Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy with curative intent

Zamboni, Stefania; Afferi, Luca; Soria, Francesco; Aziz, Atiqullah; Abufaraj, Mohammad; Poyet, Cédric; Necchi, Andrea; D’Andrea, David; Simone, Giuseppe; Ferriero, Mariaconsiglia; Trapani, Ettore Di; Simeone, Claudio; Antonelli, Alessandro; Gallina, Andrea; Montorsi, Francesco; Briganti, Alberto; Colombo, Renzo; Gandaglia, Giorgio; Mattei, Agostino; Baumeister, Philipp; Mordasini, Livio; Hendricksen, Kees; Voskuilen, Charlotte S.; Rink, Michael; Xylinas, E.; Moschini, Marco

doi:10.1007/s00345-020-03362-1

Cited by 10 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ten discussed NAC, one (12) discussed trimodal bladder preserving therapy (TMT) whereas one (4) discussed neoadjuvant immunotherapy. There were a total of 35 papers, 25 studies (5-7,9-11,14-32), then 10 studies (33)(34)(35)(36)(37)(38)(39)(40)(41)(42) reporting survival outcomes after cystectomy. Five of these studies (18,21,24,38,40) reported survival after RC with adjuvant chemotherapy.…”

Section: Actual Resultsmentioning

confidence: 99%

“…There were a total of 35 papers, 25 studies (5-7,9-11,14-32), then 10 studies (33)(34)(35)(36)(37)(38)(39)(40)(41)(42) reporting survival outcomes after cystectomy. Five of these studies (18,21,24,38,40) reported survival after RC with adjuvant chemotherapy. One study (21) reported worse OS when adjuvant chemotherapy was not administered in glandular differentiation.…”

Section: Actual Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Overview of histologic variants of urothelial carcinoma: current trends and narrative review on treatment outcomes

Ogbue

Haddad²,

Almassi³

et al. 2022

Transl Androl Urol

View full text Add to dashboard Cite

Background and Objective: The histologic variants of urothelial carcinoma (UC) are tumors arising from within the urothelium in which some component of the tumor morphology is other than urothelial.They are underdiagnosed, aggressive and have varying pathologic response rates to systemic chemotherapy.There are no consensus guidelines on the use of systemic chemotherapy in variant histology (VH) of UC. We performed a contemporary review on pathologic response rates to neoadjuvant systemic therapy and survival outcomes following radical cystectomy in order to provide a rationale for clinical practice recommendations on the management of UC with VH.Methods: A PubMed literature search was conducted for all English articles from inception reporting either pathological response rates to neoadjuvant treatment or survival outcomes after radical cystectomy in non-metastatic VH of UC.Key Content and Findings: Neoadjuvant chemotherapy (NAC) prior to radical cystectomy was shown to be a beneficial treatment strategy in UC with VH. The micropapillary, plasmacytoid, nested and sarcomatoid histologic variants were associated with worse survival outcomes compared to conventional UC and UC with squamous or glandular differentiation despite initial downstaging with chemotherapy. There is evidence of improved survival in patients with sarcomatoid differentiation receiving NAC compared to RC alone. The major prognostic factors that affect survival outcomes in VH of UC include histologic variant subtype, patient age, presence of lymphovascular invasion, hydronephrosis, nodal metastasis and advanced T stage at diagnosis. Recent studies demonstrate that VH of UC are heterogenous tumors and responsiveness to NAC may be a function of the molecular subtypes present.Conclusions: Based on these findings, NAC to achieve pathologic downstaging prior to radical cystectomy is recommended for MIBC with VH. Biomarkers identified by molecular profiling with immunohistochemistry will need to be validated as predictors of response to NAC in future trials.

show abstract

Section: Actual Resultsmentioning

confidence: 99%

Section: Actual Resultsmentioning

confidence: 99%

Overview of histologic variants of urothelial carcinoma: current trends and narrative review on treatment outcomes

Ogbue

Haddad²,

Almassi³

et al. 2022

Transl Androl Urol

View full text Add to dashboard Cite

show abstract

“…In the use of AC, there is a small case series found that no administration of AC was independently associated with poor overall survival in cases with glandular differentiation. Conversely, another study reported the administration of AC did not significantly improve survival outcomes in any histological variant ( 12 ).…”

Section: Introductionmentioning

confidence: 93%

“…Six were populations-based studies, seven studies came from different centers, and one study was based on both center and SEER. There were four studies evaluating the role of AC for VH (12,(28)(29)(30). Two were populations-based studies, while the remaining were based on different center's database.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Neoadjuvant and Adjuvant Chemotherapy for Variant Histology Bladder Cancers: A Systematic Review and Meta-Analysis

Zhu

Xiao

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

ContextTo improve the prognosis of variant histology (VH) bladder cancers, clinicians have used neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC) on the basis of radical cystectomy (RC). Despite some new data, the evidence remains mixed on their efficacy.ObjectiveTo update the current evidence on the role of NAC and AC for VH bladder cancers.Evidence AcquisitionWe searched for all studies investigating NAC or AC for bladder cancer patients with variant histology in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to December 2021. The primary end points were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS).Evidence SynthesisWe identified 18 reports comprising a total of 10,192 patients in the NAC studies. In patients with VH, the use of NAC did improve CSS (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.55–0.99, p = 0.044), and OS (HR 0.74, 95% CI 0.66–0.84, p = 0.000), but not RFS (HR 1.15, 95% CI 0.56–2.33, p = 0.706). Subgroup analyses demonstrated that receiving NAC was associated with better OS in sarcomatoid VH (HR 0.67, 95% CI 0.54–0.83, p = 0.000) and neuroendocrine VH (HR 0.54, 95% CI 0.43–0.68, p = 0.000). For AC, we identified eight reports comprising a total of 3254 patients. There was a benefit in CSS (HR 0.61, 95% CI 0.43–0.87, p = 0.006) and OS (HR 0.76, 95% CI 0.60–0.98, p = 0.032). Subgroup analyses demonstrated that only neuroendocrine VH had better CSS (HR 0.29, 95% CI 0.13–0.67, p = 0.174) when receiving AC.ConclusionsNAC or AC for VH bladder cancers confers an OS and CSS benefit compared with RC alone. For NAC, the benefit was independently observed in the sarcomatoid and neuroendocrine subgroups. As for AC, only neuroendocrine subgroups improved CSS.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42021289487.

show abstract

“…From the histological perspective, MPBC is characterized by small tumour nests and aggregates of tumour cells surrounded by empty or lacunae spaces, which often invade the bladder wall deeply [3]. Since its first description, MPBC was conventionally reported to harbour an aggressive behaviour compared with pure urothelial carcinoma (pUC), including high rates of lymphovascular invasion (LVI) and presence of carcinoma in situ (CIS), advanced clinical tumour stage at diagnosis, nodal and distant spread, as well as scarce chemosensitivity [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

Micropapillary bladder cancer: an evolving biology

Lonati

Simeone

Suardi

et al. 2022

Current Opinion in Urology

Self Cite

View full text Add to dashboard Cite

Purpose of reviewTo summarize a comprehensive overview of more recent evidence on micropapillary bladder cancer (MPBC), focusing on actual incidence, clinical features, therapeutic strategies, and prognosis.Recent findingsMPBC generally exhibits an aggressive behaviour compared with pure urothelial carcinoma (pUC) with advances in tumour stage and nodal and distant spread at diagnosis. Due to its rarity and presence of only small sample size and retrospective studies, no consensus currently exists regarding the most effective therapeutic strategy to be performed among nonmuscle-invasive (conservative treatment versus immediate radical cystectomy) and muscle-invasive MPBC (neoadjuvant therapy versus upfront radical cystectomy versus adjuvant chemotherapy).SummaryThe incidence of MPBC is recently increased according to latter literature, ranging from 2.9 to 7.6% of all bladder cancer. Despite its aggressive behaviour at time of presentation, more recent evidence fails to demonstrate a significant association between MPBC and worse outcomes compared with pUC when adjusted for clinical and pathological features. According to latter evidence, MPBC pathological response to NAC appears to be unsatisfactory compared with pUC patients while neoadjuvant immunotherapy with Pembrolizumab may represent an effective treatment among MPBC patients, based on PD-L1 and TMB expression.

show abstract

Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy with curative intent

Cited by 10 publications

References 20 publications

Overview of histologic variants of urothelial carcinoma: current trends and narrative review on treatment outcomes

Overview of histologic variants of urothelial carcinoma: current trends and narrative review on treatment outcomes

Neoadjuvant and Adjuvant Chemotherapy for Variant Histology Bladder Cancers: A Systematic Review and Meta-Analysis

Micropapillary bladder cancer: an evolving biology

Contact Info

Product

Resources

About