (CRP) at least a longer interval to develop castration resistant prostate cancer (CRPC) is shown in case of low CTC count at time of surgery. Nutrition status analyzed as the hemoglobin, albumin, lymphocyte, and platelet (HALP)-score is of significant value in demonstrating an effect of CRP. SUMMARY From retrospective findings we have several clinical and basic science parameters to select patients for CRP. PSA at the time of surgery is the most frequently analyzed one, whereas CTC and HALP-score are promising tools to select patients that need to be validated.
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Affiliation(s)
- Axel Heidenreich
- Department of Urology, Uro-Oncology and Robot-assisted Surgery University of Cologne, Cologne, Germany
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Fizazi K, Piulats JM, Reaume MN, Ostler P, McDermott R, Gingerich JR, Pintus E, Sridhar SS, Bambury RM, Emmenegger U, Lindberg H, Morris D, Nolè F, Staffurth J, Redfern C, Sáez MI, Abida W, Daugaard G, Heidenreich A, Krieger L, Sautois B, Loehr A, Despain D, Heyes CA, Watkins SP, Chowdhury S, Ryan CJ, Bryce AH. Rucaparib or Physician's Choice in Metastatic Prostate Cancer. N Engl J Med 2023; 388:719-732. [PMID: 36795891 PMCID: PMC10064172 DOI: 10.1056/nejmoa2214676] [Citation(s) in RCA: 85] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND In a phase 2 study, rucaparib, an inhibitor of poly(ADP-ribose) polymerase (PARP), showed a high level of activity in patients who had metastatic, castration-resistant prostate cancer associated with a deleterious BRCA alteration. Data are needed to confirm and expand on the findings of the phase 2 study. METHODS In this randomized, controlled, phase 3 trial, we enrolled patients who had metastatic, castration-resistant prostate cancer with a BRCA1, BRCA2, or ATM alteration and who had disease progression after treatment with a second-generation androgen-receptor pathway inhibitor (ARPI). We randomly assigned the patients in a 2:1 ratio to receive oral rucaparib (600 mg twice daily) or a physician's choice control (docetaxel or a second-generation ARPI [abiraterone acetate or enzalutamide]). The primary outcome was the median duration of imaging-based progression-free survival according to independent review. RESULTS Of the 4855 patients who had undergone prescreening or screening, 270 were assigned to receive rucaparib and 135 to receive a control medication (intention-to-treat population); in the two groups, 201 patients and 101 patients, respectively, had a BRCA alteration. At 62 months, the duration of imaging-based progression-free survival was significantly longer in the rucaparib group than in the control group, both in the BRCA subgroup (median, 11.2 months and 6.4 months, respectively; hazard ratio, 0.50; 95% confidence interval [CI], 0.36 to 0.69) and in the intention-to-treat group (median, 10.2 months and 6.4 months, respectively; hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001 for both comparisons). In an exploratory analysis in the ATM subgroup, the median duration of imaging-based progression-free survival was 8.1 months in the rucaparib group and 6.8 months in the control group (hazard ratio, 0.95; 95% CI, 0.59 to 1.52). The most frequent adverse events with rucaparib were fatigue and nausea. CONCLUSIONS The duration of imaging-based progression-free survival was significantly longer with rucaparib than with a control medication among patients who had metastatic, castration-resistant prostate cancer with a BRCA alteration. (Funded by Clovis Oncology; TRITON3 ClinicalTrials.gov number, NCT02975934.).
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Affiliation(s)
- Karim Fizazi
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Josep M Piulats
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - M Neil Reaume
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Peter Ostler
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Ray McDermott
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Joel R Gingerich
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Elias Pintus
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Srikala S Sridhar
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Richard M Bambury
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Urban Emmenegger
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Henriette Lindberg
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - David Morris
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Franco Nolè
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - John Staffurth
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Charles Redfern
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - María I Sáez
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Wassim Abida
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Gedske Daugaard
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Axel Heidenreich
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Laurence Krieger
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Brieuc Sautois
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Andrea Loehr
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Darrin Despain
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Catherine A Heyes
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Simon P Watkins
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Simon Chowdhury
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Charles J Ryan
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
| | - Alan H Bryce
- From Gustave Roussy Institute, Paris-Saclay University, Villejuif, France (K.F.); Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research -CiberOnc, Barcelona (J.M.P.), and the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga (M.I.S.) - both in Spain; the Ottawa Hospital Research Institute, Ottawa (M.N.R.), CancerCare Manitoba, Winnipeg (J.R.G.), and Princess Margaret Cancer Centre (S.S.S.) and Odette Cancer Centre, Sunnybrook Health Sciences Centre (U.E.), Toronto - all in Canada; Mount Vernon Cancer Centre, Northwood (P.O.), Guy's Hospital (E.P.) and Guy's Hospital and Sarah Cannon Research Institute (S.C.), London, Velindre University NHS Trust, Cardiff (J.S.), and Clovis Oncology UK, Cambridge (C.A.H., S.P.W.) - all in the United Kingdom; St. Vincent's University Hospital and Cancer Trials Ireland, Dublin (R.M.), and Cork University Hospital, Wilton (R.M.B.) - both in Ireland; Herlev University Hospital, Herlev (H.L.), and Copenhagen University Hospital, Rigshospitalet, Copenhagen (G.D.) - both in Denmark; Urology Associates, Nashville (D.M.); European Institute of Oncology IRCCS, Milan (F.N.); Sharp HealthCare, San Diego, CA (C.R.); Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (W.A.); Universitätsklinikum Köln, Cologne, Germany (A.H.); Medical University of Vienna, Vienna (A.H.); Genesis Care, North Shore, Sydney (L.K.); University Hospital of Liège, CHU Sart-Tilman, Liège, Belgium (B.S.); Clovis Oncology, Boulder, CO (A.L., D.D.); the University of Minnesota, Minneapolis (C.J.R.); and Mayo Clinic, Phoenix, AZ (A.H.B.)
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Heidenreich A, Seelemeyer F, Paffenholz P, Pfister DA. Interim analysis of the prospective COTRIMS (Cologne Trial of Retroperitoneal Lymphadectomy in Metastatic Seminoma) trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
409 Background: Radiation therapy or systemic chemotherapy with 3 cycles PEB represent the guideline recommended treatment options in marker negative clinical stage IIA/B seminoma. Despite a high cure rate of 90% to 94% and 82% to 90% in CS IIA and IIB, respectively, both therapeutic options are associated with significant long-term toxicities. It was the aim of our trial to evaluate the feasibility, oncological efficacy and treatment associated morbidity of primary nsRPLND in stage IIA/B seminoma. Methods: 30 patients with marker negative clinical stage IIA and IIB classical seminoma of the testis were recruited in the prospective trial. Primary goal was a relapse rate <20% within 2 years follow-up. Exclusion criteria were adjuvant carboplatin therapy for clinical stage I disease, extensive clinical stage IIb or clinical stage IIC disease, previous retroperitoneal surgery or radiation therapy, and positive tumor markers. All patients underwent nerve sparing RPLND with a modified template resection. None of the patients received adjuvant chemotherapy in the presence of positive lymph nodes. All patients underwent close follow-up with imaging studies and tumor markers at 3-month intervals during the first 2 years, at 6-month intervals in year 3 and annually thereafter. 10 pts had preoperative serum analysis of miR371. Results: Mean age was 34.2 (21-54) years. Mean follow-up is 29.4 (1-60) months and 32.5 (3-60) for those with a minimum follow-up of 3 months. All patients were treatment-naïve; 19 and 11 patients were diagnosed with stage IIA and IIB disease, respectively, at time of RPLND. 28 and 2 patients underwent open and robot assisted ns RPLND, respectively. Mean OR time was 131 (105-195) min, mean blood loss was < 150ml and the mean hospitalization time was 4.5 (3-9) days. We did not observe surgery associated complications > Clavien Dindo grade 3a. Mean number of dissected lymph nodes was 18 (7-57), the mean number of positive lymph nodes was 1.3 (1-2) and the mean diameter of positive nodes was 2.3 (0.8-4.1) cm. Histology of the resected lymph nodes revealed metastatic seminoma in 25 (80%) patients; 2 and 3 patients demonstrated embryonal carcinoma and benign disease, resp. 10 pts underwent serum analysis of miR371 preoperatively which predicted metastatic disease in 9/10 and benign histology in 1/1. 2/30 (6.7%) patients developed an outfield relapse 4 and 6 months postoperatively. Both patients were salvaged by systemic chemotherapy with 4 cycles PEB. Conclusions: NsRPLND results in a high cure rate at midterm follow-up and it is associated with a low frequency of treatment associated morbidities making this approach a feasible alternative to standard radiation therapy or systemic chemotherapy. MiR371p might be a useful marker to predict presence/absence of metastases in equivocal findings. Clinical trial information: DRKS00025384 .
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Affiliation(s)
- Axel Heidenreich
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Felix Seelemeyer
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Pia Paffenholz
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - David A. Pfister
- Dept. of Urology, University Hospital of Cologne, Cologne, Germany
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47
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Wirtz RM, Voss PC, Friedersdorff F, Barski D, Otto T, Waldner M, Veltrup E, Linden F, Schwandt M, Hake R, Eidt S, Roggisch J, Rieger C, Kastner L, Heidenreich A, Koch S, Baum RP, Ecke TH. Prediction of response to neoadjuvant chemotherapy of patients with muscle invasive bladder cancer by molecular subtyping and radioligand target quantitation: Preview of the Bladder BRIDGister. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
543 Background: Patients with muscle invasive urothelial carcinoma achieving pathological complete response (pCR) upon neoadjuvant chemotherapy (NACT) have improved prognosis. Molecular subtypes of bladder cancer differ markedly with regard to sensitivity to cisplatinum based chemotherapy and harbour FGFR treatment targets to various content. Previously we did show that lumina tumors respond better to NACT, while FGFR1 expression is associated with chemo resistance (Ecke et al. 2022). The objective of this study was to determine wether radioligand therapy may be an appropriate option in chemoresistent tumors to justify subsequent prospective validation within the "Bladder BRIDGister". Methods: Formalin fixed paraffin embedded (FFPE) tissues from transurethral resections (TUR) before chemotherapy and cystectomy samples after NACT of 36 patients were retrospectively collected. RNA from FFPE tissues were extracted by commercial kits, relative gene expression of subtyping markers (KRT5, KRT20, FGFR1) and radioligand target genes (CXCR4, FAP) were analyzed by standardized RT-qPCR systems (STRATIFYER Molecular Pathology GmbH, Cologne). Spearman correlation, hierarchical clustering, Kruskal-Wallis, chi square and contingency tests were done by JMP 9.0.0 (SAS software). Results: The neoadjuvant cohort consisted of 36 patients (median age: 69, male 83% vs. female 17%) with 92% of patients being histopathologically node negative. When comparing pretreatment with post treatment samples the median expression of KRT20 dropped 128fold, while FGFR1, CXCR4 and FAP mRNA expression increased 6,8fold, 1,9 fold and 2,9 fold, respectively. FAP was positively associated with KRT5, FGFR1 and CXCR4 in treatment naïve TUR biopsies (r=0.4051 p=0.0141, r=0.6458 p<0.0001 and r=0.7586 p<0.0001, respectively), but negatively associated with KRT20 (r=-0.3879 p=0.0194). As previously described, FGFR1 was negatively associated with pCR (r=-0.6418 p<0.0001). Similarly, CXCR4 and FAP trended to be negatively associated with pCR (r=-0.3181 p=0.0586; r=-0.3072 p=0.0684). Hierarchical clustering revealed that CXCR4 and FAP are elevated in stromal rich, KRT5 & KRT20 negative tumors not responding to NACT. Elevated FAP above median mRNA expression was significantly associated with resistance to NACT (chi2 4.314 p=0,0378). Combining elevated FAP and CXCR4 mRNA expression did identify 28% of the patients to be at high risk of NACT resistance (90%). Conclusions: Expression of the radioligand targets CXCR4 and FAP are associated with basal/stromal enriched tumors and resistance to NACT. Theranostic targeting of CXCR4 and FAP before NACT might increase response towards NACT in this poor prognosis group.
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Affiliation(s)
| | | | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Thomas Otto
- Dpt. of Urology, Rheinlandklinikum, Neuss, Germany
| | | | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | | | | | - Roland Hake
- Department of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Sebastian Eidt
- Department of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | | | | | - Lucas Kastner
- Department of Urology, University Clinic Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Stefan Koch
- Dpt of Pathology, Helios Hospital, Bad Saarow, Germany
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Wirtz RM, Voss PC, Friedersdorff F, Barski D, Otto T, Waldner M, Veltrup E, Linden F, Schwandt M, Hake R, Eidt S, Roggisch J, Rieger C, Kastner L, Heidenreich A, Koch S, Ecke TH. Prediction of response to neoadjuvant chemotherapy of patients with muscle invasive bladder cancer by molecular subtyping and antibody drug conjugate target gene quantitation: Preview of Bladder BRIDGister. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
545 Background: Patients with muscle invasive urothelial carcinoma achieving pathological complete response (pCR) upon neoadjuvant chemotherapy (NACT) have improved prognosis. Molecular subtypes of bladder cancer differ markedly with regard to sensitivity to cisplatinum based chemotherapy. Previously we did show that luminal tumors respond better to NACT, while FGFR1 expression is associated with chemo resistance (Ecke et al. 2022). The objective of this study was to determine which patients may benefit from Antibody Drug Conjugate (ADC) treatment in addition to NACT to justify subsequent prospective analysis within the "Bladder BRIDGister". Methods: Formalin fixed paraffin embedded (FFPE) tissues from transurethral resections (TUR) before chemotherapy and cystectomy samples after NACT of 36 patients were retrospectively collected. RNA from FFPE tissues were extracted by commercial kits, relative gene expression of subtyping markers (KRT5, KRT20, FGFR1) and radioligand target genes (NECTIN4, TROP2) were analyzed by standardized RT-qPCR systems (STRATIFYER Molecular Pathology GmbH, Cologne). Spearman correlation, hierarchical clustering, Kruskal-Wallis, chi square and contingency tests were done by JMP 9.0.0 (SAS software). Results: The neoadjuvant cohort consisted of 36 patients (median age: 69, male 83% vs. female 17%) with 92% of patients being pathohistologically node negative. When comparing pretreatment with post treatment samples the median expression of KRT20 dropped 128fold, while FGFR1 expression increased 6.8 fold. Interestingly, TROP2 and NECTIN4 mRNA expression also dropped significantly upon NACT by 5.7 fold and 7.1 fold, respectively. TROP2 and NECTIN4 were positively associated with the response marker KRT20 in therapy naïve TUR biopsies (r=0.5562 p=0.0004; r=0.5833 p=0.0002), but negatively associated with the resistance marker FGFR1 (r=-0.2903 p=0,0858; r=-0.3396 p=0,0427). However, TROP2 and NECTIN4 were not associated with pCR in spearman analysis with minor trend for TROP2 (r=0,2139 p=0,2103). Cluster analysis revealed a subgroup of KRT20 positive and FGFR1 negative tumors expression TROP2 and NECTIN4, which achieved 80% pCR. In addition elevated TROP2 and NECTIN4 expression was found in KRT20 positive tumors coexpressing FGFR1 and being resistant to NACT. Conclusions: Expression of the ADC targets TROP2 and NECTIN4 is associated with KRT20 positive, luminal tumors being highly sensitive to neoadjuvant chemotherapy alone. KRT5 positive, basal tumors do exhibit only very low expression of TROP2 and NECTIN4 mRNA. In view of toxicities the addition of TROP2 and NECTIN4 treatment to NACT might be considered only in luminal tumors exhibiting elevated FGFR1 expression as resistance mechanism and therefore do not respond to NACT.
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Affiliation(s)
| | | | | | | | - Thomas Otto
- Dpt. of Urology, Rheinlandklinikum, Neuss, Germany
| | | | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | | | | | - Roland Hake
- Institute of Pathology, St. Elisabeth-Krankenhaus Hohenlind, Cologne, Germany
| | - Sebastian Eidt
- Institute of Pathology, St. Elisabeth Hospital Hohenlind, Cologne, Germany
| | | | | | - Lucas Kastner
- Department of Urology, University Clinic Cologne, Cologne, Germany
| | | | - Stefan Koch
- Dpt of Pathology, Helios Hospital, Bad Saarow, Germany
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Nestler T, Kremer L, von Brandenstein M, Wittersheim M, Wagener-Ryczek S, Paffenholz P, Mueller S, Quaas A, Hellmich M, Odenthal M, Pfister D, Heidenreich A. Validation of AGR2 and KRT19 as specific proteins being significantly and differentially expressed in teratoma compared to necrosis in retroperitoneal lymph node resections after chemotherapy (pcRPLND). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
412 Background: Metastatic non-seminomatous testicular tumor patients with residual retroperitoneal tumor masses > 1cm after chemotherapy are treated with pcRPLND. The goal of pcRPLND is to remove viable tumors (V) and teratoma (T), which are present in approximately 10% and 40% of cases, respectively. However, histopathologically, only scar/necrosis (N) is identified in the remaining 50% of patients. In those patients, surgical therapy is not necessary, resulting in a relevant overtreatment. So far, no adequate distinction between the histologies exists preoperatively. Recently, the first biomarker was described with miR371a-3p in serum, which is highly specific for V, but not for T. In 2022 we reported AGR2 and KRT19 to be significantly and differentially expressed in teratoma compared to necrosis in pcRPLND tissue on protein and mRNA level. The aim of this study was to validate these proteins on an independent cohort. Methods: All consecutive pcRPLND patients from 2021 who were treated in the University Hospital of Cologne, Germany, were selected (n=66). All patients had residual masses > 1 cm and normalized or plateaued tumor markers. For immunohistochemistry, the monoclonal antibodies KRT19 and AGR2 were applied to representative Formalin-Fixed Paraffin-Embedded tissue. To quantify the results, the H-score was used. The investigators were blinded to the final pathohistological results. Results: The cohort was composed of 66 patients, 23 patients with T, 24 patients with V and 19 patients with N. Significantly higher H-scores were shown for AGR2 and KRT19 when comparing T vs. N and T vs. V (both p < 0.0001). The discriminatory ability of the two proteins AGR2 and KRT19 was calculated by AUCs for T vs. N and was 1.0 in each case with a corresponding sensitivity and specificity for T of 100%. Conclusions: With AGR2 and KRT19, we could validate the two proteins that are significantly and differentially expressed in the pcRPLND specimen in the clinically relevant groups T vs. N. In perspective, these proteins could be targeted by radiolabeled ligands as a tracer in order to reliably distinguish patients with teratoma from those with necrosis by means of functional imaging. Thus, overtreatment with pcRPLND of patients with N could be safely reduced.
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Affiliation(s)
- Tim Nestler
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Lara Kremer
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | | | - Maike Wittersheim
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | | | - Pia Paffenholz
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Stefan Mueller
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Margarete Odenthal
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital of Cologne, Cologne, Germany
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Paffenholz P, Landwehr G, Seidel CA, Poch A, Bokemeyer C, Cathomas R, Pongratanakul P, Hiester A, Albers P, Pichler M, Krege S, Syring I, Heinzelbecker J, Nestler T, Pfister D, Heidenreich A. Relapse-free and overall survival in patients with non-seminomatous testicular germ cell tumours with teratoma-free primaries. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
421 Background: Characteristics and outcome of non-seminomatous testicular germ cell tumours (NSGCT) with teratoma-containing primaries are still under debate. Methods: We performed a retrospective analysis including 557 patients with metastatic NSGCT as a registry study within the "German Testicular Cancer Study Group". Results: Of the eligible 557 patients with NSGCT, 237 (42%) of all orchiectomy specimens had teratoma-containing primaries, while 320 (58%) were teratoma-free. Teratoma-containing primaries had a significantly higher clinical stage (p=0.002) and worse prognosis (p=0.051) compared to teratoma-free specimens. Lymph node metastasis were significantly larger before (4.5 vs 2.5cm; p<0.001) and after chemotherapy (3.5 vs 2.5 cm; p<0.001) in teratoma-containing primaries. Post-chemotherapy retroperitoneal lymph node dissection was performed in 57% of all patients. As teratoma-containing specimens revealed a significantly lower number of complete responses after chemotherapy, PC-PRLND was more often performed, with teratomatous elements being more often present in the PC-RPLND specimens compared to non-teratoma containing primaries. Kaplan-Meier estimates revealed that 19% of all patients relapsed during a median follow-up of 56 months [29-112] with a median time to relapse of 10 months. Teratoma-containing had a significantly lower relapse-free survival (RFS) compared to teratoma-free NSGCT (relapse rate 24% vs 16%, p=0.020). 8% (45/533) of all patients died due to their disease. There was no difference regarding the tumour-specific survival between teratoma-containing NSGCT and teratoma-free NSGCT when looking at the entire cohort of patients (8% vs. 9%, p=0.563), however median overall survival was not reached. Conclusions: In our study, NSGCT patients with teratoma-containing primaries showed a significantly higher clinical stage and worse prognosis at time of presentation compared to teratoma-free primaries. Furthermore, patients with teratoma-containing primaries showed a significantly worse relapse-free survival. Consequently, treating physicians should be aware of these patients portending a dismal prognosis and the presence of teratomatous elements might act as a reliable stratification tool for treatment decision in TGCT patients.
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Affiliation(s)
- Pia Paffenholz
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | | | | | - Annika Poch
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburhg, Germany
| | | | | | | | - Andreas Hiester
- Department of Urology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Peter Albers
- Department of Urology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Martin Pichler
- Division of Oncology, Medical University of Graz, Graz, Austria
| | - Susanne Krege
- Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Isabella Syring
- Department of Urology, University Hospital Bonn, Bonn, Germany
| | | | - Tim Nestler
- University Hospital of Cologne, Department of Urology, Koblenz, Germany
| | - David Pfister
- Department of Urology, University Hospital of Cologne, Cologne, Germany
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