The Endless Debate Concerning the Timing of Chemotherapy in Muscle Invasive Bladder Carcinoma: Before or After the Radical Cystectomy?

2018 ◽  
Vol 09 (03) ◽  
Author(s):  
Georges El Hachem
Keyword(s):  
Radical Cystectomy ◽  
Bladder Carcinoma ◽  
Muscle Invasive

scholarly journals Pembrolizumab as Neoadjuvant Therapy Before Radical Cystectomy in Patients With Muscle-Invasive Urothelial Bladder Carcinoma (PURE-01): An Open-Label, Single-Arm, Phase II Study

2018 ◽  
Vol 36 (34) ◽  
pp. 3353-3360 ◽  
Author(s):  
Andrea Necchi ◽  
Andrea Anichini ◽  
Daniele Raggi ◽  
Alberto Briganti ◽  
Simona Massa ◽  
...  
Keyword(s):  
Neoadjuvant Therapy ◽  
Radical Cystectomy ◽  
Bladder Carcinoma ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Immune Gene ◽  
Open Label ◽  
End Point ◽  
Neoadjuvant Immunotherapy ◽  
Muscle Invasive

Purpose To determine the activity of pembrolizumab as neoadjuvant immunotherapy before radical cystectomy (RC) for muscle-invasive bladder carcinoma (MIBC) for which standard cisplatin-based chemotherapy is poorly used. Patients and Methods In the PURE-01 study, patients had a predominant urothelial carcinoma histology and clinical (c)T≤3bN0 stage tumor. They received three cycles of pembrolizumab 200 mg every 3 weeks before RC. The primary end point in the intention-to-treat population was pathologic complete response (pT0). Biomarker analyses included programmed death-ligand 1 (PD-L1) expression using the combined positive score (CPS; Dako 22C3 pharmDx assay), genomic sequencing (FoundationONE assay), and an immune gene expression assay. Results Fifty patients were enrolled from February 2017 to March 2018. Twenty-seven patients (54%) had cT3 tumor, 21 (42%) cT2 tumor, and two (4%) cT2-3N1 tumor. One patient (2%) experienced a grade 3 transaminase increase and discontinued pembrolizumab. All patients underwent RC; there were 21 patients with pT0 (42%; 95% CI, 28.2% to 56.8%). As a secondary end point, downstaging to pT<2 was achieved in 27 patients (54%; 95% CI, 39.3% to 68.2%). In 54.3% of patients with PD-L1 CPS ≥ 10% (n = 35), RC indicated pT0, whereas RC indicated pT0 in only 13.3% of those with CPS < 10% (n = 15). A significant nonlinear association between tumor mutation burden (TMB) and pT0 was observed, with a cutoff at 15 mutations/Mb. Expression of several genes in pretherapy lesions was significantly different between pT0 and non-pT0 cohorts. Significant post-therapy changes in the TMB and evidence of adaptive mechanisms of immune resistance were observed in residual tumors. Conclusion Neoadjuvant pembrolizumab resulted in 42% of patients with pT0 and was safely administered in patients with MIBC. This study indicates that pembrolizumab could be a worthwhile neoadjuvant therapy for the treatment of MIBC when limited to patients with PD-L1–positive or high-TMB tumors.

scholarly journals Complication of treatment of carcinoma in situ of the bladder with photodynamic targeted cystodiathermy

2014 ◽  
Vol 96 (7) ◽  
pp. e30-e31
Author(s):  
K Murtagh ◽  
R Kockelbergh
Keyword(s):  
Radical Cystectomy ◽  
Blue Light ◽  
Treatment Option ◽  
Bladder Carcinoma ◽  
Carcinoma In Situ ◽  
Disease Recurrence ◽  
Invasive Disease ◽  
Potential Complication ◽  
Muscle Invasive

We report two cases of bladder contracture following photodynamic or ‘blue light’ detection and cystodiathermy for bladder carcinoma in situ. These patients were unsuitable for treatment with immunotherapy/chemotherapy or had disease recurrence following such treatment. Radical cystectomy was not a treatment option in either patient. Each underwent serial photodynamic cystodiathermy over a three-year period. Neither patient developed muscle invasive disease. However, treatment resulted in contracture of the bladder and incontinence of urine. Patients need to be fully aware of this potential complication in order to make informed choices about their care.

Presurgical anemia as a predictor of relapse and survival in bladder carcinoma treated with cystectomy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 382-382 ◽  
Author(s):  
Alvaro Pinto ◽  
Luis Eduardo García ◽  
Esther García ◽  
Noelia Herradon ◽  
Enrique Espinosa
Keyword(s):  
Lymph Node ◽  
Radical Cystectomy ◽  
Bladder Carcinoma ◽  
Performance Status ◽  
Univariate Analysis ◽  
Developed Countries ◽  
Lymph Node Status ◽  
Ecog Performance Status ◽  
Node Status ◽  
Muscle Invasive

382 Background: Bladder carcinoma is the fifth most common neoplasm in developed countries. When muscle-invasive disease is diagnosed in a localized stage, radical cystectomy is the standard treatment, with or without perioperative chemotherapy. In this retrospective study we aim to identify presurgical factors that correlate with relapse risk and survival in patients being treated with radical cystectomy without neoadjuvant chemotherapy. Methods: Patients with a history of radical cystectomy for non-metastatic muscle-invasive bladder carcinoma from 1995 to 2010 were included. They had to have an appropriate follow-up, and tissue available for further correlative studies. Demographic baseline features and therapy outcomes were collected in a retrospective fashion. Results: A total of 158 patients were included, with a median overall survival (OS) for the entire cohort of 51 months (95% IC: 17.1–84.9 months). Median relapse free survival (RFS) is 39 months (95% IC: 3.8–74.1 months). In univariate analysis, the following features were prognostic factors for RFS: ECOG performance status (0 vs ³1; 72 vs 20 months, p=0.014), hemoglobin levels (normal vs low; 144 vs 21 months, p=0.001), free surgical margins (yes vs no; 39 vs 11 months, p=0.004), lymph node status (pN0 vs pN+; 119 vs 18 months, p<0.001) and pT stage (pT2 vs pT3-4; 167 vs 20 months, p< 0.001). Other previously described factors, such as neutrophil-lymphocite ratio, thrombocytosis, creatinine clearance or the presence of hydronephrosis, were not significant in our group of patients. In the multivariate analysis, only ECOG (HR 2.32), lymph node status (HR 2.0) and hemoglobin levels (HR 1.71) were independent predictors for RFS. Conclusions: In our group of patients, apart from ECOG performance status and lymph node status, the presence of presurgical anemia could be an indicator of poorer outcomes after cystectomy. These patients should be monitored closely and maybe considered for further therapeutic procedures, such as adjuvant systemic therapy.

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