Bladder CancerPub Date : 2025-01-31eCollection Date: 2025-01-01DOI: 10.1177/23523735241310388
Eryn B Callihan, Elizabeth Molina Kuna, Corbin J Eule, Elizabeth R Kessler, Thomas W Flaig
{"title":"Practice patterns and outcomes of conventional versus split-dose cisplatin in neoadjuvant ddMVAC in bladder cancer.","authors":"Eryn B Callihan, Elizabeth Molina Kuna, Corbin J Eule, Elizabeth R Kessler, Thomas W Flaig","doi":"10.1177/23523735241310388","DOIUrl":"10.1177/23523735241310388","url":null,"abstract":"<p><strong>Background: </strong>The practice patterns and efficacy of ddMVAC administered with split-dose cisplatin for patients with muscle-invasive bladder cancer (MIBC) remains largely undefined.</p><p><strong>Objective: </strong>To characterize the application and overall survival (OS) in patients with MIBC receiving conventional ddMVAC versus split-dosed ddMVAC and to examine the predictive variables in those receiving split-dosed cisplatin.</p><p><strong>Methods: </strong>Using data from the CancerLinQ Discovery database, we identified 626 patients with bladder cancer between 2000-2023 with receipt of ddMVAC. The primary outcome was OS by receipt of split-dose versus conventional ddMVAC. A secondary outcome of interest assessed predictors of receipt of split-dose ddMVAC. Use of split-dose versus conventional ddMVAC was compared using chi-square tests. Univariate and multivariable OS were estimated using Cox proportional hazards models. Predictors of receipt of split dose versus conventional ddMVAC were estimated using logistic regression models.</p><p><strong>Results: </strong>Most patients with MIBC are treated with standard dose ddMVAC. In multivariate analysis, no statistically significant difference in OS was observed between split-dose and conventional ddMVAC (HR 1.3, CI 0.78-2.18, p = 0.316). We demonstrate a notable decline in the use of split-dose cisplatin over time. Baseline GFR and performance status were not predictors of split-dosing in this cohort.</p><p><strong>Conclusions: </strong>Most patients with MIBC received conventional ddMVAC with decreasing frequency of split-dose cisplatin use over time. We did not observe a difference in OS between patients with MIBC who received standard versus split-dose cisplatin.</p>","PeriodicalId":54217,"journal":{"name":"Bladder Cancer","volume":"11 1","pages":"23523735241310388"},"PeriodicalIF":1.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bladder CancerPub Date : 2025-01-15eCollection Date: 2024-12-01DOI: 10.1177/23523735241304348
Neil Fleshner, Herbert Barton Grossman, Ryan Berglund, Jason Hafron, Brant Inman, Lawrence Karsh, Kelvin Moses, Daniel Saltzstein, Anup Shah, Jonathan Wright, Johannes Alfred Witjes, Yair Lotan
{"title":"North American study and meta-analysis evaluating performance of Bladder EpiCheck<sup>®</sup>, a FDA cleared test, in non-muscle invasive bladder cancer recurrence.","authors":"Neil Fleshner, Herbert Barton Grossman, Ryan Berglund, Jason Hafron, Brant Inman, Lawrence Karsh, Kelvin Moses, Daniel Saltzstein, Anup Shah, Jonathan Wright, Johannes Alfred Witjes, Yair Lotan","doi":"10.1177/23523735241304348","DOIUrl":"10.1177/23523735241304348","url":null,"abstract":"<p><strong>Background: </strong>Bladder EpiCheck (BE) is a novel methylation-based PCR urine test for the detection of non-muscle invasive bladder cancer (NMIBC) recurrences.</p><p><strong>Objective: </strong>We present the results of a North American study evaluating BE and meta-analysis of literature.</p><p><strong>Methods: </strong>A prospective, blinded, multicenter study was conducted in North America. Voided urine was collected from NMIBC patients prior to cystoscopic surveillance. BE testing was performed centrally. For the meta-analysis, a PUBMED search was performed to identify all published peer-reviewed clinical studies of BE for NMIBC surveillance.</p><p><strong>Results: </strong>In this study, 674 patients were enrolled of which 449 were included. Overall sensitivity was 67% (95%CI 58%-74%), specificity was 84% (80%-88%), PPV was 65% (57%-73%) and NPV was 85% (81%-89%). For high-grade (HG) recurrence, sensitivity was 77% (65%-85%) and NPV was 95% (92%-97%).In patients with negative cystoscopy and cytology at the first study visit, risk of subsequent recurrence in 12 months was 5.3 (2.7-10.3) times higher in patients with positive BE vs. negative BE (p < 0.0001). In patients with negative cystoscopy and equivocal cytology, BE was positive in 75-89% of those with later HG recurrence, with PPV of 42% (15%-72%)-63% (38%-84%).The meta-analysis included 7 studies and 1564 patients. Overall sensitivity was 82% (66-92%), HG sensitivity was 91% (82-95%), specificity was 85% (80-88%), PPV was 60% (55-64%) and HG NPV was 98% (97-99%).</p><p><strong>Conclusions: </strong>The consistently strong performance of BE indicate that a positive test could improve timely disease recurrence detection and a negative test could rule-out HG disease. Furthermore, the low rate of false positive results, potentially minimizes unnecessary downstream procedures and patient anxiety.</p>","PeriodicalId":54217,"journal":{"name":"Bladder Cancer","volume":"10 4","pages":"278-289"},"PeriodicalIF":1.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bladder CancerPub Date : 2024-12-23eCollection Date: 2024-12-01DOI: 10.1177/23523735241289237
Yelba Castellon-Lopez, Patricia A Thompson
{"title":"Achieving health equity in bladder cancer care: Addressing disparities through collaborative research and evidence-based strategies.","authors":"Yelba Castellon-Lopez, Patricia A Thompson","doi":"10.1177/23523735241289237","DOIUrl":"10.1177/23523735241289237","url":null,"abstract":"<p><p>The United States has seen a decrease in the incidence of bladder cancer and a decline in mortality rates over the past 20 years. However, not all groups have benefited equally from this trend. The American Association of Community Cancer Centers (ACCC) has issued ten strategies to improve cancer care delivery for underserved patient populations. Unfortunately, the evidence supporting the best methods for reducing disparities in different patient groups and care delivery settings remains severely limited. In this short communication, using a personalized narrative woven into a clinical case, we highlight the need for more research on bladder cancer care delivery to ensure that significant investments in precision oncology translate into genuine improvements for all patients diagnosed with bladder cancer.</p>","PeriodicalId":54217,"journal":{"name":"Bladder Cancer","volume":"10 4","pages":"264-269"},"PeriodicalIF":1.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"BCG therapy for bladder cancer: Exploring patient experiences and concerns through artificial intelligence-based social media analysis.","authors":"Zine-Eddine Khene, Isamu Tachibana, Raj Bhanvadia, Hagan Ausmann, Vitaly Margulis, Yair Lotan","doi":"10.1177/23523735241304907","DOIUrl":"10.1177/23523735241304907","url":null,"abstract":"<p><strong>Background: </strong>There is a notable disparity between the guidelines for BCG therapy in non-muscle invasive bladder cancer (NMIBC). Reddit has emerged as a popular online platform for individuals seeking information and exchanging their experiences related to bladder cancer.</p><p><strong>Objective: </strong>To investigate and classify public opinions about intravesical BCG therapy as shared on Reddit, a popular social media platform.</p><p><strong>Methods: </strong>This study employed an artificial intelligence-based approach to examine discussions related to intravesical BCG therapy on a social media platform over the past ten years. An artificial intelligence framework was developed to categorize these conversations into distinct topics and thematic categories. This framework included a partially supervised model for processing natural language (using BERT [Bidirectional Encoder Representations from Transformers]), a method for reducing data complexity, and an algorithm for clustering. Additionally, each conversation was assessed for sentiment.</p><p><strong>Results: </strong>A total of 1223 unique discussions related to BCG therapy were analyzed, comprising 110 unique posts and 1113 comments from 268 distinct authors. We identified four overarching thematic groups: 1) BCG administration procedures, (2) hesitancy in initiating or maintaining BCG treatment, (3) issues related to BCG shortage and alternative treatments, and (4) side effects of BCG treatment. Sentiment analysis of the 1223 discussions revealed that 25.2% (308) exhibited a negative sentiment, 58.3% (713) were neutral, and 16.5% (202) showed a positive sentiment.</p><p><strong>Conclusion: </strong>Online social media often contains detailed personal experiences with BCG therapy, not commonly found in medical literature. Understanding these experiences can help medical professionals improve care and treatment adherence in NMIBC.</p>","PeriodicalId":54217,"journal":{"name":"Bladder Cancer","volume":"10 4","pages":"290-299"},"PeriodicalIF":1.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bladder CancerPub Date : 2024-12-20eCollection Date: 2024-12-01DOI: 10.1177/23523735241303350
Adri M Durant, Mimi Nguyen, Mouneeb M Choudry, Lanyu Mi, Jack R Andrews, Mark D Tyson
{"title":"Repeat TURBT in large volume high-grade non-invasive bladder cancer.","authors":"Adri M Durant, Mimi Nguyen, Mouneeb M Choudry, Lanyu Mi, Jack R Andrews, Mark D Tyson","doi":"10.1177/23523735241303350","DOIUrl":"10.1177/23523735241303350","url":null,"abstract":"<p><strong>Background: </strong>The American Urological Association (AUA)/Society of Urology Oncology (SUO) guidelines recommend a repeat transurethral resection of bladder tumor (TURBT) for high-risk, non-invasive (HR Ta) nonmuscle invasive bladder cancer (NMIBC) patients. The evidence base for this recommendation is weak (grade C) and fraught with methodological shortcomings, such as the lack of adjuvant intravesical Bacillus Calmette Guerin (BCG) and single-center study designs.</p><p><strong>Objective: </strong>We sought to evaluate the effect of repeat TURBT on recurrence-free survival at a population level in HR Ta NMIBC patients who completed BCG induction therapy.</p><p><strong>Methods: </strong>High-grade Ta NMIBC patients who underwent TURBT for a ≥5 cm tumor were identified within the SEER-Medicare database. All patients completed induction BCG and were stratified into two groups: repeat TURBT within eight weeks of initial TURBT and a group without repeat TURBT (control group). The primary endpoint was the 3-year high-risk recurrence rate.</p><p><strong>Results: </strong>A cohort of 604 patients was identified, with 93 (15.4%) undergoing a repeat TURBT within eight weeks of initial TURBT and 511 (84.6%) without a repeat TURBT. Patient demographic and clinical characteristics were similar overall. No significant difference in the 3-year recurrence rate was noted (repeat TURBT: 20.4% vs. control group: 15.7%, p = 0.25). After adjusting for demographic and clinical characteristics, no association between repeat TURBT and 3-year high-risk recurrence was observed (HR (95% CI): 1.27 (0.76, 2.11); p = 0.36).</p><p><strong>Conclusion: </strong>Although our study contains several major limitations, our results suggest that repeat TURBT in large volume HG Ta NMIBC treated with induction BCG therapy was not associated with improved high-risk recurrence-free survival.</p>","PeriodicalId":54217,"journal":{"name":"Bladder Cancer","volume":"10 4","pages":"270-277"},"PeriodicalIF":1.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bladder CancerPub Date : 2024-12-20eCollection Date: 2024-12-01DOI: 10.1177/23523735241301646
Vera C Rutten, Jan-Jaap Mellema, Tahlita Cm Zuiverloon, Debbie Gj Robbrecht, Michiel S van der Heijden, Joost L Boormans
{"title":"Systemic induction therapy in patients with locally advanced or node-positive urothelial carcinoma: Evaluating treatment outcomes.","authors":"Vera C Rutten, Jan-Jaap Mellema, Tahlita Cm Zuiverloon, Debbie Gj Robbrecht, Michiel S van der Heijden, Joost L Boormans","doi":"10.1177/23523735241301646","DOIUrl":"10.1177/23523735241301646","url":null,"abstract":"<p><strong>Background: </strong>The presence of lymph node metastases in patients with urothelial carcinoma (UC) plays a pivotal role in disease management and prognosis. Patients with locally advanced irresectable or clinically node-positive UC are often considered ineligible for surgery due to the extent of affected lymph nodes. Long term remission or even cure may be achieved in a subset of patients who experience response to systemic induction therapy and consolidative locoregional treatment.</p><p><strong>Objective: </strong>To assess the pathological response to preoperative systemic induction therapy followed by radical surgery in patients with locally advanced irresectable or clinically node-positive UC.</p><p><strong>Methods: </strong>Searches were performed until September 2023 in 5 databases (EMBASE, MEDLINE, Web-of-Science, Cochrane and Pubmed Publisher). Studies including patients with cT4bNxM0/cTxN1-3M0 UC, treated with induction chemotherapy or non-chemo induction therapy followed by radical surgery, were selected. The primary outcome was the pathological complete response (pCR) rate, i.e., the proportion of patients without residual disease in the surgical resection specimen (ypT0N0). Secondary outcomes included overall and cancer-specific survival (OS, CSS).</p><p><strong>Results: </strong>Fourteen studies were included, representing 5715 patients. Two studies reported on non-chemo induction therapy. The reported pCR rate in patients receiving induction chemotherapy varied from 9% to 27% compared to 25% after induction immunotherapy. The 5-year OS and CSS after induction chemotherapy and radical surgery ranged from 25 to 34% and 30 to 49%.</p><p><strong>Conclusion: </strong>Systemic induction therapy in patients with locally advanced irresectable or clinically node-positive UC resulted in modest pCR rates. Due to considerable heterogeneity between studies, no direct comparison on the efficacy of induction therapy regimens was possible.</p>","PeriodicalId":54217,"journal":{"name":"Bladder Cancer","volume":"10 4","pages":"251-263"},"PeriodicalIF":1.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bladder CancerPub Date : 2024-12-20eCollection Date: 2024-12-01DOI: 10.1177/23523735241296763
Mohammad Jad Moussa, Iuliia Kovalenko, Emanuele Crupi, Ekaterina Proskuriakova, Yimin Geng, Giuseppe Fallara, Raed Benkhadra, Daniele Raggi, Matthew T Campbell, Pavlos Msaouel, Omar Alhalabi
{"title":"Antiangiogenic therapy combined with immune checkpoint blockade in urothelial cancer: Systematic review and meta-analysis.","authors":"Mohammad Jad Moussa, Iuliia Kovalenko, Emanuele Crupi, Ekaterina Proskuriakova, Yimin Geng, Giuseppe Fallara, Raed Benkhadra, Daniele Raggi, Matthew T Campbell, Pavlos Msaouel, Omar Alhalabi","doi":"10.1177/23523735241296763","DOIUrl":"10.1177/23523735241296763","url":null,"abstract":"<p><strong>Background: </strong>Antiangiogenic therapy had been tested in urothelial cancer (UC) without reaching the clinic.</p><p><strong>Objective: </strong>We provide a systematic review and meta-analysis of trials to assess efficacy of immune checkpoint inhibitors (ICI) combined with antiangiogenic agents in UC.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we searched for trials with at least one arm of patients with UC treated with ICI plus antiangiogenics. Data were analyzed with the \"meta\" package from R using a one-staged frequentist meta-analysis.</p><p><strong>Results: </strong>After screening 13,708 titles and abstracts, 9 studies were selected for analysis with 14 identified cohorts comprising 621 patients: 448 were ICI-naïve (ICI-N) and 173 were ICI-exposed (ICI-E). The estimated objective response rate (ORR) in all patients was 27% (21-35). In the ICI-N group, ORR was 34% (28-41). Conversely, the ICI-E group had a lower ORR of 16% (9-28). This difference was mainly driven by a higher partial response rate of 27% (23-31) in ICI-N group compared to 13% (8-20) in the ICI-E group. Disease control rate was 72% (66-77) ICI-N group vs. 71% (64-78) in ICI-E group. Median overall survival ranged from 6.4 to 24.9 months in the ICI-N group, and 8.2 to 10.4 months in ICI-E group. Median progression free survival ranged from 1.9 to 10.1 months and from 3 to 3.9 months in both groups, respectively.</p><p><strong>Conclusion: </strong>ORR with ICI plus antiangiogenics was lower after prior ICI exposure, with substantial variability estimates among included trials, either due to differences among antiangiogenic agents used or trial-related factors. Future exploration of ICI combined with antiangiogenics in UC, especially in ICI-refractory setting, will benefit from better patient selection.</p>","PeriodicalId":54217,"journal":{"name":"Bladder Cancer","volume":"10 4","pages":"300-312"},"PeriodicalIF":1.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bladder CancerPub Date : 2024-10-23eCollection Date: 2024-01-01DOI: 10.3233/BLC-240017
Joep J de Jong, Florus C de Jong, Angelique C J van der Made, Niels J van Casteren, Hossain Roshani, Eric H G M Oomens, Rob C M Pelger, Ewout W Steyerberg, Joost L Boormans, Chris H Bangma, Tahlita C M Zuiverloon, Ellen C Zwarthoff
{"title":"A Molecular Urine Assay to Detect Recurrences During Surveillance of High-Risk Non-Muscle Invasive Bladder Cancer.","authors":"Joep J de Jong, Florus C de Jong, Angelique C J van der Made, Niels J van Casteren, Hossain Roshani, Eric H G M Oomens, Rob C M Pelger, Ewout W Steyerberg, Joost L Boormans, Chris H Bangma, Tahlita C M Zuiverloon, Ellen C Zwarthoff","doi":"10.3233/BLC-240017","DOIUrl":"10.3233/BLC-240017","url":null,"abstract":"<p><strong>Background: </strong>High-risk non-muscle invasive bladder cancer (HR-NMIBC) patients require long-term surveillance with cystoscopies, cytology and upper tract imaging. Previously, we developed a genomic urine assay for surveillance of HR-NMIBC patients with high sensitivity and anticipatory value.</p><p><strong>Objective: </strong>We aimed to validate the performance of the assay in an unselected prospectively collected cohort of HR-NMIBC patients under surveillance.</p><p><strong>Methods: </strong>We included patients from five centers and collected urine sample pairs (evening and morning urines) prior to cystoscopy. Mutation status (<i>FGFR3/TERT)</i> and methylation status (<i>OTX1)</i> was analyzed on DNA from voided urine specimens. A test was considered positive if≥1 alteration was detected in at least one urine sample. The primary endpoint was tumor recurrence. Sensitivity and specificity were determined. A generalized mixed effects model was used to adjust for within-patient correlation. Cox proportional hazard analyses with time-dependent covariates assessed the anticipatory effect of the urine assay.</p><p><strong>Results: </strong>In total, 204 patients and 736 sample pairs were collected. Sixty-three recurrences were diagnosed for which we had concomitant assay results. On cross-sectional analyses, the assay detected 75% (95% CI 62.1% -84.7%) of recurrences, with a specificity of 70% (95% CI 66.4% -73.5%). Furthermore, mixed effects model analyses revealed <i>OTX1</i> (<i>p</i> = 0.005) and <i>TERT</i> (<i>p</i> = 0.004) as significant predictors for disease recurrence. Median follow-up was 25.3 months (IQR 18.6-30.7). Twenty-nine tumors were diagnosed without concomitant urine samples, which included recurrences detected after urine collection ended. Longitudinal analyses showed that a positive urine assay predicted a recurrence over time (HR 3.5, <i>p</i> < 0.001). Furthermore, a recurrence during the study period was also a predictor for developing future recurrences (HR 2.1, p < 0.001).</p><p><strong>Conclusions: </strong>This study validates the performance of a previously developed urine assay in an unselected cohort of HR-NMIBC patients under surveillance. With a robust sensitivity/specificity and a strong anticipatory effect, this assay proves a useful adjunct ready for evaluation in a future randomized controlled trial.</p>","PeriodicalId":54217,"journal":{"name":"Bladder Cancer","volume":"10 3","pages":"233-242"},"PeriodicalIF":1.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bladder CancerPub Date : 2024-10-23eCollection Date: 2024-01-01DOI: 10.3233/BLC-230105
Tyler F Stewart, Healther Chalfin, Nicholas Simon, Alan Tan, Andrea Apolo, Rana R McKay
{"title":"Perioperative Use of ctDNA to Guide Treatment for Urothelial Carcinoma: The Future is Now.","authors":"Tyler F Stewart, Healther Chalfin, Nicholas Simon, Alan Tan, Andrea Apolo, Rana R McKay","doi":"10.3233/BLC-230105","DOIUrl":"10.3233/BLC-230105","url":null,"abstract":"<p><p> Muscle-invasive bladder cancer represents a potentially curable disease, yet often disease recurs and is ultimately fatal. Outcomes for patients with localized urothelial carcinoma are heterogeneous with some patients cured with surgery alone, deriving no benefit from perioperative systemic therapy, while others are left with residual disease and may benefit from additional therapy. Neoadjuvant chemotherapy increases cure rates but comes with significant toxicity. Recently, adjuvant nivolumab has demonstrated significant improvement in disease free survival (DFS), and overall survival analysis is pending. With more therapies approved for urothelial cancer within the last 5 years than ever before, there is incredible potential to improve clinical outcomes and potentially cure more patients with integrated multimodal therapy. Biomarkers are needed to dichotomize those most likely to benefit from perioperative systemic therapy for residual disease, and de-escalate therapy for those likely to be cured with surgery alone. Ultrasensitive assays for circulating tumor DNA (ctDNA) have emerged as a method to identify patients at high risk of recurrence after definitive therapy and may benefit from escalated therapy, while also identifying those least likely to benefit from systemic therapy. Studies have demonstrated that the presence of ctDNA after surgery is prognostic of disease recurrence across multiple cancer types, including bladder cancer, but questions remain as to the utility of these tests, and whether they can be predictive of benefit of adjuvant therapy. Although these liquid biopsies hold significant promise to transform perioperative treatment, prospective studies are needed to validate their utility as prognostic and predictive biomarkers. To bridge this knowledge gap, contemporary clinical trials are incorporating ctDNA as an integral biomarker to guide therapy for MIBC.</p>","PeriodicalId":54217,"journal":{"name":"Bladder Cancer","volume":"10 3","pages":"183-198"},"PeriodicalIF":1.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}