Prognosis of T1G3 Tumors: Clinical Factors

Barmoshe, Sas; Zlotta, Alexandre R.

doi:10.1016/j.eursup.2004.02.013

Cited by 9 publications

(8 citation statements)

References 63 publications

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“…Nonetheless, the reported response rate to this therapy is only 60% with a 5-year recurrence rate of 30% to 40% [7] and [8]. Moreover, for those patients with T1 disease or carcinoma in situ or both that are unresponsive to BCG therapy, the risk of progression to invasive disease may reach 50% [9] and [10]. …”

Section: Introductionmentioning

confidence: 99%

Predicting response to bacillus Calmette-Guérin (BCG) in patients with carcinoma in situ of the bladder

Núñez-Nateras

Castle

Protheroe

et al. 2014

Urologic Oncology: Seminars and Original Investigations

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Purpose Currently, there is no reliable tool to predict response to intravesical bacillus Calmette-Guérin (BCG). Based on the fact that BCG is a Th1-polarizing immunotherapy, we attempt to correlate the pretreatment immunologic tumor microenvironment (Th1 or Th2) with response to therapy. Materials and methods Bladder cancer patients with initial diagnosis of carcinoma in situ (Tis) were stratified based on their response to BCG treatment. A total of 38 patients met inclusion criteria (20 patients who responded and 18 patients who did not respond). Immunohistochemical (IHC) methods known to assess the type of immunologic microenvironment (Th1 vs. Th2) were performed on tumor tissue obtained at initial biopsy/resection: the level of tumor eosinophil infiltration and degranulation (Th2 response); the number of tumor-infiltrating GATA-3+ (Th2-polarized) lymphocytes; and the number of tumor-infiltrating T-bet+ (Th1-polarized) lymphocytes. Results obtained from these metrics were correlated with response to treatment with BCG immunotherapy. Results The IHC metrics of the tumor immune microenvironment prior to BCG treatment were each statistically significant predictors of responders (R) vs. nonresponders (NR). Eosinophil infiltration and degranulation was higher for R vs. NR: 1.02±0.17 vs. 0.5±0.12 (P = 0.01) and 1.1±0.15 vs. 0.56±0.15 (P = 0.04), respectively. Ratio of GATA-3+ (Th2-polarized) lymphocytes to T-bet+ (Th1-polarized) lymphocytes was higher for R vs. NR: 4.85±0.94 vs. 0.98±0.19 (P<0.001). The 3 markers were combined to create a Th2 signature biomarker, which was a statistically significant (P<0.0001) predictor of R vs. NR. All IHC markers demonstrated that a preexisting Th1 immunologic environment within the tumor was predictive of BCG failure. Conclusion The Th1 vs. Th2 polarization of bladder tumor immune microenvironment prior to treatment with BCG represents a prognostic metric of response to therapy. If a patient has a preexisting Th1 immunologic response within the tumor, there is no value in using a therapy intended to create a Th1 immunologic response. An algorithm integrating 3 IHC methods provided a sensitive and specific technique that may become a useful tool for pathologists and urologists to predict response to BCG in patients with carcinoma in situ of the bladder.

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Section: Introductionmentioning

confidence: 99%

Predicting response to bacillus Calmette-Guérin (BCG) in patients with carcinoma in situ of the bladder

Núñez-Nateras

Castle

Protheroe

et al. 2014

Urologic Oncology: Seminars and Original Investigations

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“…Intravesical BCG is used as first-line therapy for carcinoma in situ of the urinary bladder. BCG therapy showed a complete response rate of 60-68% (Syelvester et al, 2002;Barmoshe et al, 2004). Persistent disease after a complete course of therapy is cause of concern (Herr et al, 1989).…”

Section: Introductionmentioning

confidence: 99%

A Rare Complication of BCG Immunotherapy

Kolovani

Ramosaço²,

Byku³

et al. 2017

CBUP

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Intravesical Bacillus Calmette-Guérin immunotherapy is an effective agent for superficial bladder carcinoma. The main adverse effect of this treatment is cystitis. Arthralgia and migratory arthritis occur only in 0.5% of patients. Reiter syndrome is a very rare complication that can occur after intravesical apply of Bacillus Calmette-Guérin Immunotherapy. We report the first Albanian patient who developed Reiter's syndrome, following intravesical Bacillus Calmette-Guérin. Diagnose of Reiter's Syndrome was clinically based, excluding every other reason that could have caused it. Treatment was made with non-steroid and steroid anti-inflammatory drugs, followed by a full recovery result. Even though Reiter's Syndrome is a rare, but significant complication of BCG immunotherapy, it's important to identify it in time, in order we to offer an adequate treatment.

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“…1 This scenario is different from that where BCG intravesical therapy is unsuccessful in highrisk T1 disease and/or CIS, where a risk of progression may sometimes reach 50%. 1,2 Controversy exists over the most appropriate treatment for high-risk superficial bladder cancer 1 (stage T1, grade G3 or the new classification of high grade). 2,3 Immediate cystectomy offers the best chance for survival but may be associated with impaired quality of life (QOL) compared with conservative therapy.…”

Section: Introduction and Issuesmentioning

confidence: 99%

“…1,2 Controversy exists over the most appropriate treatment for high-risk superficial bladder cancer 1 (stage T1, grade G3 or the new classification of high grade). 2,3 Immediate cystectomy offers the best chance for survival but may be associated with impaired quality of life (QOL) compared with conservative therapy. A second option is administration of BCG.…”

Section: Introduction and Issuesmentioning

confidence: 99%

“…It represents a frequent dilemma, since approximately 30% to 40% of patients do not respond to this therapy. 1,2 Treatment options should be divided between those patients with low-grade disease who do not respond to treatment and those with high-grade disease and/or progress who do not respond, the latter being associated with poor prognosis. Although grouped under the same terminology, NMIBC consists of 2 biologically different diseases.…”

Section: Introduction and Issuesmentioning

confidence: 99%

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The management of BCG failure in non-muscle-invasive bladder cancer: an update

Zlotta

Fleshner

Jewett

2013

CUAJ

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Up to 40% of patients with non-muscle-invasive bladder cancer (NMIBC) will fail intravesical bacillus Calmette-Guérin (BCG) therapy. There is unfortunately no current gold standard for salvage intravesical therapy after appropriate BCG treatment. Indeed, outcomes are at best suboptimal. The vast majority of low-grade NMIBC are prone to recur but very rarely progress. Failure after intravesical BCG in these patients is usually superficial and lowgrade. At the other end of the spectrum, failure to respond to BCG in high-risk T1 bladder cancer and/or carcinoma in situ (CIS or TIS) is more problematic, since those tumours often have the potential to progress to muscle invasion. In these cases, radical cystectomy remains the mainstay after BCG failure. With appropriate selection, certain patients who "fail" BCG (but with favourable risk factors) can be managed with intravesical regimens, including repeated BCG, BCG plus cytokines, intravesical chemotherapy, thermochemotherapy or new immunotherapeutic modalities. In this review, reasons explaining BCG failure, how to define BCG failure, optimal risk stratification and prediction of response and management of BCG failures are discussed.

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Prognosis of T1G3 Tumors: Clinical Factors

Cited by 9 publications

References 63 publications

Predicting response to bacillus Calmette-Guérin (BCG) in patients with carcinoma in situ of the bladder

Predicting response to bacillus Calmette-Guérin (BCG) in patients with carcinoma in situ of the bladder

A Rare Complication of BCG Immunotherapy

The management of BCG failure in non-muscle-invasive bladder cancer: an update

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