Clinical genitourinary cancer最新文献

{"title":"Patterns of Failure After Definitive Trimodality Therapy for Muscle-Invasive Bladder Cancer","authors":"Nikhil V. Kotha ,&nbsp;Abhishek Kumar ,&nbsp;Paul Riviere ,&nbsp;Tyler J. Nelson ,&nbsp;Edmund M. Qiao ,&nbsp;Amirali Salmasi ,&nbsp;Rana R. McKay ,&nbsp;Jason A. Efstathiou ,&nbsp;Brent S. Rose ,&nbsp;Tyler F. Stewart","doi":"10.1016/j.clgc.2024.102229","DOIUrl":"10.1016/j.clgc.2024.102229","url":null,"abstract":"<div><h3>Background</h3><div>Real-world outcomes, especially patterns of failure, are limited for patients with muscle-invasive bladder cancer (MIBC) treated with trimodality therapy (TMT). We aim to evaluate patterns of failure after TMT for MIBC in a typical heterogeneous population.</div></div><div><h3>Methods</h3><div>In the national Veterans Affairs database, patients with urothelial histology, MIBC (T2-4a/N0-3/M0) who underwent definitive intent TMT between 2000-2018. Successful TMT was defined as ≥ 50% definitive radiation dose and ≥ 1 cycle chemotherapy. Endpoints of any recurrence, metastatic (nonbladder) recurrence (MR), and local (bladder) recurrence (LR) evaluated in multivariable Fine-Gray models. Times to recurrence calculated from radiation start date.</div></div><div><h3>Results</h3><div>In 347 patients with MIBC treated with TMT, 65% of patients were deemed ineligible for surgery while 35% were surgically eligible but elected for TMT. Median follow-up time was 77 months. Median overall survival was 32.4 months (95% CI: 28.2-36.7). 154 (44%) patients had no recurrence. 130 (37%) patients developed MR, median time 9.9 months. 117 (34%) patients developed LR, median time 8.7 months. In multivariable models, lymph node positive (LN+) disease (HR:3.31, 95% CI: 1.45-7.55, <em>P</em> &lt; .01) and pretreatment hydronephrosis (HR:1.62, 95% CI:1.11-2.36, <em>P</em> = .01) were associated with higher rates of MR. No patient, tumor, or treatment variables were associated with LR.</div></div><div><h3>Conclusions</h3><div>Across a multi-institutional and heterogeneous population, TMT is an effective treatment for many real-world patients with MIBC. However, a notable proportion of patients develop MR and/or LR which emphasizes the need for post-treatment surveillance and improved treatment pathways. Identified high risk features (LN+ disease, pretreatment hydronephrosis) and other markers should be further investigated to delineate the patients at high risk of TMT failure who therefore may potentially benefit from augmented treatment, such as additional systemic therapy.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102229"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Immunotherapy in High-Risk Muscle-Invasive Urothelial Cancer: An Updated Meta-Analysis of Randomized Controlled Trials","authors":"Isadora Mamede ,&nbsp;Caroliny Silva ,&nbsp;Ana Caroline Alves ,&nbsp;Joao Pedro Oliveira ,&nbsp;Melissa Maia ,&nbsp;Caio Dabbous de Liz ,&nbsp;Audrey Cabral de Oliveira","doi":"10.1016/j.clgc.2024.102288","DOIUrl":"10.1016/j.clgc.2024.102288","url":null,"abstract":"<div><h3>Introduction</h3><div>Neoadjuvant cisplatin-based chemotherapy followed by radical surgery is the standard treatment for muscle-invasive urothelial carcinoma (MIUC). The Checkmate-274 and AMBASSADOR trials have demonstrated improvements in disease-free survival (DFS) with adjuvant immunotherapy. Consequently, this meta-analysis aimed to assess the effectiveness of strategies involving checkpoint inhibitors in managing high-risk MIUC.</div></div><div><h3>Patients and Methods</h3><div>We searched PubMed, Embase, Cochrane, ClinicalTrials.gov, EAU24, and ASCO GU abstracts for randomized controlled trials (RCTs) comparing adjuvant PD-1 and PD-L1 inhibitors against control (placebo or observation) for MIUC. Outcomes included DFS, grade ≥3 adverse events (AEs), and overall survival (OS). Heterogeneity was assessed using I2 statistics, employing a random-effects model for analysis.</div></div><div><h3>Results</h3><div>In a cohort of 2220 patients from three RCTs, 1,113 (50.14%) underwent adjuvant immunotherapy. This treatment significantly increased DFS (HR 0.76; 95% CI, 0.65-0.90; <em>P</em> &lt; .01), particularly in lower tract tumors (HR 0.71; 95% CI, 0.56-0.91; <em>P</em> &lt; .01). No substantial DFS improvement surfaced in the upper tract subgroup (<em>P</em> = .28) (p-interaction = .01). PD-L1 status (p-interaction = .83) and previous neoadjuvant chemotherapy (p-interaction = .11) did not significantly affect outcomes. However, immunotherapy correlated with higher grade ≥3 AEs (RR 1.47; <em>P</em> &lt; .01), with no notable difference in OS (<em>P</em> = .07).</div></div><div><h3>Conclusions</h3><div>Adjuvant PD-1/PD-L1 inhibitors notably enhance MIUC DFS, particularly in lower tract tumors, regardless of PD-L1 status. These findings support immunotherapy, especially anti-PD1, as a valuable adjuvant treatment strategy for high-risk MIUC patients.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102288"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A French Multicenter Real-Life Study on the Biological and Clinical Parameters Associated With Response to Immune Checkpoint Inhibitors (ICIs) in Second-Line Treatment of Advanced Urothelial Carcinoma: Impact of Antibiotics Administration at the Time of ICIs Initiation","authors":"Pierre Grassi ,&nbsp;Werner Hilgers ,&nbsp;Romain Boissier ,&nbsp;Alexandre Bertucci ,&nbsp;Damien Bruyat ,&nbsp;Florence Duffaud ,&nbsp;Faustine Enoch ,&nbsp;Philippe Rochigneux ,&nbsp;Julien Mancini ,&nbsp;Jean-Laurent Deville","doi":"10.1016/j.clgc.2024.102283","DOIUrl":"10.1016/j.clgc.2024.102283","url":null,"abstract":"<div><h3>Background</h3><div>After failure of first-line chemotherapy, standard of care for advanced urothelial cancer (aUC) is immune checkpoint inhibitors (ICIs) targeting PD-1/PD-L1 pathway. Several prognostic models (Bajorin and Bellmunt scores) have been evaluated, but only in the context of chemotherapy.</div></div><div><h3>Objective</h3><div>To study whether the variables in these scores and new emerging clinical and biological criteria have an impact on the probability of objective response in aUC treated with ICIs in 2nd-line setting and beyond.</div></div><div><h3>Materials and methods</h3><div>Between October 2016 and March 2023, we included 168 patients treated with ICIs in 2nd-line setting or more in 2 French centers. Variables of interest were selected after a literature review and collected retrospectively. Analyses used log-rank test and multivariate models (binary logistic and Cox regressions).</div></div><div><h3>Results and limitations</h3><div>Median age at diagnosis was 68 years. Patients presented with bladder tumors in 73.8% and upper urinary tract tumors in 26.2%. 63.7% of patients had received only one line of chemotherapy before ICIs<strong>.</strong> Median follow-up after starting ICIs was 8.9 months.</div><div>The variables statistically associated with objective response were:</div><div>− The presence of locally advanced or lymph node-only disease compared with visceral involvement (adjusted Odds Ratio 0.19, 95% confidence interval [0.06-0.55], <em>P</em> = .002) and bone-only involvement (aOR 0.22 [0.08-0.64], <em>P</em> = .005)</div><div>− The absence of antibiotic therapy the month before/after ICIs initiation (aOR 0.31 [0.12-0.84], <em>P</em> = .021).</div><div>Limitations included retrospective design and small number of patients included.</div></div><div><h3>Conclusion</h3><div>This real-life study from 2 French centers found a higher likelihood of objective response:</div><div>− In the absence of antibiotic therapy at ICIs initiation:</div><div>− In locally advanced or lymph node-only disease, in contrast to visceral or bone-only disease.</div><div>Our results suggest that negative impact of antibiotic therapy on the response to ICIs needs to be further investigated to optimize the management of these patients.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102283"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activity of Platinum Chemotherapy in Men With Prostate Cancer With and Without DNA Damage Repair Mutations","authors":"Stephanie Lakritz ,&nbsp;Andrew Nicklawsky ,&nbsp;Vida Alami ,&nbsp;Manish Kohli ,&nbsp;Chris Moskaluk ,&nbsp;Greg Riedlinger ,&nbsp;Bodour Salhia ,&nbsp;Eric A. Singer ,&nbsp;Abdul Rafeh Naqash ,&nbsp;Ken Nepple ,&nbsp;Stephen Edge ,&nbsp;Zin Myint ,&nbsp;Jill Kolesar ,&nbsp;Nabil Adra ,&nbsp;Thomas Flaig ,&nbsp;Laura S. Graham","doi":"10.1016/j.clgc.2024.102293","DOIUrl":"10.1016/j.clgc.2024.102293","url":null,"abstract":"<div><h3>Introduction</h3><div>Alterations in homologous recombination repair (HRR) genes occur in 20%-30% of men with metastatic castration-resistant prostate cancer (mCRPC) which may increase sensitivity to platinum chemotherapy. Specifically, exceptional responses to platinum chemotherapy have been reported among patients with <em>BRCA</em> mutations. This study aimed to evaluate the efficacy of platinum chemotherapy in patients with mCRPC with and without HRR.</div></div><div><h3>Patient and Methods</h3><div>In this retrospective, multi-institution series, we analyzed patients with mCRPC to assess response to platinum-containing chemotherapy based on HRR alteration status. Outcome measures were prostate specific antigen (PSA)50 response rate (percentage of patients achieving at least a 50% decline in PSA from baseline), overall survival (OS) and progression-free survival (PFS).</div></div><div><h3>Results</h3><div>From 1999 to 2020, 24 patients with mCRPC who received platinum chemotherapy were included with 7 patients analyzable for PSA outcomes. HRR alterations were found in 19 out of 24 patients (79.2%) with mutations recognized in 11 different HRR genes. Patients with a HRR alteration achieved a PSA50 response rate of 20% (1 out of 5) after platinum chemotherapy compared to 50% (1 out of 2) in patients without a HRR mutation. No difference in OS or PSA PFS was detected among patients with <em>BRCA1/2</em> mutations compared to HRR alterations other than <em>BRCA1/2</em> and patients without HRR alterations.</div></div><div><h3>Conclusion</h3><div>In patients with mCRPC, we did not find a statistical difference in anti-tumor activity after receiving platinum chemotherapy among patients harboring a pathogenic HRR alterations compared to patients without a HRR alteration. Additionally, we were unable to detect an association between <em>BRCA1/2</em> mutation status and response to platinum chemotherapy. Platinum chemotherapy, however, had clinically meaningful activity in a subset of patients regardless of HRR alteration status. Additional studies are warranted using genomic data to predict sensitivity to platinum chemotherapy.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102293"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Non-interventional Real-World Study of cabozantinib in Pretreated Patients With Advanced Renal Cell Carcinoma Refractory to Vascular Endothelial Growth Factor-Targeted Therapy (CASSIOPE)","authors":"Michael Staehler ,&nbsp;Umberto Basso ,&nbsp;Jean-Christophe Eymard ,&nbsp;Philippe Barthelemy ,&nbsp;Pierre Bigot ,&nbsp;Mathieu Laramas ,&nbsp;Michael Rink ,&nbsp;Cristina Suarez ,&nbsp;Aline Guillot ,&nbsp;Jens Bedke ,&nbsp;Paul Hamberg ,&nbsp;Rocco De Vivo ,&nbsp;Pablo Gajate ,&nbsp;Martín Lázaro-Quintela ,&nbsp;Priti Rastogi ,&nbsp;Valérie Perrot ,&nbsp;Bryan Qvick ,&nbsp;Pascale Dutailly ,&nbsp;Elena Verzoni ,&nbsp;Giuseppe Procopio","doi":"10.1016/j.clgc.2024.102285","DOIUrl":"10.1016/j.clgc.2024.102285","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of published data on real-world cabozantinib use in patients with advanced renal cell carcinoma after prior vascular endothelial growth factor (VEGF)-targeted therapy.</div></div><div><h3>Methods</h3><div>CASSIOPE was a real-world, prospective, multicenter, non-interventional postauthorization safety study of cabozantinib in adult patients with advanced renal cell carcinoma in Europe following prior VEGF-targeted treatment (NCT03419572). Endpoints included cabozantinib utilization (dose modifications due to adverse events [AEs; primary endpoint], dose, dose modifications, and treatment duration), safety, effectiveness (progression-free survival [PFS], overall survival [OS], best overall response [BOR]), and healthcare resource utilization.</div></div><div><h3>Findings</h3><div>Full analysis set (FAS)/safety population comprised 679 patients; 433 of these initiated cabozantinib at 60 mg/day (recommended dose) (primary safety population). Median age (FAS) was 67 (range, 29-93) years; most were male (73·0%), had clear-cell histology (85·7%), metastatic disease at cabozantinib initiation (97·8%), and prior nephrectomy (80·3%). In the primary safety population, 77·1% experienced dose modification owing to an AE. In the safety population, the median daily dose was 40·0 (range, 7·8-60·0) mg/day and the median treatment duration was 7·8 (&lt; 0·1-15·2) months. Treatment-emergent and treatment-related AEs were experienced by 95·9% and 90·4% of patients, respectively. Median PFS (FAS) assessed by the local investigator using any method was 8·3 months, and 1-year OS rate was 74%. Approximately one-third of all patients had a BOR of partial response and 6 had a complete response.</div></div><div><h3>Interpretation</h3><div>Second- or later-line cabozantinib was effective and manageable in a real-world setting and had a safety profile consistent with previous studies.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102285"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Cystectomy in Patients With Previous Pelvic Irradiation: A Comprehensive Systematic Review and Single-Arm Meta-Analysis","authors":"Richard Dobrucki de Lima ,&nbsp;Lucas Schenk de Almeida ,&nbsp;Eduardo Lopes Martins Filho ,&nbsp;José Maurício Mota ,&nbsp;Leopoldo Alves Ribeiro-Filho ,&nbsp;Caio Vinicius Suartz","doi":"10.1016/j.clgc.2024.102259","DOIUrl":"10.1016/j.clgc.2024.102259","url":null,"abstract":"<div><div>To evaluate the perioperative outcomes of robot-assisted cystectomy in previous pelvic irradiation patients. We performed a systematic review with a single-arm meta-analysis, searching the PubMed, Embase, Scopus, and Cochrane databases through July 2024. Included studies reported perioperative outcomes of robot-assisted radical cystectomy in patients with prior pelvic irradiation. Extracted data included operative time, blood loss, complication rates (using the Clavien-Dindo classification), readmission rates, and length of hospital stay. Study quality was assessed and a single-arm meta-analysis was conducted to synthesize the data. This systematic review included 150 patients from 4 retrospective studies. The median operative time ranged from 330 to 382 minutes (Overall Mean = 349.50 min; 95% CI, 331-380), and blood loss varied between 264 mL and 495 mL (Overall Mean = 351.50 mL; 95% CI, 264-495). Major complications, defined as Clavien-Dindo grade ≥ III, were reported in 20% to 32% of cases, while total early complications within 90 days ranged from 53% to 59% (Overall rate = 0.58; 95% CI, 0.42-0.75). The readmission rate within 90 days varied between 22% and 40% (Overall rate = 0.31; 95% CI, 0.16-0.47). RARC in patients with prior pelvic irradiation resulted in comparable perioperative outcomes to nonirradiated patients. This review highlights the potential safety and efficacy of RARC in this complex patient group. Future studies comparing surgical approaches with detailed reporting on radiation exposure are essential to validate these findings.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102259"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes With Immune Checkpoint Inhibitors in Patients With FGFR2/3, MTAP or ERBB2 Genomic Alterations in Advanced Urothelial Carcinoma","authors":"Rafee Talukder ,&nbsp;Dimitra Rafailia Bakaloudi ,&nbsp;Dimitrios Makrakis ,&nbsp;Leonidas N. Diamantopoulos ,&nbsp;Thomas Enright ,&nbsp;Jacob B. Leary ,&nbsp;Ruben Raychaudhuri ,&nbsp;Nishita Tripathi ,&nbsp;Neeraj Agarwal ,&nbsp;Tanya Jindal ,&nbsp;Jason R. Brown ,&nbsp;Yousef Zakharia ,&nbsp;Macarena Rey-Cárdenas ,&nbsp;Daniel Castellano ,&nbsp;Charles B. Nguyen ,&nbsp;Ajjai Alva ,&nbsp;Roubini Zakopoulou ,&nbsp;Aristotelis Bamias ,&nbsp;Rafael Morales Barrera ,&nbsp;David Marmolejo ,&nbsp;Petros Grivas","doi":"10.1016/j.clgc.2024.102284","DOIUrl":"10.1016/j.clgc.2024.102284","url":null,"abstract":"<div><h3>Background</h3><div><em>FGFR2/3, MTAP</em> and <em>ERBB2</em> genomic alterations have treatment targets in advanced urothelial carcinoma (aUC). These alterations may affect tumor microenvironment and outcomes with immune checkpoint inhibitors (ICIs) in aUC.</div></div><div><h3>Patients and Methods</h3><div>We identified patients with available genomic data in our multi-institution cohort of patients with aUC treated with ICI. Outcomes (observed response rate [ORR], progression-free and overall survival [PFS, OS]) with ICI were compared between patients with and without <em>FGFR 2/3, MTAP, ERBB2</em> alterations. We compared ORR using logistic regression and PFS/OS using Cox proportional hazards.</div></div><div><h3>Results</h3><div>Out of 1,514 patients, 276 (18%), 174 (11%) and 208 (14%) patients had known <em>FGFR2/3, MTAP</em> and <em>ERBB2</em> alteration status, respectively. and were treated with ICI in 1L or 2 + L. In patients with (vs. without) <em>FGFR2/3</em> alteration, ORR with ICI was 21% vs. 32% (OR 0.54; [95%CI 0.32-0.91]), PFS was significantly shorter in patients with <em>FGFR2/3</em> alterations (HR = 1.36 [95%CI 1.03-1.80]; <em>P=</em>0<em>.</em>03); OS was not significantly different (HR = 1.22 [95%CI 0.86-1.47]). In patients with (vs. without) <em>MTAP</em> alteration, ORR with ICI was 25% versus 40% (OR 0.52 [95%CI 0.20-1.38]); PFS and OS were nonsignificantly different. In patients with (vs. without) <em>ERBB2</em> alteration, ORR with ICI was similar (37% vs. 35%; OR 1.06; 95%CI 0.57-1.97); PFS and OS were significantly longer in patients with <em>ERBB2</em> alteration [HR 0.63 (95%CI 0.41-0.95); <em>P=</em>0<em>.</em>03; HR 0.66, [95% CI 0.44-0.97]), respectively.</div></div><div><h3>Conclusion</h3><div>Our results support further evaluation of <em>FGFR2/3, MTAP</em> and <em>ERBB2</em> alterations as putative biomarkers in patients with aUC treated with ICI.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102284"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Gemcitabine and Carboplatin Dosing in Patients With Cisplatin-Ineligible Metastatic Urothelial Carcinoma","authors":"Eleni Gamvroulas ,&nbsp;Erin Bailey ,&nbsp;Erik Harrington ,&nbsp;Emma Jones ,&nbsp;Rebecca Martin ,&nbsp;Benjamin L. Maughan","doi":"10.1016/j.clgc.2024.102279","DOIUrl":"10.1016/j.clgc.2024.102279","url":null,"abstract":"<div><h3>Background</h3><div>The National Comprehensive Cancer Network Bladder Cancer Guidelines recommend carboplatin and gemcitabine first-line treatment in patients with cisplatin-ineligible, metastatic urothelial cancer (mUC) -- a Category 1 recommendation. For these patients, the median overall survival is 9.3 months. While carboplatin is purported to offer a more tolerable side-effect profile, many patients still require dose-reductions, dose-delays, and hospitalizations. Given the inability for mUC patients to tolerate this palliative regimen, we aim to determine whether initiating therapy with a lower dose regimen is justified.</div></div><div><h3>Methods</h3><div>A single-institution retrospective analysis was conducted to review eligible patients treated with carboplatin plus gemcitabine from May 2014 through October 2022. Data collected via manual chart review included patient baseline characteristics, chemotherapy doses, reductions, delays, toxicities, and effectiveness.</div></div><div><h3>Results</h3><div>Forty-three patients met inclusion criteria. Nineteen patients (44%) required ≥ 1 dose reduction during therapy. Twenty-six patients (60%) started with a full-dose regimen, and 14 (54%) of those patients required a dose reduction during treatment. Seventeen patients (40%) started with a reduced-dose regimen, and 5 (29%) of those patients required a dose reduction during treatment. No patients received the anticipated 6 cycles at full dose, but 14% completed 6 cycles with dose reductions. One patient (2%) was able to tolerate &gt;80% relative dose intensity of both carboplatin and gemcitabine.</div></div><div><h3>Conclusions</h3><div>Cisplatin-ineligible mUC patients were unable to tolerate full-dose carboplatin and gemcitabine. As this is a palliative regimen, it would be pertinent to consider starting therapy at a reduced dose to minimize treatment interruptions, dose omissions and side effects.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102279"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinical Case Series of BCGosis as a Rare Complication of Intravesical BCG","authors":"Joseph Inauen ,&nbsp;James Geake ,&nbsp;Alice Sawka ,&nbsp;Sam Labroome ,&nbsp;Richard Hoffmann ,&nbsp;Simone Barry","doi":"10.1016/j.clgc.2024.102271","DOIUrl":"10.1016/j.clgc.2024.102271","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>Intravesical BCG treatment for NMIBC can be associated with severe systemic complications including disseminated BCG infection (BCGosis).</div></span></li><li><span>•</span><span><div>Clinicians should be aware of the vast array of clinical presentations and diagnostic challenges of BCGosis.</div></span></li><li><span>•</span><span><div>Morbidity can be associated not only with disseminated BCG infection but also with its treatment which is long and not uncommonly poorly tolerated.</div></span></li></ul></div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102271"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Treatment Patterns and Clinical Outcomes in Patients With Locally Advanced or Metastatic Urothelial Carcinoma by Eligibility for Maintenance Avelumab","authors":"Alicia K. Morgans ,&nbsp;Guru P. Sonpavde ,&nbsp;Vanessa Shih ,&nbsp;Phoebe Wright ,&nbsp;Zsolt Hepp ,&nbsp;Candice L. Willmon ,&nbsp;Nancy N. Chang ,&nbsp;Lisa Mucha ,&nbsp;Sai Sriteja Boppudi Naga ,&nbsp;Thomas Powles","doi":"10.1016/j.clgc.2024.102270","DOIUrl":"10.1016/j.clgc.2024.102270","url":null,"abstract":"<div><h3>Introduction</h3><div>1L PBC has historically been recommended for patients with la/mUC. Maintenance avelumab is recommended for patients without disease progression following 1L PBC. Real-world data on the proportion of patients eligible for maintenance avelumab are limited, and outcomes among patients ineligible for maintenance avelumab are uncertain. This study assessed the proportion of patients with la/mUC initiating 1L PBC who were maintenance-avelumab eligible and real-world outcomes following 1L PBC by maintenance-avelumab eligibility.</div></div><div><h3>Methods</h3><div>A retrospective, observational study was conducted using a longitudinal electronic health record–derived database comprising de-identified patient-level structured and unstructured data including adults with Ia/mUC who received ≥1 dose of 1L PBC (April 2020-January 2022). The proportion of patients eligible for maintenance avelumab (real-world stable disease, partial response, or complete response following 1L PBC) was estimated and median overall survival (mOS) assessed for maintenance avelumab–eligible and –ineligible patients.</div></div><div><h3>Results</h3><div>Of 336 patients with Ia/mUC treated with 1L PBC (55.4% received cisplatin-based treatment 44.6% carboplatin-based treatment); 181 (54%) were maintenance-avelumab eligible; and 138 (41%) maintenance-avelumab ineligible (17 [5%] were nonevaluable). Of 181 maintenance-avelumab–eligible patients, 67 (37.0%; 19.9% of all 1L PBC–treated patients) received maintenance avelumab. mOS (95% CI) among all 1L PBC–treated patients was 15.0 (12.2-19.6) months and among maintenance-avelumab–ineligible patients was 8.0 (6.7-10.3) months; whereas among maintenance-avelumab–eligible patients (including 37% who received maintenance avelumab), mOS was 27.6 (23.4-not reached) months.</div></div><div><h3>Conclusions</h3><div>In this study, approximately half of 1L PBC–treated patients were maintenance-avelumab eligible, and one-fifth received it. Real-world OS remains short for the overall 1L PBC–treated population. These results support the use of treatment-guideline preferred 1L treatment options that demonstrate survival benefit for all patients with la/mUC, and are available to patients irrespective of their eligibility for cisplatin, or response to PBC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102270"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}