Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer

Marcq, Gautier; Jarry, Edouard; Ouzaïd, I.; Hermieu, Jean-François; Hénon, François; Fantoni, Jean-Christophe; Xylinas, Évanguelos

doi:10.1177/1756287218823678

Cited by 15 publications

(8 citation statements)

References 66 publications

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“…Neoadjuvant chemotherapy (NAC) followed by radical cystectomy is the standard treatment for MIBC; however, only about one third (25-50%) of patients achieve a pathologic response (5). Thus, the need to identify markers that predict response to neoadjuvant cisplatinbased chemotherapy is urgent because patients who do not respond to NAC are at risk of unnecessary drug-related complications and delayed surgery (6,7). Recently, immune checkpoint inhibitors atezolizumab, durvalumab, avelumab (targeting PD-L1), nivolumab, and pembrolizumab (targeting PD-1), along with the FGFR-targeted therapy erdafitinib, have been approved by the FDA for the treatment of advanced BC; however, unavailability of solid Review Article on Muscle-Invasive Bladder Cancer Tumor heterogeneity in muscle-invasive bladder cancer tumor-specific biomarkers that predict treatment response limits the utility of these new therapeutic strategies in clinical practice (8,9).…”

Section: Introductionmentioning

confidence: 99%

Tumor heterogeneity in muscle-invasive bladder cancer

et al. 2020

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Muscle-invasive bladder cancer (MIBC), a highly heterogeneous disease, shows genomic instability and a high mutation rate. Clinical outcomes are variable and responses to conventional chemotherapy differ among patients (due to inter-patient tumor heterogeneity and inter-tumor heterogeneity) and even within each individual tumor (intra-tumor heterogeneity). Emerging evidence indicates that tumor heterogeneity may play an important role in cancer progression, resistance to therapy, and metastasis. Comprehensive molecular subtyping classifies MIBC into distinct categories that have potential to guide prognosis, patient stratification, and treatment. Genomic characterization of timeseries analyses at the single cell level, and of cell-free circulating tumor DNA or circulating tumor cells, are emerging technologies that enable dissection of the complex clonal architecture of MIBC. This review provides insight into the clinical significance of the molecular mechanisms underlying heterogeneity, focusing on inter-and intra-tumor heterogeneity, with special emphasis on molecular classification and methods used to analyze the complex patterns involved.

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Section: Introductionmentioning

confidence: 99%

Tumor heterogeneity in muscle-invasive bladder cancer

et al. 2020

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“…Doxorubicin has been used for many years to treat bladder cancer [9]. If systemic chemotherapy is warranted to invade the muscle layer, superficial bladder cancer can be successfully treated by instilling the drug into the bladder.…”

Section: Discussionmentioning

confidence: 99%

Development of a method for serial intravesical administration of drugs in experiment

Kostiuk

Hodovan

Таран

et al. 2020

Biomed. and Biosoc. Anthrop.

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The technical difficulties of serial intravesical administration of drugs are a significant problem in preclinical studies of the effectiveness of local chemotherapy for superficial bladder cancer. The aim of the study was to develop and evaluate the effectiveness of the method of serial intravesical administration of drugs in the experiment. The study included 49 Wistar rats of both sexes. Five proposed methods of intravesical administration of drugs were investigated: retrograde catheterization of the urinary bladder under anesthesia, method of transcutaneous puncture of the urinary bladder in rats, intraoperative puncture of the bladder, method of subcutaneous fixation of the bladder for subsequent puncture in the experiment, method of serial intravesical administration of drugs in female rats using special catheter. The obtained data were processed using a package of statistical programs SPSS 20.0 for Windows. The disadvantage of the first technique is its trauma – each insertion of the catheter is accompanied by trauma of the urethral mucosa and associated pain. The manipulations were failed because of edema of the urethral mucosa. The manipulation should be performed under general anesthesia. The second technique also requires general anesthesia. The aggressive cytostatic action of Doxorubicin prevented the closure of the puncture hole and caused the development of complications. Sealing the bladder with a collagen plate when performing the third technique prevents the release of the drug into the abdominal cavity, however, the adhesion of the tissues of the surrounding organs to the plate promotes the formation of an adhesive conglomerate and makes further manipulations impossible. The withdrawal of the bladder from the abdominal cavity during the implementation of the fourth technique, theoretically, should have helped to avoid the complications observed during the third technique. However, insufficiently reliable fixation of the urinary and adhesions in the area of the implanted ring make this technique such that it does not correspond to the tasks set. The fifth method was the only one proposed that met all the assigned tasks. This technique made it possible to perform a series of 5 intravesical injections of Doxorubicin without general anesthesia and without the development of postoperative complications from the postoperative wound and abdominal cavity. The proposed method of serial intravesical administration of drugs in female rats using a special catheter makes it technically easy to perform serial intravesical administration of drugs without the use of general anesthesia and without the development of complications from the postoperative wound and abdominal cavity.

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“…Neo-adjuvant chemo-radiotherapy has been the mainstay of the treatment of bulky or loco-regionally advanced bladder tumor for the down-staging of the tumor. 29 However, the patient undergoing RC following neo-adjuvant chemo or radiotherapy might lead to some technical difficulties during surgery and postoperative period due to adhesions and bleeding tendency. 30,31 But with careful planning and use of modern techniques, those complications could be minimized.…”

Section: Bpkmchmentioning

confidence: 99%

Peri-Operative Morbidity and Outcomes of Radical Cystectomy- Institutional Experience of Single Center

et al. 2020

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Introduction: The incidence of urinary bladder carcinoma increases distinctly with increasing age. Radicalcystectomy has been the gold standard for the treatment of patients with muscle-invasive bladder cancer or recurrent high-grade non-muscle invasive bladder cancer. Our study aimed to see the peri-operative morbidity and surgical outcomes of the patient who had undergone radical cystectomy in our low volume center. Methods: We retrospectively reviewed the inpatient charts as well as the outpatient records of 10 patients who had undergone radical cystectomy performed in our center for 9 years. A review of the literature on perioperativemorbidity of radical cystectomy was also done using the combination of keywords like mortality, complications, and outcomes of surgery. Results: Age of the patients ranged from 40-80 years. Eight of them were male and two were female. Painlesshematuria (70%) was the commonest presenting symptom, 80% of them were smokers. Three patients received neoadjuvant chemotherapy. Nine patients had radical cystectomy with an ileal conduit, whereas one patient hadradical cystectomy with orthotropic neo-bladder. In postoperative complications, five patients had Clavien-Dindograde I, three patients had grade II, one patient had grade IIIB and one patient had grade V complications. Two years of cancer-free survival was 90% and five years of cancer-free survival was 50%. Conclusions: Radical cystectomy with ileal conduit was still the choice of surgery in muscle-invasive and recurrent high-grade non-muscle invasive bladder cancer.

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Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer

Cited by 15 publications

References 66 publications

Tumor heterogeneity in muscle-invasive bladder cancer

Tumor heterogeneity in muscle-invasive bladder cancer

Development of a method for serial intravesical administration of drugs in experiment

Peri-Operative Morbidity and Outcomes of Radical Cystectomy- Institutional Experience of Single Center

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