The Value of Multiparametric Magnetic Resonance Imaging Sequences to Assist in the Decision Making of Muscle-invasive Bladder Cancer

Bandini, Marco; Calareso, Giuseppina; Raggi, Daniele; Marandino, Laura; Colecchia, Maurizio; Gallina, Andrea; Giannatempo, Patrizia; Pederzoli, Filippo; Gandaglia, Giorgio; Fossati, Nicola; Capitanio, Umberto; Colombo, Renzo; Salonia, Andrea; Briganti, Alberto; Montorsi, Francesco; Cobelli, Francesco De; Messina, Antonella; Necchi, Andrea

doi:10.1016/j.euo.2020.06.004

Cited by 25 publications

(15 citation statements)

References 13 publications

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“…While the diagnostic accuracy of the internally and externally assessed complete RaR for pT0 outcome was comparable (AUC 0.76, 95% CI 0.68-0.83, and 0.74, CI 0.66-0.82, respectively), the outcomes from the combined complete/partial responders' assessment (i.e., pT ≤ 1) were less promising (rate of response 94.6% and 96% in internal and external assessments, respectively). These results were similar to those presented in the following analysis made on the final population of evaluable patients [14]. Additionally, the spectrum for optimal partial responders' classification was not sufficiently reached with some of the mpMRI step combinations for RaR judgment, suffering from granular distribution and thus resulting not consistent with clinical applicability.…”

Section: Discussionsupporting

confidence: 81%

“…To date, Necchi et al [13,14] were the first reporting the outcomes of the use of MRI for tumor response to neoadjuvant pembrolizumab assessment form the PURE-01 trial. In this experience, three readers assessed response to therapy relying on a dichotomized answer (yes vs. no) to predefined per-sequence (T2, DWI, DCE) question whether the mpMRI was suggestive for residual disease.…”

Section: Discussionmentioning

confidence: 99%

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Vesical Imaging-Reporting and Data System (VI-RADS) for assessment of response to systemic therapy for bladder cancer: preliminary report

et al. 2021

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Purpose The Vesical Imaging-Reporting and Data System (VI-RADS) criteria are expanding, providing fine differentiation of bladder wall layers involvement. We aimed to explore the feasibility of a novel categorical scoring, the Neoadjuvant chemotherapy VI-RADS (nacVI-RADS) for radiologic assessment of response (RaR), to define the spectrum of treatment response among patients with muscle invasive bladder cancer (MIBC). Methods Ten consecutive patients diagnosed with non-metastatic MIBC were prospectively enrolled and addressed to NAC and underwent mpMRI before staging resection and after the chemotherapy cycles. The follow-up MRI assessment was performed using the nacVI-RADS algorithm for evaluation of response to therapy. NacVI-RADS categorically define complete RaR, based on prior VI-RADS score, presence of residual disease, tumor size, and infiltration of the muscularis propria. Results NacVI-RADS categories were able to match all the final radical cystectomy pathology both for complete pT0 responders and for the patients defined as partial or minimal responders, who only showed some RaR inter-scoring class downstaging. Conclusion This report is the preliminary evidence of the feasibility of nacVI-RADS criteria. These findings might lead to possible paradigmatic shifts for cancer-specific survival risk assessment and to possibly drive the therapeutic decision through active surveillance programs, bladder-sparing modalities, or to the standard of care.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Vesical Imaging-Reporting and Data System (VI-RADS) for assessment of response to systemic therapy for bladder cancer: preliminary report

et al. 2021

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“…In particular, EFS was able to count as events the few patients who did not experience a disease progression according to RECIST but who received sequential standard chemotherapy per investigator decision, based on the radiologically-ascertained potential lack of response to pembrolizumab. 13,14 The definition that we adopted, in the study as well as in this analysis, is a modified version of the one proposed by the United States Food and Drug Administration (US-FDA; accessible at https://fda1.webex. com/webappng/sites/fda1/recording/ef2209fadb7c4add 90483d716977d32c).…”

Section: Discussionmentioning

confidence: 99%

“…unresectable tumor, metastases discovered at RC), (v) local or distant recurrence assessed by cross-sectional imaging and/or biopsy after RC, and (vi) death from any cause. In this study, patient refusal to undergo RC after the evidence of CR assessed with multiparametric magnetic resonance imaging (mpMRI) of the bladder (as previously described) 13,14 was not considered an event. These patients were censored at the date of last follow-up if no events occurred.…”

Section: Study Outcomesmentioning

confidence: 99%

Does the administration of preoperative pembrolizumab lead to sustained remission post-cystectomy? First survival outcomes from the PURE-01 study☆

et al. 2020

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Background: Initial studies of preoperative checkpoint inhibition before radical cystectomy (RC) have shown promising pathologic complete responses. We aimed to analyze the survival outcomes of patients enrolled in the PURE-01 study (NCT02736266). Patients and methods: We report the results of the secondary end points of PURE-01 in the final population of 143 patients. In particular, we report the event-free survival (EFS) outcomes, defined as the time from the first cycle of pembrolizumab to radiographic disease progression precluding RC, initiation of neoadjuvant chemotherapy (NAC), recurrence after RC, or death from any cause. Other end points were recurrence-free survival (RFS) and overall survival (OS). Subgroup analyses were carried out, including pathological response category, clinical complete responses (CR) assessed via multiparametric magnetic resonance imaging (mpMRI), and molecular subtyping. Cox regression analyses for EFS were also carried out. Results: After a median [interquartile range (IQR)] follow-up of 23 (15-29) months, 12-and 24-month EFS were 84.5% [95% confidence interval (CI): 78.5-90.9] and 71.7% (62.7-82). The prognosis was favorable across all the different pathological response subgroups, with the exception of ypNþ (N ¼ 21), showing a 24-month RFS (95% CI) of 39.3% (19.2% to 80.5%). A statistically significant EFS benefit was observed in patients with a clinical CR (P ¼ 0.002). Programmed cell-death-ligand-1 combined positive score was significantly associated with longer EFS in multivariable analyses. Four patients refused RC after clinical evidence of CR, and none of them have recurred after a median follow-up of 10 months . The claudin-low subtype displayed a numerically longer EFS after pembrolizumab and RC compared with the other subtypes. Conclusions: The EFS results from PURE-01 revealed that the immunotherapy effect was maintained post-RC in most patients. Pembrolizumab compared favorably with neoadjuvant chemotherapy, irrespective of the biomarker status. Molecular subtyping may be a useful tool to select the patients who are predicted to benefit the most from neoadjuvant pembrolizumab.

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“…(1) Bimanual palpation has always been recommended in textbooks, but we have never been able to appreciate its value in our everyday practice. In the era of sophisticated imaging [2][3][4], we have been able to address reasonably well every single case of bladder cancer presenting for observation without using bimanual palpation. (2) Flexible cystoscopy should always be performed before transurethral resection of a bladder mass identified by noninvasive imaging [5].…”

mentioning

confidence: 99%

Re: Hugh Mostafid, Ashish M. Kamat, Siamak Daneshmand, et al. Best Practices to Optimise Quality and Outcomes of Transurethral Resection of Bladder Tumours. Eur Urol Oncol 2021;4:12–9

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et al. 2021

European Urology Oncology

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The Value of Multiparametric Magnetic Resonance Imaging Sequences to Assist in the Decision Making of Muscle-invasive Bladder Cancer

Cited by 25 publications

References 13 publications

Vesical Imaging-Reporting and Data System (VI-RADS) for assessment of response to systemic therapy for bladder cancer: preliminary report

Vesical Imaging-Reporting and Data System (VI-RADS) for assessment of response to systemic therapy for bladder cancer: preliminary report

Does the administration of preoperative pembrolizumab lead to sustained remission post-cystectomy? First survival outcomes from the PURE-01 study☆

Re: Hugh Mostafid, Ashish M. Kamat, Siamak Daneshmand, et al. Best Practices to Optimise Quality and Outcomes of Transurethral Resection of Bladder Tumours. Eur Urol Oncol 2021;4:12–9

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