Expert Commentary Articles

Articles

  • Patient-Reported Outcomes in Randomized Clinical Trials Including Bladder Cancer Patients - Expert Commentary

    Several randomized clinical trials (RCTs) have incorporated patient-reported outcomes (PRO) to evaluate the effectiveness of new treatment modalities. Adhering to systematic and consistent reporting methods is critical for defining the impact of cancer treatments on clinical trial participants.
    Published January 7, 2020
  • Photoimmunotherapy: A New Method for Targeting EGFR in Bladder Cancer - Expert Commentary

    Clinically-localized bladder cancer is amenable to local treatments because of its accessibility. A team of investigators led by Dr. Piyush Agarwal at the National Institutes of Health developed a novel way to target bladder cancers that express epidermal growth factor receptor (EGFR). By combining infrared radiation with an anti-EGFR antibody panitumumab labeled with the photo-absorber, IR dye 700Dx.
    Published July 11, 2017
  • Racial Differences in Urinary Bladder Cancer in the United States - Expert Commentary

    To achieve progress against Urinary bladder cancer (UBC), studies are needed to understand to understand the racial differences in the incidence, presentation, outcomes, and biology of UBC. However, there is a lack of studies addressing this knowledge gap.
    Published October 1, 2018
  • Randomized Phase 1 Trial of Pembrolizumab with Sequential Versus Concomitant Stereotactic Body Radiotherapy in Metastatic Urothelial Carcinoma - Expert Commentary

    Radiotherapy has the potential to sensitize tumors to immune checkpoint blockade. A recent article published by Sundahl et al. in European Urology assessed the toxicity and efficacy of stereotactic body radiotherapy (SBRT) at different time points to patients who receive pembrolizumab for mUC.1 In this randomized phase 1 trial, the investigators enrolled 18 patients who received at least one dose of SBRT and at least one dose of pembrolizumab. Patients were randomly divided into two groups, arm A included patients who received SBRT before the first cycle of pembrolizumab and arm B who received SBRT before the third cycle of pembrolizumab.
    Published November 19, 2019
  • Recurrence Risk Prediction Nomogram for Non-muscle Invasive Bladder Cancer Patients - Expert Commentary

    Non-muscle invasive bladder cancers (NMIBC) represent the majority of new bladder cancer diagnoses. A high recurrence rate characterizes the natural history of the disease. Understanding the risk factors for recurrence is critical for predicting the individual recurrence risk of recurrence. 
    Published August 16, 2019
  • Response to Platinum Reintroduction After Immune Checkpoint Inhibitors for Metastatic Urothelial Carcinoma - Expert Commentary

    Immune checkpoints inhibitors (ICIs) are approved as a second line of treatment for metastatic urothelial carcinoma (mUC) patients with progression on cisplatin-based chemotherapy. Chemotherapy is rarely reintroduced in these patients after the ICI.
    Published March 8, 2019
  • Risk Factors of Intravesical Recurrence in Patients with Upper Tract urothelial Carcinoma After Radical Nephroureterectomy - Expert Commentary

    Intravesical recurrence (IVR) rates remain high in urothelial carcinoma of the upper urinary tract (UTUC) patients following radical nephroureterectomy (RNU). Understanding the risk factors that predict IVR is critical for optimal management of these patients. A recent study published by Rinaldetti et al. in Clinical Genitourinary Cancer investigated the significance of the presence of preoperative pyuria in predicting IVR in UTUC patients who underwent RNU.
    Published January 30, 2020
  • Sarcopenia as a Predictor of Survival in Bladder Cancer Patients Receiving Radiotherapy - Expert Commentary

    There is not enough data on the prognostic value of sarcopenia and nutritional indices in bladder cancer patients who receive definitive radiotherapy. A recent paper by Stangl-Kremser et al. in Urologic Oncology studied the role of sarcopenia and nutritional indices in the overall survival for patients with high-risk urothelial carcinoma who are unfit to for chemotherapy or radical cystectomy. 
    Published May 15, 2019
  • Survival Benefit of Chemotherapy in Metastatic Upper Tract Urothelial Carcinoma - Expert Commentary

    Upper tract urothelial carcinoma (UTUC) is a distinct clinical entity with poor clinical outcomes. A recent paper published by Nazzani et al. in Clinical Genitourinary Cancer studied the efficacy of chemotherapy in treating non-surgically treated metastatic upper tract urothelial carcinoma (mUTUC) in a large cohort. The investigators identified 539 patients with non-surgically treated mUTUC within the Surveillance, Epidemiology, and End Results database (2004-2014). Of these, 277 (51.4%) received chemotherapy. The investigators compared the overall mortality and cancer-specific mortality in the group that received chemotherapy to the control group. 
    Published March 11, 2019
  • TERT Promoter Mutations in Primary and Recurrent Bladder Cancer - Expert Commentary

    Point mutations in telomerase reverse transcriptase (TERT) promotor are reported in invasive and noninvasive, primary and recurrent urothelial bladder cancer (UBC). A deeper understanding of the clinical correlates of TERT promoter mutations is critical for designing early detection tools for predicting outcomes in UBC patients.
    Published January 14, 2020
  • Testing A Novel Molecular Urine Assay in Patients with Equivocal Urine Cytology - Expert Commentary

    Urine cytology plays a critical role as a noninvasive tool in bladder cancer detection and surveillance. However, a substantial fraction of cytology tests is classified as atypical or indeterminate. A need for a minimally-invasive high sensitivity and specificity test that can early detect genetic alterations associated with bladder cancer in these patients is needed.
    Published December 9, 2019
  • The Distinct Molecular Profile of the Small-Cell Bladder Cancer Variant - Expert Commentary

    Urothelial carcinoma variants are rare and some are associated with poor clinical outcomes. The small-cell variant comprises less than 1% of all bladder cancers. These cancers are more aggressive and have poorer prognoses than conventional urothelial carcinoma.
    Published April 6, 2020
  • The Efficacy of a Second BCG Induction Course for Non-Muscle Invasive Bladder Cancer - Expert Commentary

    The American Urological Association (AUA) recommends that non-muscle invasive bladder cancer (NMIBC) patients with persistent or recurrent Ta or CIS should receive a second induction course of Bacillus Calmette-Guerin (BCG) after the first course. However, a significant number of patients decline. Real-world data evaluating the efficacy of a second BCG induction course is needed.

    Published January 27, 2020
  • The Efficacy of Immunotherapy and Carboplatin-Based Chemotherapy in Cisplatin-Ineligible Metastatic Urothelial Cancer Patients - Expert Commentary

    The optimal treatment for patients with metastatic urothelial carcinoma (mUC) patients who are unfit to receive the standard cisplatin-based chemotherapy is uncertain.

    A new study published by Feld et al. in European Urology1 compared the outcomes of carboplatin-based chemotherapy versus immunotherapy. The investigators used the Flatiron Health electronic health record–derived database to find patients with mUC who started first line of treatment. The study included 1530 mUC patients who received carboplatin-based treatment and 487 mUC patients who received immunotherapy between 2011 and 2018. The investigators compared the overall survival (OS) at 12 months and 36 months between the treatment groups. They used propensity score–based inverse probability of treatment weighting (IPTW) to adjust for confounding factors that could affect clinical outcomes.

    The investigators found that, at 12 months, the IPTW-adjusted OS of the immunotherapy group was lower than chemotherapy group (39.6% [95% confidence interval {CI} 34.0–45.3%] versus 46.1% [95% CI 43.4–48.8%]). On the other hand, at 36 months, the IPTW-adjusted OS of the immunotherapy group was higher than chemotherapy group (28.3% [95% CI 21.8–34.7%] vs. 13.3% [95% CI 11.1–15.5%]). Although immunotherapy showed higher hazard of death (HR 1.37, 95% CI 1.15–1.62, p < 0.001) than chemotherapy during the first 12 months, immunotherapy survival rates improved (HR 0.50, 95% CI 0.30–0.85, p= 0.01) for those who survived the one year after the first line.

    This interesting real-world data show temporal variations in patterns of response to different treatments for mUC patients who are ineligible for cisplatin-based chemotherapy. Prospective randomized trials comparing carboplatin-based treatment versus immunotherapy in this patient population is needed to validate this data. Pre-specified analyses should be planned to examine whether specific patient subgroups derive more clinical benefit from chemotherapy or immunotherapy.

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

    Reference: 
    1. Feld, Emily, Joanna Harton, Neal J. Meropol, Blythe JS Adamson, Aaron Cohen, Ravi B. Parikh, Matthew D. Galsky et al. "Effectiveness of First-line Immune Checkpoint Blockade Versus Carboplatin-based Chemotherapy for Metastatic Urothelial Cancer." European urology (2019).

    Read the Abstract
    Published September 9, 2019
  • The Impact of Bacillus Calmette-Guérin Shortage on Non-Muscle-Invasive Bladder Cancer Patients - Expert Commentary

    A shortage of the Bacillus Calmette-Guérin (BCG) Connaught strain occurred between 2013-2016. A recent paper published by Ourfali et al. in European Urology Focusinvestigated the medical and financial sequelae of BCG shortage on intermediate-risk and high-risk NMIBC patients between 2013 and 2016.
    Published August 8, 2019
  • The Molecular Characteristics of Upper Tract Urothelial Carcinoma - Expert Commentary

    Upper tract urothelial carcinoma is less common than bladder urothelial carcinoma. The biological characteristics of this form of the disease is not completely understood. A new study published in European Urology by Moss et al. performed an integrated DNA, RNA and protein analysis of upper tract urothelial carcinoma to characterize its molecular landscape. 
    Published July 11, 2017
  • The Prognostic Value of the Urokinase Plasminogen Activator (uPA) Pathway Proteins in Non-Muscle Invasive Bladder Cancer Patients - Expert Commentary

    Non-muscle invasive bladder cancer (NMIBC) has a high recurrence rate. Understanding the risk factors for recurrence is essential.
    Published January 22, 2020
  • The Role of Aurora Kinase A in Bladder Cancer - Expert Commentary

    Aurora kinase A (AURKA) plays a vital role in several cancers, but little is known about its role in bladder cancer. A recent study published by Guo et al. in BMC Systems Biology investigated the relationship between AURKA expression, clinicopathologic characteristics and overall survival in patients with bladder cancer using sequential gene expression profiling.
    Published May 15, 2019
  • The Significance of Persistent Muscle Invasive After Neoadjuvant Chemotherapy - Expert Commentary

    Downstaging of muscle-invasive bladder cancer (MIBC) following neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) has been correlated with higher survival rates.  
    Published October 8, 2018
  • The Use of High-Resolution Micro-Ultrasound in Diagnosing and Staging Bladder Cancer - Expert Commentary

    High-resolution micro-ultrasound is a promising technology in the staging of prostate cancer but has not been well studied in bladder cancer patients. A recent paper published by Saita et al. in European Urologyevaluated the accuracy and feasibility of micro-ultrasound in detecting and staging bladder cancer. The investigators studied 23 bladder cancer patients using a micro-ultrasound system before the transurethral resection of their bladder tumors. They evaluated the accuracy of micro-ultrasound in identifying bladder wall layers, non-muscle-invasive bladder cancer, and muscle-invasive cancers in comparison to histopathological results.
    Published August 8, 2019
  • The Utility of Urine Cytology in Predicting Recurrence following Intravesical Therapy for Non‐Muscle Invasive Bladder Cancer - Expert Commentary

    Urine cytology plays an essential role in detecting patients who are at high risk for disease recurrence following non-muscle invasive bladder cancer (NMIBC) treatment. A recent study Gupta et al. in the World Journal of Urology evaluated the accuracy of urine cytology in detecting recurrence and progression following therapy for NMIBC. The investigators included 90 cytology samples and biopsy specimens from 76 patients who were diagnosed with NMIBC between 2013 and 2016 and received intravesical treatment. The majority of samples 80% (71) were taken from patients treated for high-grade disease, and 20% (18) from patients treated for low- grade disease. 56/90 samples came from patients who received bacillus Calmette–Guerin (BCG) induction therapy and 34/90 from patients who received second-line intravesical gemcitabine/docetaxel, mitomycin, or BCG/interferon. The accuracy of urine cytology was compared to systemic biopsies.
    Published December 10, 2019
  • Trends of Perioperative Chemotherapy for Muscle-Invasive Bladder Cancer - Expert Commentary

    Perioperative chemotherapy is frequently underutilized. Understanding the trends in the utilization of neoadjuvant or adjuvant cisplatin-based chemotherapy in muscle-invasive bladder cancer (MIBC) undergoing cystectomy is critical.

    A new article published by Macleod et al. in Urologic Oncologyevaluated the trends and factors associated with perioperative chemotherapy use in MIBC patients. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, the researchers identified 3,826 patients with MIBC between 2004 and 2013 who underwent radical cystectomy. They categorized the patients into three groups: radical cystectomy only, neoadjuvant chemotherapy and adjuvant chemotherapy. A multinomial multivariable logistic regression model was used to study the association of patients' characteristics with the treatment received.
    Published August 8, 2019
  • Understanding the Field Effects Which Initiate Bladder Carcinogenesis - Expert Commentary

    Bladder cancer is a ‘field’ disease in which early-events occurring in morphologically-normal urothelium eventually give rise to urothelial carcinoma. A recent study published in Cell Reports by Majewski et al. examined the field defects that lead to urothelial carcinoma. The investigators performed whole-organ genomic and epigenetic mapping to identify the changes that occur in the urothelium and ultimately lead to the development of urothelial carcinoma. 
    Published March 12, 2019
  • Urothelial Carcinoma with Uncertain Muscularis Propria Invasion - Expert Commentary

    Detecting muscle-invasion is a critical step that dictates treatment recommendations. A definitive assessment of muscularis propria (MP) invasion cannot be made in a small number of transurethral resections of bladder tumor (TURBTs). Understanding the clinical course of these patients is critical for defining the optimal management strategies.
    Published August 8, 2019
  • Validation of a Molecular Urine Test for the Detection of Bladder Cancer Recurrence - Expert Commentary

    Frequent long-term monitoring is required for non-muscle-invasive bladder cancer (NMIBC) patients due to the high rate of recurrence. White light cystoscopy (WLC) and urine cytology are widely used in surveillance methods. Although urine cytology has high specificity (SP), it has low sensitivity (SN) and negative predictive value (NPV). WLC is an invasive and expensive method that lack SN for flat lesions such as carcinoma in situ (CIS). A non-invasive surveillance method with a high SN, NPV is needed to detect NMIBC recurrences.
    Published March 12, 2019
  • When Partial Nephrectomy Is Unsuccessful: Understanding the Reasons for Conversion From Robotic Partial to Radical Nephrectomy at a Tertiary Referral Center - Expert Commentary

    Partial nephrectomies are the standard of care with treatment of T1a or T1b tumors due to their better functional outcomes and decrease cardiovascular morbidity. However, with the increasing trend of using robotic partial nephrectomy (RPN) to treat more and more complex tumors, there is a greater risk of conversion to radical nephrectomy (RN). As there is little literature about analyzing the conversion rate and risks, these authors investigated the incidence of RPN to RN conversion and analyzed the preoperative factors that could possibly lead to a RN without having to convert. 
    Published September 20, 2017

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