Expert Commentary Articles

Articles

  • A Multicentered, Propensity Matched Analysis Comparing Laparoscopic and Open Surgery for pT3a Renal Cell Carcinoma: Expert Commentary

    Laparoscopic renal surgery (LRS) has long been recognized for its improvements over open renal surgery for patient quality of life. However, LRS efficiency in terms of oncology and recurrences has yet to be compared. This team attempted to do just that by contrasting ORS and LRS on patients with Pathologic T3a (pT3a).
    Published September 15, 2017
  • A Phase I Study of Enfortumab Vedotin in Japanese Patients with Locally Advanced or Metastatic Urothelial Carcinoma - Expert Commentary

    Enfortumab Vedotin (EV) is a novel antibody-drug conjugate targeting Nectin-4, which is overexpressed in urothelial cancer. A recent study published by Takahashi et al. in Investigational New Drugs studied EV in locally advanced/metastatic urothelial cancer in a phase I study (NCT03070990).1 The researchers included patients who were diagnosed with locally advanced or metastatic urothelial carcinoma and were cisplatin-ineligible or failed at least one chemotherapy treatment. Nine patients were randomly assigned to Arm A to receive EV at 1.0 mg/kg, and eight patients were assigned to Arm B to receive EV at 1.25 mg/kg on days 1, 8, and 15 of 28-day cycles.

    Published January 6, 2020
  • A Prognostic Nomogram for Patients with Intravesical Recurrence After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma - Expert Commentary

    Defining the prognosis of patients who develop intravesical recurrence (IVR) after radical nephroureterectomy (RNU) is critical for the optimal management of these patients. A recent study published by Hou et al. in the World Journal of Urologyexamined the independent prognostic factors and constructed a nomogram to predict the 1-, 3-, and 5-year probability of individual cancer-specific survival (CSS).
    Published March 2, 2020
  • A Randomized Phase II Trial of Vinflunine and Gemcitabine Versus Carboplatin and Gemcitabine in Cisplatin-Ineligible Patients with Advanced Urothelial Carcinoma - Expert Commentary

    A significant number of patients with locally advanced and metastatic urothelial cancer (aUC) are not eligible for cisplatin-based chemotherapy.
    Published January 16, 2020
  • A Urine-Based Methylation Test for Bladder Cancer — Expert Commentary

    Early identification of bladder cancer (BC) is critical for improving clinical outcomes. Developing urine-based molecular biomarkers is an area of active research. A recent study published in Urologic Oncology: Seminars and Original Investigations described a urine-based methylation analysis of TWIST1, NID2, RUNX3, GATA4, and FOXE1 in urinary cell pellet DNA as a biomarker.
    Published June 23, 2020
  • Adjuvant Chemotherapy in Patients with Urothelial Carcinoma and Adverse Pathologic Features Receiving Prior Neoadjuvant Chemotherapy and Radical Cystectomy - Expert Commentary

    Neoadjuvant chemotherapy is a standard of care for patients with cisplatin-eligible muscle-invasive urothelial carcinoma. For patients who do not receive neoadjuvant chemotherapy, there is evidence of a benefit associated with cisplatin-based adjuvant chemotherapy after radical cystectomy for patients with pT3/T4 and/or pN+ bladder cancer. It is unknown whether additional adjuvant chemotherapy is beneficial for patients with adverse pathological features after neoadjuvant chemotherapy and radical cystectomy. 
    Published September 2, 2017
  • Adjuvant Chemotherapy in Upper Tract Urothelial Carcinoma: Results of the POUT Trial - Expert Commentary

    Upper tract urothelial (UTUC) is an uncommon malignancy. Defining the impact of adjuvant chemotherapy on long term outcomes in UTUC patients is a critical clinical question. Recently, Birtle et al. reported in The Lancet the results of a landmark Phase III, open-label, randomized controlled POUT trial to evaluate the use of adjuvant platinum-based chemotherapy after radical nephroureterectomy in UTUC patients1.
    Published March 26, 2020
  • APOBEC Mutagenesis is Associated with FGFR3 S249C Mutations in Bladder Cancer - Expert Commentary

    FGFR3 mutations are common in urothelial carcinoma. The APOBEC mutational process is the dominant mutational mechanism in bladder cancer. The relationship between the overexpression of FGFR3 S249C mutation and APOBEC mutagenesis is not well understood. A new study published by Shi et al. in European Urology examined the link between the APOBEC mutational load and different FGFR3 recurrent mutations in bladder cancer.
    Published August 16, 2019
  • Arsenic Exposure and Upper Tract Urothelial Carcinoma Outcomes — Expert Commentary

    Arsenic exposure is associated with a higher risk of developing urothelial carcinoma (UC). Previous studies mostly focused on UC of the bladder. A deeper understanding of how this environmental exposure affects clinical outcomes in upper tract urothelial carcinoma (UTUC) is needed.
    Published June 29, 2020
  • Association of Testosterone Replacement With Cardiovascular Outcomes Among Men With Androgen Deficiency: Expert Commentary

    As men get older, starting at the age of 30 years, their testosterone levels decrease by an average of 3.1 to 3.5ng/dL per year1. Low levels of testosterone can lead to androgen deficiency, symptoms which include: loss of sexual desire, erectile dysfunction, breast enlargement or tenderness, hot flashes, reduced energy, irritability, and depressed mood. Exogenously administered testosterone, or testosterone replacement therapy (TRT) is used to treat androgen deficiency2; Some studies have shown an increase in cardiovascular  (CV) adverse events when using TRT3-5, while others show that TRT may have CV benefits6-8. The primary goal of this study was to view more closely the association between TRT and CV outcomes in androgen deficient men. 

    This was a retrospective cohort study that looked at men at least 40 years old between January 1, 1999 and December 31, 2010, with evidence of androgen deficiency, either by coded diagnosis or serum testosterone testing. The cohort was then followed-up to the first 90, 180, and 365 days through December 31, 2012, and was classified into ever-TRT or never-TRT groups. The primary outcome was c omposite of 4 CV events: (1) acute myocardial infarction, (2) unstable angina, (3) combined stroke, and (4) sudden cardiac death. Baseline conditions and comorbidities were accounted for and controlled. For statistical analysis, a multivariable Cox proportional hazards model was used. 

    In total, 129, 544 were identified in the study and 44,335 of these men met inclusion and exclusion criteria. The cohort consisted of 8808 men in the ever-TRT group and 35,527 men in the never-TRT group. The rates of the composite cardiovascular end point were 23.9 vs 16.9 per 1000 person in the never-TRT and ever-TRT groups, respectively. The adjusted hazard ratio (HR) for the composite cardiovascular end point in the ever-TRT group was 0.67. When outcome was restricted to combine stroke and cardiac events, similar scores of 0.72 and 0.66 were seen, respectively.

    In conclusion, the results of the study showed that TRT was associated with a lower risk of CV events, which are consistent with other studies9-11. In addition, it is recommended that men with hypogonadism be receiving TRT, as they are other plentiful of health benefits. Some limitations that the authors note was the criteria for identifying androgen-deficient males did not meet strict criteria and therefore by misclassified as androgen-deficient, and the observational nature of the study. 

    Written by: Zhamshid Okhunov, MD Department of Urology, University of California, Irvine Urology

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    References:
    • Venhola M, Reunanen M, Taskinen S et al: Interobserver and intra-observer agreement in interpreting urodynamic measurements in children. J Urol 2003; 169: 2344.
    • Bauer SB, Nijman RJ, Drzewiecki BA et al: International Children’s Continence Society standardization report on urodynamic studies of the lower urinary tract in children. Neurourol Urodyn 2015; 34: 640
    Published November 9, 2017
  • Avelumab, an Anti–Programmed Death-Ligand 1 Antibody, In Patients With Refractory Metastatic Urothelial Carcinoma: Results From a Multicenter, Phase Ib Study - Expert Commentary

    Platinum-resistant urothelial carcinoma is a lethal disease. After a long period of therapeutic stagnation, the last two years have witnessed an explosion in the development of new second-line therapies.
    Published August 10, 2017
  • BCG Immunotherapy Versus Radical Cystectomy in Intermediate or High-Risk Non-Muscle Invasive Bladder Cancer Patients - Expert Commentary

    Treatment options available for intermediate or high-risk non-muscle invasive bladder cancer include intravesical Bacillus Calmette-Guerin (BCG) and radical cystectomy.
    Published February 5, 2020
  • Bladder Cancer Outcomes in Women Vary over Time - Expert Commentary

    Understanding differences in bladder cancer outcomes between men and women can help physicians tailor optimal treatment and follow-up strategies.
    Published November 11, 2019
  • Carcinoma In Situ of the Bladder with Plasmacytoid Features - Expert Commentary

    Carcinoma in situ (CIS) is a distinct pathological entity. The significance of histological variants associated with CIS is not well-understood.
    Published September 9, 2019
  • Circulating Tumor Cells in Bladder and Upper Tract Urothelial Carcinoma - Expert Commentary

    Circulating tumor cells (CTCs) are cancer cells shed from the tumor that enter the circulation. Isolating circulating tumor cells from urothelial carcinoma patients has several potential diagnostic, prognostic and predictive clinical applications but the available data has been inconclusive.
    Published July 11, 2017
  • Clinical Outcomes in Patients with Micropapillary Urothelial Carcinoma of the Bladder - Expert Commentary

    Micropapillary (MP) is a histological variant of bladder cancer. As with most other histological variants of bladder cancer, the available data is derived from small case series and treatment is based on expert opinion. More knowledge about treatment and prognosis of MP UBC is needed to identify the optimal therapy for MP UBC. 
    Published May 15, 2019
  • Comparing the Outcomes of ddMVAC vs. GC before Cystectomy in Patients with Muscle Invasive Bladder Cancer - Expert Commentary

    Patients with muscle-invasive bladder cancer  (MIBC) who are treated with neoadjuvant chemotherapy (NAC) before cystectomy have a survival advantage. Few studies comparing cancer control and survival outcomes for different NAC regimens exist.
    Published October 26, 2018
  • Conditional Reprogramming of Patient-derived Bladder Cancer Cells for Personalized Treatment Strategies – Expert Commentary

    There is a broad spectrum of bladder cancer responsiveness to treatment in the clinic. The development of practical methods to provide accurate, individualized drug sensitivity information from each patient's tumor is needed to improve outcomes.
    Published August 16, 2019
  • Contemporary Use Trends and Survival Outcomes in Patients Undergoing Radical Cystectomy or Bladder-Preservation Therapy for Muscle-Invasive Bladder Cancer - Expert Commentary

    Bladder preservation therapy is a definitive treatment option for clinically localized bladder cancer.  Previous studies demonstrated improved 10-year locoregional control when comparing chemo-radiotherapy with radiation therapy alone. However, evidence from prospective or randomized controlled trials comparing survival outcomes of patients treated with bladder preservation with those of patients receiving radical cystectomy is generally lacking.
    Published August 8, 2017
  • Cytological Features of Micropapillary and Plasmacytoid Variants of Urothelial Carcinoma - Expert Commentary

    The micropapillary and plasmacytoid variants are rare and aggressive urothelial carcinoma (UC) subtypes. The morphological features of these variants in urine cytology are not well described. A recent study published by Straccia et al. in Diagnostic Cytopathologyevaluated the urine cytology of 15 high-grade UC cases with plasmacytoid and micropapillary histology to define their cytomorphological characteristics. The study included six patients with the plasmacytoid variant and nine patients with the micropapillary variant. The cohort included three females and 12 males. The median age was 79 years (range 72-90 years).
    Published February 27, 2020
  • Detection of TERT Promoter Mutations in Urine Precedes the Clinical Diagnosis of Bladder Cancer - Expert Commentary

    There is a need for a non-invasive for early detection of bladder cancer (BC). Telomerase reverse transcriptase (TERT) promoter mutations are common in bladder cancer patients. A recent study by Hosen MI et al. in BioMedicine investigated the use of an amplicon-based Ion Torrent sequencing assay (UroMuTERT) and digital PCR assays to examine the use of TERT promoter mutations for BC screening.1 In this case-control study, the investigators included 30 BC cases and 101 controls in the final analysis.
    Published March 30, 2020
  • Diagnosing Bladder Cancer using Urinary Cell-Free microRNA - Expert Commentary

    Although hematuria is the most common symptoms of bladder cancer (BC), it can be caused by many non-malignant conditions. The low sensitivity of voided urine cytology (VUC) and the invasiveness the cystoscopy, create an unmet need for a noninvasive test with high accuracy to detect BC in patients with hematuria. 
    Published October 24, 2018
  • Do Molecular Subtypes of Muscle-invasive Bladder Cancer Predict Response to Neoadjuvant Chemotherapy? - Expert Commentary

    Neoadjuvant chemotherapy is a standard of care for muscle-invasive bladder cancer (MIBC). Recently, new molecular subtypes based on gene-expression were identified but their impact on response to neoadjuvant has been unclear.
    Published April 21, 2017
  • Does Pathologic Response to Neoadjuvant Chemotherapy Predict Survival in Muscle-Invasive Bladder Cancer Patients? - Expert Commentary

    Patients who achieved a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) have a better prognosis compared to patients with pathologic residual disease (pRD). The clinical value of these pathological responses over the long-term to NAC is not well understood.

    A new article published by Waingankar et al. in Urologic Oncology: Seminars and Original Investigations1examined the impact of NAC pathological response on the anticipated survival (conditional survival) based on the years from the RC. Using the National Cancer Database, the investigators identified patients diagnosed with localized MIBC and treated with NAC and RC between 1998 and 2012. They included 1,533 patients in the study. Of these, 314 patients achieved pCR (pathologic stage of Ta, Tis, or T0 and N0) and 1,239 had pRD patients (≥ pT1 disease and/or ≥pN1). They used Kaplan-Meier analysis to calculate the survival between the two groups and used a Cox proportional hazard model to study the effect of achieving pCR on survival from the time of RC.

    During the follow-up period, Patients with pCR had a significantly higher initial probability of survival in year zero (P < 0.001). This effect was sustained in subsequent years. Patients with pCR had improved overall survival relative to those with pRD. As expected, the prognosis for MIBC patients continued to improve with ongoing survivorship, both for patients with pCR and pRD following NAC and RC.

    This study adds to the growing literature examining the pCR after NAC as a predictor of overall survival. However, several pathologic and clinical factors affect the accuracy of pCR assessment. Testing this concept in prospective clinical trials is needed to validate pCR as an endpoint for future clinical trials.

    Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

    Reference: 
    1. Waingankar, Nikhil, Rachel Jia, Kathryn E. Marqueen, Francois Audenet, John P. Sfakianos, Reza Mehrazin, Bart S. Ferket, Madhu Mazumdar, and Matthew D. Galsky. "The impact of pathologic response to neoadjuvant chemotherapy on conditional survival among patients with muscle-invasive bladder cancer." In Urologic Oncology: Seminars and Original Investigations. Elsevier, 2019.

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    Published September 9, 2019
  • Does Pre-Treatment Quality of Life Impact the Prognosis of Patients with Urothelial Carcinoma? - Expert Commentary

    The relationship between the baseline quality of life (QOL) and clinical outcomes for urothelial cancer (UC) patients is not well defined. A recent study published by Suppanuntaroek et al. investigated the relationship between pre-treatment quality of life (QOL) and overall survival (OS) in UC patients. The authors included 125 non-metastatic UC patients who underwent a radical cystectomy or nephroureterectomy for non-metastatic UC (M0 group) and 80 metastatic UC who received chemotherapy for metastatic UC (M1 group) between June 2013 and May 2019.
    Published February 19, 2020
  • Drivers of the Immune Microenvironment in Bladder Cancer - Expert Commentary

    Understanding cancer-cell autonomous mechanisms that shape the immune microenvironment and mediate resistance to immune checkpoint blockade in bladder cancer is of paramount importance.
    Published July 8, 2020
  • Early Detection of Bladder Urothelial Cell Carcinoma Using Micronuclei, Nucleoplasmic Bridges and Nuclear Buds - Expert Commentary

    Chromosomal damage, breakage, loss, and rearrangement are early events in cancer initiations. A recent study published by Podrimaj-Bytyqi et al. in Scientific Reports evaluated the use of chromosomal damage as a biomarker for the early detection of bladder cancer using micronuclei (MN) assays. The investigator assessed the frequencies of biomarkers of chromosomal damage including: (MN), nucleoplasmic bridges (NPBs) and nuclear buds (NBUDs) as predictors of genomic instability. The study enrolled 40 non-smoker urothelial carcinoma patients and 20 controls. The investigators simultaneously conducted MN assays in urothelial exfoliated cells (UEC), buccal exfoliated cells (BEC), and a cytokinesis-block micronucleus (CBMN) cytome assay in peripheral blood lymphocytes (PBL). 
    Published March 12, 2019
  • Early Detection of Relapse using Circulating Tumor DNA in Patients with Urothelial Bladder Carcinoma – Expert Commentary

    The use of circulating tumor DNA (ctDNA) as an early detection tool is a promising development. However, the clinical utility of ctDNA in urothelial bladder cancer is not fully understood.
    Published August 16, 2019
  • Efficacy and Safety of Neoadjuvant Pembrolizumab in Patients with Muscle-Invasive Bladder Cancer - Expert Commentary

    Neoadjuvant chemotherapy followed by radical cystectomy (RC) with lymph node dissection is the standard of care in patients with muscle-invasive urothelial bladder carcinoma (MIBC). Unfortunately, many patients are ineligible or unwilling to receive cisplatin-based neoadjuvant chemotherapy.
    Published March 6, 2019
  • EMT Dysregulation Promotes the Most Aggressive Variant of Sarcomatoid Bladder Cancer - Expert Commentary

    Sarcomatoid urothelial bladder cancer (SARC) is an aggressive histological variant of bladder cancer. It is associated with early distant metastasis and poor survival rates. Understanding the molecular characteristics of SARC will lead to improved clinical outcomes.
    Published January 20, 2020
  • Factors Associated with Recurrence in Primary Carcinoma in situ of the Bladder Treated with Bacillus Calmette-Guérin - Expert Commentary

    Primary carcinoma in situ (P-CIS) of the bladder is rare. Adjuvant intravesical Bacillus Calmette-Guérin (BCG) immunotherapy has been reported to be effective in reducing recurrence rates in CIS and P-CIS patients but the clinical factors associated with the recurrence of P-CIS are not well-defined. 
    Published November 5, 2018
  • FOXA1 and Oncogenic HRAS are Required for Maintenance of Urothelial Hyperplasia - Expert Commentary

    The oncogene addiction model occurs when cancer cells become dependent on one mutated oncogene or pathway for the maintenance of a malignant phenotype. Withdrawal of the oncogenic signal leads to the regression of cancer. The role of oncogenic addiction in precursor lesions such as hyperplasia is not well understood. A recent study by Yee et al.  in Scientific Reports examined the interaction between Forkhead box A1 (FOXA1), a transcriptional activator of the Upk2-promoter in controlling the expression of oncogenic HRAS to induce urothelial hyperplasia in transgenic mice.1 By knocking out FOXA1, the investigators simulated oncogenic HRAS withdrawal. This resulted in a significant reduction of urothelial proliferation consistent oncogenic addiction to HRAS.

    Interestingly, the investigators found that reduced proliferation did not affect basal cells indicating that the regulation of oncogenic HRAS by Upk2 occurs mainly in luminal cells. These results demonstrate the dependence of urothelial hyperplasia on the continuous expression of Foxa1 and activated HRAS in this model.

    This important study adds to our understanding of the events that result in oncogenic addiction in urothelial hyperplasia. Additional studies characterizing the molecular events that occur in normal urothelium and precursor lesions such as hyperplasia have the potential for improving early-detection and for designing strategies to prevent progression.

    Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

    Reference: 1. Yee CH, Zheng Z, Shuman L, Yamashita H, Warrick JI, Wu XR, Raman JD, DeGraff DJ. Maintenance of the bladder cancer precursor urothelial hyperplasia requires FOXA1 and persistent expression of oncogenic HRAS. Sci Rep. 2019 Jan 22;9(1):270. doi: 10.1038/s41598-018-36720-6.


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    Published October 15, 2019
  • Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy in Patients with Locally Advanced Bladder Cancer - Expert Commentary

    Methotrexate-vinblastine-doxorubicin-cisplatin (MVAC) neoadjuvant chemotherapy is a standard of care for muscle-invasive urothelial bladder cancer. However, gemcitabine-cisplatin (GC) is equally effective and associated with less toxicity in the metastatic setting. This has been extrapolated to the neoadjuvant setting in clinical practice. A recent study by Niedersüss-Beke et al. in the journal Oncologyprospectively evaluated the clinical outcomes of neoadjuvant GC in patients with locally advanced urothelial cancer.
    Published April 28, 2017
  • Gemcitabine-Eribulin in Cisplatin-Ineligible Patients with Metastatic Urothelial Carcinoma - Expert Commentary

    The optimal treatment for cisplatin-ineligible patients with metastatic urothelial cancer is unknown. A recent study published by Sadeghi et al. in the Journal of Clinical Oncology1 examined the efficacy of the gemcitabine-eribulin combination in this patient population.

    Cisplatin-ineligibility was defined as a creatinine clearance <60 ml/min and ≥30ml/min, grade 2 or above hearing loss and grade 2 or higher neuropathy. The study enrolled twenty-four patients between 2015 and 2017. Subjects received 1,000 mg/m2 of gemcitabine intravenously 30 minutes before 1.4 mg/m2 eribulin on day 1 and 8 in 21-day cycles until progression or unacceptable toxicity. The median age of enrolled patients was 73 years (range 62-88 years). Most patients had a performance status of 0 or 1. The majority of patients (16/24) had lymph node metastases, and several patients had visceral metastases.

    The observed objective response rate was 50% (95% CI, 29% to 71%) in 12/24 patients. The median overall survival was 11.9 months (95% CI, 5.6 to 20.4 months), and median progression-free survival was 5.3 months (95% CI, 4.5 to 6.7 months). Common toxicities included fatigue (83% of patients), neutropenia (79%), anemia (63%), alopecia (50%), elevated AST (50%), constipation, nausea, and thrombocytopenia (42% each).

    This study demonstrated the efficacy of the combination of gemcitabine-eribulin in cisplatin-ineligible metastatic urothelial cancer patients. Prospective trials comparing the efficacy of carboplatin-based regimens, immunotherapy, and gemcitabine-eribulin combinations are needed to determine the optimal treatment regimen.

    Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

    Reference: 
    1. Sadeghi, Sarmad, Susan G. Groshen, Denice D. Tsao-Wei, Rahul Parikh, Amir Mortazavi, Tanya B. Dorff, Cheryl Kefauver et al. "Phase II California Cancer Consortium Trial of Gemcitabine-Eribulin Combination in Cisplatin-Ineligible Patients With Metastatic Urothelial Carcinoma: Final Report (NCI-9653)." Journal of Clinical Oncology (2019): JCO-19.

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    Published September 9, 2019
  • Gender Disparities in Clinical Outcomes after Cystectomy - Expert Commentary

    Understanding the demographic factors which affect clinical outcomes following radical cystectomy (RC) is critical for improving oncologic outcomes for all patients. A recent study published in European Urology Oncology examined intraoperative and postoperative differences in outcomes between male and female patients who underwent radical cystectomy.
    Published January 23, 2020
  • Gene Methylation and Urine Cytology to Monitor Bladder Cancer - Expert Commentary

    Currently, intermediate or high-risk non-muscle-invasive bladder cancer patients (NMIBC) require intensive follow-up. This usually consists of urethrocystoscopy (gold standard) and urine cytology to monitor the recurrence of NMIBC. The current methods are expensive and invasive and have low sensitivity. 
    Published July 23, 2018
  • Immune Phenotype of Peripheral Blood Mononuclear Cells in Patients with High-risk Non-muscle Invasive Bladder Cancer - Expert Commentary

    Non-muscle-invasive bladder cancer (NMIBC) has a high recurrence rate. Although the BCG therapy is recommended as an immune targeting treatment in high-risk NMIBC tumors, the BCG’s role in the eliciting a response by the innate and adaptive immunity is unclear. A recent study by Audenet et al. published recently in the World Journal of Urology, investigated the immune phenotype of peripheral blood mononuclear cells (PBMC) in patients with NMIBC treated with intravesical BCG. 
    Published July 31, 2018
  • Immunohistochemical Markers for Risk Stratification of Patients with Muscle-Invasive Bladder Cancer - Expert Commentary

    The relationship between the expression of GATA3, cytokeratin (CK) 20, CK 5/6, and p53 and survival in patients with muscle-invasive bladder cancer (MIBC) is not well characterized.
    Published January 9, 2020
  • Impact of Time to the Second TURBT on Oncological Outcomes in Non-Muscle Invasive Bladder Cancer Patients Treated with BCG - Expert Commentary

    The effect of restaging transurethral resection (Re-TUR) timing after initial transurethral resection of bladder tumor (TURBT) on survival rates is not well studied. A recent study published by Calò et al. in the World Journal of Urologyinvestigated the appropriate time frame for patients with high-grade T1 bladder cancer (BC) to undergo Re-TUR.
    Published June 16, 2020
  • Intravesical BCG Versus Radical Cystectomy for High-Risk NMIBC with Histologic Variants - Expert Commentary

    The optimal management of non-muscle invasive bladder cancer (NMIBC), some histologic variants, including squamous and glandular, is challenging. A recent article published by Suh et al. in Scientific Reports compared Bacillus Calmette-Guérin (BCG) instillation to radical cystectomy in high-risk NMIBC patients with squamous/glandular variants. In this retrospective study, the authors identified 1263 high-risk NMIBC patients from January 2000 to December 2017. 62 out of 1263 (4.9%) had squamous or glandular histologic variants. Of these 30 patients who received BCG, 15 patients underwent radical cystectomy and 17 patients were observed.
    Published February 3, 2020
  • Intravesical Doxorubicin Following Resection of Primary Non-muscle-invasive Bladder Cancer - Expert Commentary

    Effective intravesical postoperative chemotherapy can reduce the risk of bladder cancer recurrence. A recent study by Fukuokaya et al. published in Clinical Genitourinary Cancerexamined the value of a single dose instillation of intravesical doxorubicin (SID) immediately after transurethral resection of bladder tumor (TURBT) on decreasing the recurrence risk of non-muscle-invasive bladder cancer (NMIBC).
    Published February 25, 2020
  • Late Recurrences of Bladder Cancer - Expert Commentary

    Patients with muscle-invasive and high-risk non-muscle invasive urothelial carcinoma of bladder who undergo radical cystectomy (RC) and lymphadenectomy are closely monitored for recurrence.  The risk of disease recurrence is highest during the first few years. Defining late recurrence patterns is critical for designing optimal surveillance and management strategies.
    Published October 22, 2019
  • Lynch Syndrome in Japanese Patients with Upper Urinary Tract Carcinoma - Expert Commentary

    Lynch syndrome (LS), caused by a mutation in the mismatch repair (MMR) genes (MLH1, MSH2, MSH6PMS2). LS increases the individual’s risk of getting upper urinary tract urothelial carcinoma (UTUC). A recent article published by Ito et al. in the Japanese Journal of Clinical Oncology evaluated the prevalence of LS among UTUC patients. The authors examined clinical and pathological factors associated with the disease, and two LS screening methods microsatellite instability (MSI) and MMR protein immunohistochemistry. The study included 166 tumor samples from 164 UTUC patients.
    Published January 29, 2020
  • Mental Health Problems are Common in Bladder Cancer Patients - Expert Commentary

    Bladder cancer takes an enormous physical, emotional and economic toll on patients. Psychological distress can be caused by the diagnosis, the associated high risk of recurrence, and the stress from major surgery and the possible loss of sexual and urinary function. In the literature, little attention is paid to the impact of both pre- and post- treatment mental health of bladder cancer on clinical outcomes.
    Published March 12, 2019
  • Microfluidic Analysis of Captured Urinary Exfoliated Tumor Cells - Expert Commentary

    Due to the very high risk of recurrence, bladder cancer patients require periodic screening and monitoring. Due to the invasiveness and cost of the currently used tools like cystoscopy, the low sensitivity of urine cytology and the lack of sensitivity and specificity of the recent molecular techniques (BTA and NMP22), there is an unmet clinical need for less invasive and more sensitive and specific methods to detect UBC. 
    Published August 6, 2018
  • Mismatch Repair Deficiency in Urothelial Carcinoma of the Bladder - Expert Commentary

    Mutations in mismatch repair (MMR) genes result in changes in the expression of MMR proteins that can be detected by immunohistochemistry and high microsatellite instability (MSI). MSI-high tumors have higher rates of response to immune checkpoint inhibitors. Identifying these MSH-high tumors is essential for selecting patients who are likely to respond to immunotherapy.
    Published June 19, 2020
  • Mismatch Repair Gene Alterations and Microsatellite Instability in Upper Tract Urothelial Carcinoma - Expert Commentary

    Lynch Syndrome (LS) is a common hereditary cancer syndrome that is characterized by mutations in the mismatch repair (MMR) genes. The three most common malignancies in LS patients are colorectal, endometrial and upper tract urothelial carcinoma (UTUC). Unlike colorectal and endometrial carcinoma, universal MMR immunohistochemistry (IHC) and microsatellite instability (MSI) testing are not routinely performed in all the UTUC cases.
    Published September 27, 2018
  • Molecular Alterations in Urothelial Carcinoma Using CLIA-certified Genomic Testing - Expert Commentary

    Defining the genomic landscapes that characterize the different disease states of urothelial carcinoma is an important area of investigation. A recent study by Nassar et al. recently published in Clinical Cancer Research characterized the molecular changes across the clinical spectrum of urothelial carcinoma (UC).
    Published May 15, 2019
  • Monthly Maintenance Intravesical Combination Gemcitabine/Docetaxel for Non Muscle-invasive Bladder Cancer - Expert Commentary

    Bacillus Calmette-Guerin shortage is a critical access issue for patients with non-muscle-invasive bladder cancer (NMIBC). Defining the efficacy of alternative intravesical treatments is an active area of investigation.
    Published November 11, 2019
  • Multi-Receptor Tyrosine Kinase Inhibitor Pazopanib versus Weekly Paclitaxel in Relapsed or Progressive Urothelial Cancer - Expert Commentary

    Patients with advanced platinum-resistant urothelial carcinoma have limited therapeutic options. Even after the advent of immune checkpoint inhibitors, only a third of patients will have a response. The development of targeted therapies for this disease state continues to be a priority.
    Published May 4, 2017

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