Clinical genitourinary cancer最新文献

{"title":"Prognostic Nomogram, Demographics and Comparative Analysis of Urinary Bladder Small Cell and Large Cell Neuroendocrine Carcinoma","authors":"Asad Ullah ,&nbsp;Kue Tylor Lee ,&nbsp;Hannah Chaudhury ,&nbsp;Abdul Qahar Khan Yasinzai ,&nbsp;Abdullah Chandasir ,&nbsp;Tristin Chaudhury ,&nbsp;Nimra Jamil ,&nbsp;Bisma Tareen ,&nbsp;Agha Wali ,&nbsp;Meenu Sharma ,&nbsp;Dauod Arif ,&nbsp;Abdul Waheed ,&nbsp;Luis Brandi ,&nbsp;Marjan Khan ,&nbsp;Asif Iqbal ,&nbsp;Nabin R. Karki","doi":"10.1016/j.clgc.2024.102183","DOIUrl":"10.1016/j.clgc.2024.102183","url":null,"abstract":"<div><h3>Background</h3><p>This retrospective study aims to provide a comprehensive analysis of the demographics, survival rates, and therapeutic approaches of small-cell neuroendocrine carcinoma (SCNEC) and large-cell neuroendocrine carcinoma (LCNEC) while highlighting key differences compared to common urinary bladder cancers.</p></div><div><h3>Methods</h3><p>Our analysis utilized the Surveillance, Epidemiology, and End Results database (SEER), and data was collected from 2000-2020.</p></div><div><h3>Results</h3><p>A total of 1040 cases of urinary bladder SCNEC and LCNEC were identified. Most patients were over the age of 80 years (33.2%), male (78.9%), and Caucasian (83.6%). Most tumors were over 4.1cm (47.4%) and in the lateral wall of the bladder (37.8%). The overall 5-year survival was 22.1% (95% confidence interval (95% CI):20.7-23.5). The 5-year survival by sex was greatest for the female population (28.0%; (95% CI: 24.5-35.0). For treatment modality, the 5-year survival for each was as follows: surgery, 12.5% (95% CI: 10.5-14.5) multimodality therapy (surgery and chemotherapy), 31.1% (95% CI: 28.5-33.7) and combination (surgery, chemotherapy, and radiation) 32.8% (95% CI: 29.1-36.5). On multivariable analysis, positive nodal status hazar ratio (HR)(HR3.65 [95% CI: 2.34-5.71], <em>P</em> &lt; .001) was identified as a negative predictor for survival, and increasing age was nearly significant for a worse prognosis (<em>P</em> = .052). The prognostic nomogram that was created to predict patient survivability mirrored the findings from the statistical analysis, with a statistically significant difference found in race, treatment modality, and tumor stage.</p></div><div><h3>Conclusions</h3><p>SCNEC and LCNEC are rare yet highly intrusive subtypes of bladder cancer that usually affect Caucasian males over the age of 80 years old. The study identifies older age and positive nodal status as adverse prognostic indicators. Our findings offer crucial insights that can inform future clinical guidelines and serve as a basis for more tailored treatment strategies for these aggressive subtypes of bladder cancer.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136649","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":"Phase II Trial of Intermittent Therapy in Patients with Metastatic Renal Cell Carcinoma Treated with Front-line Ipilimumab and Nivolumab","authors":"Moshe C. Ornstein ,&nbsp;Laeth George ,&nbsp;Wei Wei ,&nbsp;C. Marcela Diaz-Montero ,&nbsp;Pat Rayman ,&nbsp;Allison Martin ,&nbsp;Arnab Basu ,&nbsp;Kathryn E. Beckermann ,&nbsp;Amanda Nizam ,&nbsp;Christopher E. Wee ,&nbsp;Timothy D. Gilligan ,&nbsp;Shilpa Gupta ,&nbsp;Brian I. Rini","doi":"10.1016/j.clgc.2024.102181","DOIUrl":"10.1016/j.clgc.2024.102181","url":null,"abstract":"<div><h3>Introduction</h3><p>The combination of ipilimumab/nivolumab is approved for patients with treatment-naïve, intermediate-, and poor-risk metastatic renal cell carcinoma (mRCC), but duration of therapy and safety/efficacy of reinduction at progression is unknown. A phase II trial of intermittent ipilimumab/nivolumab with reinduction at progression was conducted (NCT03126331).</p></div><div><h3>Patients and Methods</h3><p>Patients with treatment-naïve mRCC were treated with induction ipilimumab/nivolumab followed by up to 24 weeks of maintenance nivolumab. Patients who achieved a complete response (CR) or partial response (PR) were eligible for inclusion and entered a treatment-free observation period. Patients were restaged every 12 weeks. Patients with no disease progression (PD) remained off therapy. Upon PD, patients were re-challenged with 2 doses of ipilimumab/nivolumab every 3 weeks. Study objectives were to estimate success rate of observation in patients who achieve a CR/PR, and to assess toxicity in patients undergoing reinduction. The study accrued slower than expected and was closed prior to the anticipated accrual goal of 20 patients.</p></div><div><h3>Results</h3><p>Nine patients were included; 89% male, median age 57, 67% clear-cell histology, and 78% intermediate-risk by IMDC criteria. Response to ipilimumab/nivolumab followed by nivolumab maintenance prior to enrollment was 33% CR and 67% PR. Most (78%) patients have remained off therapy, with a median treatment-free interval (TFI) of 34.3 months (range, 8.7-41.8). Two patients had PD off therapy and received 2 cycles of reinduction ipilimumab and nivolumab. No grade 3 or greater toxicities occurred with reinduction. Both patients developed PD at their first scans after reinduction.</p></div><div><h3>Conclusion</h3><p>This prospective study demonstrates that patients with a radiographic response to ipilimumab/nivolumab can have prolonged treatment-free intervals. Further studies of de-escalation strategies are warranted.</p><p><strong>Trial Registration:</strong> NCT03126331 [Date of registration 4/27/2017; <span><span>https://clinicaltrials.gov/ct2/show/NCT03126331</span><svg><path></path></svg></span>].</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1558767324001526/pdfft?md5=3efcf7480016a98eaf95720afbd4bebf&pid=1-s2.0-S1558767324001526-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089323","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":"Hospital-Level Variability in the Adoption of Image-Guided Focal Therapy for Localized Prostate and Kidney Cancer","authors":"Zhiyu Qian ,&nbsp;Dejan K. Filipas ,&nbsp;Mara Koelker ,&nbsp;Benjamin V. Stone ,&nbsp;Edoardo Beatrici ,&nbsp;Muhieddine Labban ,&nbsp;Kemal Tuncali ,&nbsp;Stuart Lipsitz ,&nbsp;Quoc-Dien Trinh ,&nbsp;Alexander P. Cole","doi":"10.1016/j.clgc.2024.102184","DOIUrl":"10.1016/j.clgc.2024.102184","url":null,"abstract":"<div><h3>Background</h3><p>Focal therapy, a minimally invasive procedure, offers targeted treatment for kidney and prostate cancer using image guidance. However, the current institutional landscape of its adoption in localized prostate and kidney cancer remains less understood. This analysis compares its usage between the 2 cancers to discern health system determinants affecting the adoption of these treatments.</p></div><div><h3>Methods</h3><p>The study used data from adult patients with localized prostate and kidney cancer from the National Cancer Database. We calculated adjusted probabilities of focal therapy usage per facility via multivariable mixed-effects logistic regression model with hospital-level random effects. We analyzed interhospital variability through ranked caterpillar plots and Spearman correlation coefficient.</p></div><div><h3>Results</h3><p>Among 1,559,334 prostate and 425,753 kidney cancer patients, 1.6% and 6.3% received focal therapy, respectively. The interhospital variation ranged from 0.13% to 32.17% for prostate cancer and 1.16% to 30.48% for kidney cancer. The hospital-level odds of focal therapy for prostate and kidney cancer were weakly correlated (Spearman's ρ = 0.21; <em>P</em> &lt; .001).</p></div><div><h3>Conclusions</h3><p>Our analysis revealed a substantial hospital-level discrepancy in the utilization of focal therapy. Despite this, there was a limited correlation between the use of focal therapy for these two types of cancer within the same hospital. Our findings emphasize the presence of multifaceted factors influencing the adoption of focal therapy, both at facility and healthcare system levels.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147164","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":"Cabozantinib Induces Isolated Hyperbilirubinemia in Renal Cell Carcinoma Patients carrying the UGT1A1*28 Polymorphism","authors":"Sajedeh Mobaraki ,&nbsp;Peter Henrik Nissen ,&nbsp;Frede Donskov ,&nbsp;Agnieszka Wozniak ,&nbsp;Yannick Van Herck ,&nbsp;Lina Coosemans ,&nbsp;Tine van Nieuwenhuyse ,&nbsp;Diether Lambrechts ,&nbsp;Oliver Bechter ,&nbsp;Marcella Baldewijns ,&nbsp;Eduard Roussel ,&nbsp;Annouschka Laenen ,&nbsp;Benoit Beuselinck","doi":"10.1016/j.clgc.2024.102180","DOIUrl":"10.1016/j.clgc.2024.102180","url":null,"abstract":"<div><h3>Background</h3><p>Genetic variants of <em>UGT1A1</em>, involved in glucuronidation and clearance of bilirubin, are associated with reduced bilirubin metabolization and drug-induced isolated hyperbilirubinemia. We studied the impact of the <em>UGT1A1*28</em> polymorphism on drug-induced isolated hyperbilirubinemia in metastatic renal cell carcinoma patients treated with pazopanib, cabozantinib, and axitinib.</p></div><div><h3>Methods</h3><p>We genotyped the <em>UGT1A1*28</em> TA6/TA6-TA6/TA7-TA7/TA7 polymorphism and correlated with median baseline, on-treatment and peak bilirubin levels during therapy, incidence of grade-1- or -2 (G1/2)-hyperbilirubinemia and time-to-G1-hyperbilirubinemia.</p></div><div><h3>Results</h3><p>Of the 66 patients treated with pazopanib, 29 received axitinib and 28 cabozantinib upon progression. Median baseline bilirubin was higher in TA7/TA7-carriers versus TA6/TA6+TA6/TA7-carriers at start of pazopanib (<em>P</em> &lt; .0001), cabozantinib (<em>P</em> &lt; .0001), and axitinib (<em>P</em> = .007). During pazopanib therapy, median bilirubin increased 1.4-fold in TA7/TA7+TA6/TA7-carriers but not in TA6/TA6-carriers. On cabozantinib, bilirubin increased 1.5-fold in TA7/TA7-carriers but not in TA6/TA6+TA6/TA7-carriers. Axitinib did not increase bilirubin in any genotype. Peak bilirubin in TA7/TA7- versus TA6/TA6+TA6/TA7-carriers was higher on pazopanib (<em>P</em> &lt; .0001) or cabozantinib (<em>P</em> &lt; .0001). With pazopanib, G1-hyperbilirubinemia occurred in 57% of TA7/TA7- and 12% of TA6/TA6+TA6/TA7-carriers (<em>P</em> = .0009) and G2-hyperbilirubinemia in 36% and 6% of the patients, respectively (<em>P</em> = .004). On cabozantinib, G1-hyperbilirubinemia occurred in 100% of TA7/TA7- and 5% of TA6/TA6+TA6/TA7-carriers (<em>P</em> &lt; .0001) and G2-hyperbilirubinemia in 33% and 0% of the patients, respectively (<em>P</em> = .04). On axitinib, no correlation between the genotypes and G1/2-hyperbilirubinemia was observed.</p></div><div><h3>Conclusion</h3><p>We validate the previously described impact of the <em>UGT1A1*28</em> polymorphism on isolated bilirubin increase on pazopanib. We report for the first time that cabozantinib also interferes with <em>UGT1A1</em> and causes isolated bilirubin increase.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845646","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 in Patients With Metastatic Castration-Resistant Prostate Cancer in Greece: The PROSPECT Study","authors":"M. Liontos ,&nbsp;E. Bournakis ,&nbsp;A. Bournakis ,&nbsp;E. Kostouros ,&nbsp;V. Zolota ,&nbsp;A.P. Papatheodoridi ,&nbsp;K. Karalis ,&nbsp;A. Kyriazoglou ,&nbsp;R. Zakopoulou ,&nbsp;E. Vasili ,&nbsp;A. Tzovaras ,&nbsp;I. Dimitriadis ,&nbsp;G. Emmanouil ,&nbsp;D. Mauri ,&nbsp;C. Christodoulou ,&nbsp;M. Tsiatas ,&nbsp;F. Zagouri ,&nbsp;A. Bamias","doi":"10.1016/j.clgc.2024.102170","DOIUrl":"10.1016/j.clgc.2024.102170","url":null,"abstract":"<div><h3>Introduction</h3><p>Real-world data on management of metastatic castration resistant prostate cancer (mCRPC) with novel therapies is sparse. The aim of this study was to capture real-world management strategies in patients with mCRPC who initiated first line (1L) systemic therapy with chemotherapy or novel hormonal agents (NHAs) in Greece and describe the therapeutic sequencing strategy among patients who advanced to 2L and 3L treatment.</p></div><div><h3>Patients and Methods</h3><p>In this noninterventional, multicentre, retrospective study (PROSPECT), a medical chart review of 149 patients with mCRPC who initiated 1L systemic therapy with chemotherapy or NHAs in 7 major anticancer hospital clinics, from public, academic, and private sectors in Greece was conducted. All endpoints were descriptively analysed. Kaplan–Meier was used for time-to-event outcomes.</p></div><div><h3>Results</h3><p>At 1L (N = 149), most (78.5%) patients received NHAs; enzalutamide (52.3%), and abiraterone (26.2%). At 2L (N = 68), most (72.1%) patients received chemotherapy, most frequently docetaxel (50.0% of all patients). At 3L (N = 32), 56.3% and 31.3% of patients received chemotherapy and NHAs, respectively. Regarding treatment sequencing from 1L→2L (N = 68), most patients (55.9%) advanced from NHA→chemotherapy. Regarding treatment sequencing from 1L→2L→3L (N = 32), 34.4% advanced from NHAs→chemotherapy→chemotherapy and 31.3% from NHAs→chemotherapy→NHA. Estimated median times spent on treatment at 1L, 2L, and 3L were 9.8, 4.4, and 3.7 months, respectively.</p></div><div><h3>Conclusion</h3><p>Most patients were treated with 1L NHAs, in accordance to established guidelines (which suggest both NHA and chemo as preferred 1st line options). There appeared to be a longer time on treatment of NHAs at 1L than chemotherapy, suggesting an unmet need for treatment optimisation/recommendations for 2L and 3L treatment in mCRPC.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851955","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":"Metastatic Tropism in Urothelial Carcinoma With Variant Histology: A Comprehensive NCDB Analysis","authors":"Arthur Drouaud,&nbsp;Vincent Xu,&nbsp;Alejandro Velasquez,&nbsp;Ryan Antar,&nbsp;Brandon Boyarsky,&nbsp;Jacob Weiss,&nbsp;Diego Gonzalez,&nbsp;Rachel Silverman,&nbsp;Michael J Whalen","doi":"10.1016/j.clgc.2024.102179","DOIUrl":"10.1016/j.clgc.2024.102179","url":null,"abstract":"<div><h3>Introduction</h3><p>Bladder cancer (BCa) with variant histology (VH) is notably aggressive and not as well studied as pure urothelial carcinoma (UC). The characteristics of variant BCa in the setting of metastatic disease may contribute to treatment response/resistance and subsequent disease progression. In this study, we sought to assess VH's impact on metastasis sites at presentation in metastatic BCa.</p></div><div><h3>Methods</h3><p>The National Cancer Database was queried from 2004 to 2019 to analyze cT1-4 cN0-3 cM1 patients with UC and VH BCa. The primary endpoint was the presence of metastasis to different organs. Binomial multivariable logistic regression was performed to determine the impact of VH on metastatic sites while controlling for multiple variables.</p></div><div><h3>Results</h3><p>Total 6005 eligible patients diagnosed with either UC or VH were included. Patients with small cell histology, the second most common VH, were more likely to have liver metastasis (OR: 4.335) while less likely to have lung metastases (OR: 0.521). Squamous cell carcinoma decreased the odds of bone metastasis (OR: 0.449). Adenocarcinoma increased the odds of lung metastases (OR: 1.690). Micropapillary VH is less likely to metastasize to the lungs (OR: 0.182) but more likely to spread to nonregional lymph nodes (OR: 2.623). Sarcomatoid subtype did not exhibit a statistically significant variation in the odds ratio for any of the metastatic sites.</p></div><div><h3>Conclusion</h3><p>This study comprehensively analyzes the limited research regarding metastatic BCa and VH. Our analysis underscores each subtype exhibiting heterogeneous metastatic tropism. Importantly, these findings illustrate the role of routine somatic gene expression profiling to guide adequate staging and treatment intensification and to offer a foundation for future studies of VH BCa care.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850399","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":"Impact of DPP4 Inhibition on Survival in Patients With Metastatic Renal Cell Carcinoma and Type 2 Diabetes Mellitus","authors":"Soham Ali ,&nbsp;Kathryn Fortune ,&nbsp;Jack Masur ,&nbsp;Paul Vincent Viscuse ,&nbsp;Michael Edward Devitt ,&nbsp;Robert Dreicer ,&nbsp;William Paul Skelton IV","doi":"10.1016/j.clgc.2024.102173","DOIUrl":"10.1016/j.clgc.2024.102173","url":null,"abstract":"<div><h3>Background</h3><p>Dipeptidyl peptidase IV (DPP4) is a cell surface receptor that possesses numerous substrates implicated in tumor growth and metastasis. Prior studies have suggested an association between DPP4 inhibition and increased progression-free survival (PFS) and overall survival (OS) in colorectal and lung cancers but no benefit in breast or pancreatic cancers. However, no studies to date have explored the impact of DPP4 inhibitors (DPP4i) in patients with metastatic renal cell carcinoma (mRCC). In this study we present a first-time analysis examining the impact of DPP4i use on PFS and OS in patients with mRCC and type 2 diabetes mellitus.</p></div><div><h3>Methods</h3><p>We performed a retrospective analysis of patients with diabetes and mRCC at the University of Virginia. The study group comprised those whose diabetic regimen included a DPP4i during mRCC treatment. The control group comprised patients whose diabetic regimen did not include a DPP4i during treatment. Cox regression analysis was utilized to determine the hazard ratios of progression and death between groups.</p></div><div><h3>Results</h3><p>Fifty-nine patients were eligible for the study, with 11 in the DPP4i group and 48 in the control group. Cancer progression occurred in 81.8% of patients in the DPP4i group and 66.7% in the control group. No statistically significant differences on PFS (HR: 1.60 [95% CI, 0.75-3.43]) or OS (HR: 0.69 [95% CI, 0.28-1.70]) were found between groups.</p></div><div><h3>Conclusions</h3><p>This retrospective study explored the effect of DPP4i on outcomes in patients with mRCC and diabetes. DPP4i have been shown to have favorable effects on PFS and OS in some cancers but not in others. The results of this study suggest that DPP4i do not confer clinical benefit in patients with mRCC. Larger studies are warranted to better elucidate the effect of DPP4i in mRCC and the mechanisms underlying differential tumor response to these agents in different malignancies.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843529","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":"The Impact of Fibroblast Growth Factor Receptor Alterations in Clinical Outcomes of Patients With Advanced Urothelial Carcinoma: Real-World Data From a Latin American Population","authors":"Vinicius Carrera Souza ,&nbsp;Fernando Sabino Marques Monteiro ,&nbsp;Fernando Cotait Maluf ,&nbsp;Gustavo Werutsky ,&nbsp;Vanessa de Carvalho Fabrício ,&nbsp;Rosemarie Gidekel ,&nbsp;Maria Natalia Gandur-Quiroga ,&nbsp;Marcelo Roberto Pereira Freitas ,&nbsp;Murilo Luz ,&nbsp;Saul Campos-Gomez ,&nbsp;Jose Augusto Rinck Junior ,&nbsp;Diogo Assed Bastos ,&nbsp;Juan Pablo Sade ,&nbsp;Karine Martins da Trindade ,&nbsp;Augusto Cesar de Andrade Mota ,&nbsp;Roni de Carvalho Fernandes ,&nbsp;Allan Omar Barillas Ruíz ,&nbsp;Breno Dauster Pereira e Silva ,&nbsp;Fernando Nunes Galvão de Oliveira ,&nbsp;Hernan Javier Cutuli ,&nbsp;André Poisl Fay","doi":"10.1016/j.clgc.2024.102174","DOIUrl":"10.1016/j.clgc.2024.102174","url":null,"abstract":"<div><h3>Introduction</h3><p>Fibroblast growth factor receptor (FGFR) mutations and fusions are relevant biomarkers in metastatic urothelial carcinoma (mUC). However, the prevalence of genomic alterations and their impact on clinical outcomes in a Latin American population remains unknown. This study aimed to explore the prevalence of FGFR mutations and/or fusions in patients with mUC in Latin America (LATAM) and its association with clinicopathological characteristics, Bellmunt's prognostic model, and survival outcomes.</p></div><div><h3>Patients and methods</h3><p>A multicenter retrospective cohort study from 2016 to 2019 of patients with mUC from several LACOG LATAM institutions. FGFR alterations were analyzed by real-time PCR and/or next-generation sequencing in tumor samples and clinicopathologic characteristics and survival outcomes data were collected. The prevalence of FGFR, patient characteristics, and treatment in real-world settings were summarized. Kaplan-Meier survival estimates and Cox regression analyses were used to evaluate the associations of FGFR mutation and/or fusion status with median overall survival (mOS), median time to treatment failure (mTTF), and clinicopathological characteristics.</p></div><div><h3>Results</h3><p>In total, 222 patients were screened. Of these, 196 patients were considered eligible and were included in the analysis. FGFR mutations and/or fusions were found in 35 (17.9%) patients. There was no statistical difference in mOS and mTTF in FGFR-altered and non-altered patients (13.1 vs. 16.8 months, <em>P =</em> .20 and 3.9 vs. 4.1 months, <em>P =</em> .96, respectively). Bellmunt's prognostic model correctly predicted overall survival (<em>P =</em> .049).</p></div><div><h3>Conclusions</h3><p>This is the largest study evaluating the prevalence of FGFR alterations in patients with mUC in the LATAM population. FGFR alterations in mUC were found in 17.9% of the patients, and the presence of this biomarker was not associated with OS. We validated Bellmunt's prognostic model in this cohort.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850018","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":"Split-Dose Cisplatin in Patients With Locally Advanced or Metastatic Urothelial Carcinoma: A Systematic Literature Review and Network Meta-Analysis","authors":"Richard O'Dwyer ,&nbsp;Mihaela G. Musat ,&nbsp;Ioana Gulas ,&nbsp;Elizabeth Hubscher ,&nbsp;Hoora Moradian ,&nbsp;Silke Guenther ,&nbsp;Mairead Kearney ,&nbsp;Srikala S. Sridhar","doi":"10.1016/j.clgc.2024.102176","DOIUrl":"10.1016/j.clgc.2024.102176","url":null,"abstract":"<div><h3>Background</h3><p>Gemcitabine plus cisplatin (GC) is a highly active and commonly used regimen in locally advanced/metastatic urothelial carcinoma (la/mUC). With GC, cisplatin is dosed at 70 mg/m² on day 1 of a 3-week cycle; however, for many patients, impaired renal or cardiac function, neuropathy, or poor performance status (PS) can preclude the use of cisplatin. A promising alternative is split-dose GC, in which the cisplatin dose is divided over 2 days.</p></div><div><h3>Methods</h3><p>We conducted a systematic literature review (SLR) and network meta-analysis (NMA) to better understand treatment patterns and comparative effectiveness and safety of split-dose GC vs gemcitabine plus carboplatin (GCa), GC, and methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC).</p></div><div><h3>Results</h3><p>Among 120 identified studies, 16 studies representing 1,767 patients included split-dose GC. Common reasons for choosing split-dose GC were impaired renal function, age &gt; 70 years, comorbidities, and physician preference. Split-dose GC had objective response rates (ORRs) of 39%-80%, median progression-free survival (PFS) of 3.5-9.9 months, and median overall survival (OS) of 8.5-18.1 months. Discontinuation rates due to adverse events were 5%-38%. In the NMA, ORR with split-dose GC was significantly higher than with GCa. PFS and OS for split-dose GC were similar to that observed with the other regimens (GCa, GC, and MVAC).</p></div><div><h3>Conclusions</h3><p>This is the first SLR and NMA of split-dose GC in la/mUC. Despite heterogeneity in the limited studies included, split-dose GC demonstrated comparable effectiveness and safety profile to those seen with other regimens. Split-dose GC thus has the potential to extend the la/mUC population eligible to receive cisplatin-based regimens and warrants further prospective study.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1558767324001472/pdfft?md5=e38cab7f362ab1d33da43736c08b07ab&pid=1-s2.0-S1558767324001472-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853585","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":"Urachal Carcinoma: Insights From a National Database","authors":"Angelo Orsini ,&nbsp;Gabriele Bignante ,&nbsp;Francesco Lasorsa ,&nbsp;Eugenio Bologna ,&nbsp;Spencer M. Mossack ,&nbsp;Matteo Pacini ,&nbsp;Michele Marchioni ,&nbsp;Francesco Porpiglia ,&nbsp;Giuseppe Lucarelli ,&nbsp;Luigi Schips ,&nbsp;Gary D. Steinberg ,&nbsp;Edward E. Cherullo ,&nbsp;Riccardo Autorino","doi":"10.1016/j.clgc.2024.102175","DOIUrl":"10.1016/j.clgc.2024.102175","url":null,"abstract":"<div><h3>Introduction</h3><p>Urachal carcinoma (UrC) is a rare, nonurothelial malignancy, comprising less than 1% of all bladder cancers. It usually affects males in their fifth to sixth decade and is often diagnosed at an advanced stage with metastasis. This study examines UrC population characteristics and management.</p></div><div><h3>Methods</h3><p>We identified UrC patients from bladder biopsies or TURB in the PearlDiver Mariner database (2010-2022). Descriptive statistics detailed patient characteristics. Student's T-Tests compared ages for partial vs. radical cystectomy, and Fisher's exact test compared SDOH presence. Significance was set at <em>P</em> &lt; .05. Analyses used R version 3.6.0 within PearlDiver's software.</p></div><div><h3>Results</h3><p>Among 2475 UrC patients (mean age 69.2 ± 9.2 years, 73.1% men), most were in the south (36.5%), outpatient settings (84.5%), and privately insured (65.3%). A total of 418 (16.2%) had at least 1 SDOH. Imaging before diagnosis was used in 65.74% of patients, primarily ultrasound. Smoking was present in 54.5%, diabetes in 42.9%, and obesity in 25.2%. After diagnosis, 1246 (50.34%) had localized disease; 407 underwent radical cystectomy and 330 partial cystectomy. Patients undergoing radical cystectomy were older (66.74 ± 8.13 years) compared to those undergoing partial cystectomy (60.55 ± 12.92 years) (<em>P</em> &lt; .001), with SDOH factors more prevalent in the partial cystectomy group (<em>P</em> = .03).</p></div><div><h3>Conclusion</h3><p>UrC is a rare, often advanced-stage cancer predominantly affecting older men. Our study shows a trend towards partial cystectomy for localized UrC. Further research is needed to personalize surgery and integrate multidisciplinary approaches for better outcomes.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141771734","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}