scholarly journals Treatment options for muscle-invasive urothelial cancer for patients who were not eligible for cystectomy or neoadjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin

Cancer ◽  
2008 ◽  
Vol 112 (10) ◽  
pp. 2181-2187 ◽  
Author(s):  
Celestia S. Higano ◽  
Catherine M. Tangen ◽  
Wael A. Sakr ◽  
James Faulkner ◽  
Saul E. Rivkin ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Urothelial Cancer ◽  
Treatment Options ◽  
Muscle Invasive

Adjuvant chemotherapy for residual disease after neoadjuvant chemotherapy for muscle invasive urothelial cancer (MIUC).

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. 4524-4524 ◽  
Author(s):  
Lauren Christine Harshman ◽  
Lillian Werner ◽  
Yu-Ning Wong ◽  
Evan Y. Yu ◽  
Ajjai Shivaram Alva ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Urothelial Cancer ◽  
Residual Disease ◽  
Muscle Invasive

scholarly journals Different responses to neoadjuvant chemotherapy in urothelial carcinoma molecular subtypes

2021 ◽  
Author(s):  
Gottfrid Sjödahl ◽  
Johan Abrahamsson ◽  
Karin Holmsten ◽  
Carina Bernardo ◽  
Gunilla Chebil ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Urothelial Cancer ◽  
Molecular Subtypes ◽  
Treatment Approach ◽  
Pathological Response ◽  
Chemotherapy Response ◽  
Muscle Invasive Bladder Cancer ◽  
Gene Coding ◽  
Differential Gene ◽  
Muscle Invasive

For muscle-invasive bladder cancer (MIBC), there are no tissue biomarkers in clinical use that identify patients sensitive or resistant to neoadjuvant chemotherapy. The present study investigates how molecular subtypes impact pathological response and survival in 149 patients receiving preoperative cisplatin-based chemotherapy. Tumor classification was performed by transcriptomic profiling and by a 13-marker immunostaining panel. Furthermore, we explored differential gene expression and chemotherapy response beyond molecular subtypes. Tumors with Genomically Unstable (GU) and Urothelial-like (Uro) subtypes had higher proportions of pathological response and superior survival outcomes as compared to the Basal-Squamous (Ba/Sq) subtype following neoadjuvant chemotherapy and radical cystectomy. Based on our findings, we suggest that urothelial cancer of the luminal-like GU- and Uro-subtypes are more responsive to cisplatin-based chemotherapy. We also found the gene coding for osteopontin (SPP1) to display a subtype-dependent effect on chemotherapy response, confirmed at the protein level by immunohistochemistry. Combined analyses of second-generation, subtype-specific biomarkers may be an additional way forward to develop a more precision-based treatment approach for neoadjuvant chemotherapy in MIBC.

scholarly journals Neoadjuvant chemotherapy (NC) should be administered to fit patients with newly diagnosed, potentially resectable muscle-invasive urothelial cancer (MIUC) of the bladder – A 2013 CAGMO Consensus Statement and Call for a Streamlined Referral Process

2013 ◽  
Vol 7 (9-10) ◽  
pp. 312 ◽  
Author(s):  
Jo-An Seah ◽  
Srikala Sridhar ◽  
Lori Wood ◽  
Normand Blais ◽  
Scott North ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Patient Outcomes ◽  
Urothelial Cancer ◽  
Consensus Statement ◽  
Urologic Oncology ◽  
Canadian Association ◽  
Medical Oncologists ◽  
Cancer Of The Bladder ◽  
Muscle Invasive ◽  
Improve Patient

Neoadjuvant chemotherapy (NC) improves overall survival inpatients with resectable muscle-invasive urothelial cancer of the bladder (MIBC). However uptake of NC in Canada is disappointingly low. Following a detailed literature review and in consultation with urologic oncology, the Canadian Association of Genitourinary Medical Oncologists (CAGMO) has developed a consensus statement for the use of NC in MIBC. Our primary goal is to increase the uptake of NC for MIBC in Canada and improve patient outcomes.

scholarly journals Evolving Immunotherapy Strategies in Urothelial Cancer

2015 ◽  
pp. e284-e290 ◽  
Author(s):  
Sam J. Brancato ◽  
Keidren Lewi ◽  
Piyush K. Agarwal
Keyword(s):  
Urothelial Carcinoma ◽  
Urothelial Cancer ◽  
Treatment Options ◽  
Invasive Disease ◽  
T Helper ◽  
Therapeutic Approaches ◽  
Cell Therapies ◽  
Muscle Invasive ◽  
Th1 Immune Responses

The treatment of nonmuscle-invasive urothelial carcinoma with bacillus Calmette-Guérin (BCG) represents the importance of immunotherapy in the treatment of cancer. Despite its clinical efficacy, up to 30% of patients will ultimately experience progression to muscle-invasive disease. This, along with an improved understanding of the biologic pathways involved, has led to efforts to improve, enhance, or alter the immune response in the treatment of urothelial carcinoma. A number of novel therapeutic approaches currently are being pursued, including recombinant BCG to induce T helper type 1 (Th1) immune responses, nonlive Mycobacterium agents, targeted agents toward cancer-associated antigens, immune-modulating vaccines, and adoptive T-cell therapies. Here, we review the current and future immunotherapy treatment options for patients with urothelial cancer.

scholarly journals Pathologic Response Rates of Gemcitabine/Cisplatin versus Methotrexate/Vinblastine/Adriamycin/Cisplatin Neoadjuvant Chemotherapy for Muscle Invasive Urothelial Bladder Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Franklin C. Lee ◽  
William Harris ◽  
Heather H. Cheng ◽  
Jaideep Shenoi ◽  
Song Zhao ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Urothelial Cancer ◽  
Response Rates ◽  
Complete Response ◽  
Pathologic Response ◽  
Urothelial Bladder Cancer ◽  
Urothelial Bladder ◽  
Muscle Invasive ◽  
Alternative Regimen

Objectives. To compare pathologic outcomes after treatment with gemcitabine and cisplatin (GC) versus methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) in the neoadjuvant setting.Methods. Data was retrospectively collected on 178 patients with T2-T4 bladder cancer who underwent radical cystectomy between 2003 and 2011. Outcomes of interest included those with complete response (pT0) and any response (≤pT1). Odds ratios were calculated using multivariate logistic regression.Results. Compared to those who did not receive neoadjuvant chemotherapy, there were more patients with complete response (28% versus 9%, OR 3.11 (95% CI: 1.45–6.64),P=0.03) and any response (52% versus 25%, OR 3.23 (95% CI: 1.21–8.64),P=0.01). Seventy-two patients received GC (n=41) or MVAC (n=31). CR was achieved in 29% and 22% of GC and MVAC patients, respectively (multivariate OR 0.39, 95% CI 0.10–1.58). Any response (≤pT1) was achieved in 56% of GC and 45% of MVAC patients (multivariate OR 0.45, 95% CI 0.12–1.71).Conclusions. We observed similar pathologic response rates for GC and MVAC neoadjuvant chemotherapy in this cohort of patients with muscle invasive urothelial cancer (MIBC). Our findings support the use of GC as an alternative regimen in the neoadjuvant setting.

Can we reliably identify patients for radical cystectomy without neoadjuvant chemotherapy?

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 258-258 ◽  
Author(s):  
R. J. Dickstein ◽  
H. B. Grossman ◽  
S. M. Pretzsch ◽  
J. A. Karam ◽  
R. E. Millikan ◽  
...  
Keyword(s):  
High Risk ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Lymphovascular Invasion ◽  
Urothelial Cancer ◽  
Recurrent Disease ◽  
Disease Recurrence ◽  
Salvage Chemotherapy ◽  
Variant Histology ◽  
Muscle Invasive

258 Background: When neoadjuvant chemotherapy is administered prior to radical cystectomy in patients with muscle-invasive urothelial cancer, the patients who benefit most are those with pathologic T3-4 or N+ disease. Thus, some advocate reserving neoadjuvant chemotherapy for patients considered high risk based on presence of the following clinical parameters: lymphovascular invasion, hydroureteronephrosis, presence of a palpable or visible mass on exam under anesthesia or imaging (suggesting cT3 disease), and/or variant histology. The goal of this study was to report the outcome of patients who were classified as “not high risk” (i.e., lacking the above-mentioned criteria) and underwent radical cystectomy without neoadjuvant chemotherapy. Methods: On retrospective review of 858 patients who underwent radical cystectomy from 2000 to 2008, we identified 174 patients with muscle-invasive disease (cT2) who were classified as “not high risk” (i.e., did not have lymphovascular invasion, hydroureteronephrosis, variant histology, and/or palpable or visible mass on imaging studies) and underwent radical cystectomy without neoadjuvant chemotherapy. Endpoints of interest included pathologic upstaging (≥ pT3), pathologic lymph node positivity, need for adjuvant or salvage chemotherapy, disease recurrence, and disease specific survival (DSS). Results: Of the 174 patients, 155 (88.6%) were male and the median age was 67.6 years (range 39-86). At radical cystectomy, 75 patients (42.9%) were upstaged (pT3N0: 45; pT4N0: 6; pTxN+: 24). Thirteen patients (7.4%) received adjuvant chemotherapy for adverse pathology. After a median interval of 27 months, 38 patients (21.7%) developed recurrent disease; isolated pelvic recurrences: 4, distant recurrences: 34, and 2 had both. Eighteen patients with recurrent disease went on to receive salvage chemotherapy. Overall, 25 patients (14.3%) died of disease with a 5-year DSS of 82.3%. Conclusions: Although clinical understaging remains a problem in the management of patients with muscle-invasive urothelial cancer, our criteria for selection of patients for primary radical cystectomy without neoadjuvant chemotherapy results in a cohort with a 5-year DSS of 83%. No significant financial relationships to disclose.

scholarly journals Metabolomic credentialing of murine carcinogen-induced urothelial cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hesham Afify ◽  
Alia Ghoneum ◽  
Sameh Almousa ◽  
Ammar Yasser Abdulfattah ◽  
Bailey Warren ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Human Disease ◽  
Urothelial Cancer ◽  
Treatment Options ◽  
Chemical Carcinogenesis ◽  
Metabolomic Profiling ◽  
Species Analysis ◽  
Metabolic Heterogeneity ◽  
Muscle Invasive ◽  
Common Malignancy

AbstractBladder cancer (BCa) is the most common malignancy of the urinary system with increasing incidence, mortality, and limited treatment options. Therefore, it is imperative to validate preclinical models that faithfully represent BCa cellular, molecular, and metabolic heterogeneity to develop new therapeutics. We performed metabolomic profiling of premalignant and non-muscle invasive bladder cancer (NMIBC) that ensued in the chemical carcinogenesis N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) mouse model. We identified the enriched metabolic signatures that associate with premalignant and NMIBC. We found that enrichment of lipid metabolism is the forerunner of carcinogen-induced premalignant and NMIBC lesions. Cross-species analysis revealed the prognostic value of the enzymes associated with carcinogen-induced enriched metabolic in human disease. To date, this is the first study describing the global metabolomic profiles associated with early premalignant and NMIBC and provide evidence that these metabolomic signatures can be used for prognostication of human disease.

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