Higher resilience in radical cystectomy patients is associated with improved health related quality of life post-operatively

Abstract:

Background

Radical cystectomy (RC) with urinary diversion (UD) is associated with substantial morbidity. Enhanced recovery after surgery protocols, increased robotic usage, and improvements in urinary diversion have been evaluated for their effects on health-related Quality of Life (HRQoL), however, results are mixed. How psychosocial traits inherent to the patient influence HRQoL outcomes is unknown in this population.

Objective

This study aimed to evaluate resilience and its correlation with HRQoL in a cohort of patients undergoing RC for bladder cancer.

Methods

Patients with bladder cancer undergoing RC with UD at the University of Kansas Medical Center were screened for prospective enrollment in this clinical trial (NCT06337305). The validated Connor-Davidson Resilience Scale 25 (CD-RISC), the Functional Assessment of Cancer Therapy-Bladder-Cystectomy (FACT-BL-Cys), and the PROMIS 29-v2.0 were administered preoperatively, 2–3 weeks postoperatively, and at 90 days postoperatively. Patient demographics, pathology, and complication data were collected.

Results

Between November 2020 and August 2022, 52 patients completed the survey data. Patients were stratified based on baseline resilience score. The higher resilience group scored 85.7, 85.0, and 81.9 compared to 64.9, 70.4, and 72.0 at the three time points which all remained statistically significant. Participant resilience scores using the CD-RISC did not correlate with quality-of-life measures using the PROMIS or FACT-Bl-Cys at baseline or two weeks but did correlate at 90 days (p < 0.01). Resilience did not correlate with the patient’s pathology stage or 90-day complication data.

Conclusions

Patients with higher baseline resilience maintain higher levels throughout the perioperative period and correlate with QOL.
Read More

The role of blue light cystoscopy and additional operative evaluations during first surveillance after induction therapy for high-risk NMIBC

Abstract:

Background

During surveillance of high-risk non-muscle invasive bladder cancer (HR-NMIBC), occult disease can be missed by standard cystoscopy.

Objective

To determine the utility of enhanced restaging procedures.

Methods

We retrospectively reviewed 297 patients with HR-NMIBC who underwent enhanced restaging procedures during the first surveillance following induction intravesical therapy between 2010–2021. Patients were stratified by number of induction treatments with unique agents (161, 63, and 73 patients with 1, 2, and 3+ treatments) and analyzed using exact logistic regression models. Enhanced restaging procedures included standard cystoscopy (white-light cystoscopy with bladder wash cytology) plus additional components including blue-light cystoscopy, mapping bladder biopsies, retrograde pyelograms, upper tract cytologies, and prostatic urethral biopsies.

Results

When standard cystoscopy was negative, blue light cystoscopy detected occult bladder cancer in 6.0%, 7.4%, and 19% of patients in the 1, 2, and 3+ treatment groups. History of CIS was associated with increased detection with blue light (p = 0.03). Extravesical (upper tract or prostatic urethral) cancer was detected by additional restaging components in 0.6%, 1.7%, and 15% of patients with 1, 2, and 3+ intravesical treatments. On multivariable analysis, receipt of 3+ intravesical inductions increased the odds of having at least one additional restaging component identify cancer (HR 3.76; p < .01).

Conclusions

Blue light cystoscopy improves surveillance of HR-NMIBC, particularly in those with CIS. Additional restaging procedures improved detection of extravesical disease in patients with heavier pre-treatment history. Risk-adapted utilization of enhanced restaging procedures requires further study.
Read More

Organoid models in bladder cancer: From bench to bedside?

Abstract:

Background

Bladder cancer (BC), one of the most prevalent and aggressive urological malignancies, poses significant challenges in diagnosis, treatment, and recurrence management. Patient-derived organoid provides new directions for the precision diagnosis and treatment of bladder cancer.

Objective

To make a comprehensive summary of the current bladder cancer organoid studies.

Methods

A comprehensive database search was conducted to provide an in-depth overview of the current state of bladder cancer organoid models, with a focus on their applications in basic research, clinical translation, and therapeutic discovery.

Results

We summarized the current bladder cancer organoid studies, highlighting their advantages, such as genetic fidelity and high-throughput drug screening capabilities. Additionally, we also address the challenges, including their limited representation of the tumour microenvironment and technical complexity. Finally, we discuss future directions, including the integration of immunotherapy, the development of co-culture systems, and the exploration of non-invasive sampling methods and organoid-on-chip systems.

Conclusions

Traditional pre-clinical models have inherent limitations in mimicking the complexity of human tumours. The emergence of organoid technology has offered a groundbreaking approach to address this challenge, providing an innovative tool for studying tumour biology, genetic alterations, drug screening, and personalized medicine in bladder cancer.
Read More

Intravesical instillation of chemotherapy before surgery for upper tract urothelial cancer

Urothelial cancer that occurs in the bladder following radical surgery for upper tract urothelial cancer (UTUC) occurs in 22–47% of cases within two years.1,2 There are many proposed reasons for this occurring including the possibility of pan-urothelial cancer diathesis, recurrence of previously treated bladder cancer, technical factors including not taking a complete bladder cuff at the time of radical nephroureterectomy (RNU),3 not clipping the distal ureter early on in the case,4 or whether/and how the diagnosis of UTUC was made, as evidence of a contributory role for diagnostic ureteroscopy has become compelling.5 To try to reduce this recurrence rate, two randomized prospective trials (each with their own flaws) have “demonstrated” that a single postoperative instillation of chemotherapy6,7 does reduce one- and two-year bladder recurrences. However, in part because of concern about potential extravasation of the chemotherapy, postoperative instillations have not been widely adopted into practice.7,8

Read More

Advancements in systemic therapy for muscle-invasive bladder cancer: A systematic review from the beginning to the latest updates

Abstract: 

Context

Several phase III randomized controlled trials (RCTs) have shown the importance of perioperative systemic therapy, especially for the efficacy of immune checkpoint inhibitors (ICIs) in both neoadjuvant and adjuvant settings for muscle-invasive bladder cancer (MIBC).

Objective

To synthesize the growing evidence on the efficacy and safety of systemic therapies for MIBC utilizing the data from RCTs.

Evidence acquisition

Three databases and ClinicalTrials.gov were searched in October 2024 for eligible RCTs evaluating oncologic outcomes in MIBC patients treated with systemic therapy. We evaluated pathological complete response (pCR), disease-free survival (DFS), progression-free survival (PFS), event-free survival (EFS), overall survival (OS), and adverse events (AEs).

Evidence synthesis

Thirty-three RCTs (including 14 ongoing trials) were included in this systematic review. Neoadjuvant chemotherapy improved OS compared to radical cystectomy alone. Particularly, the VESPER trial demonstrated that dd-MVAC provided oncological benefits over GC alone in terms of pCR rates, OS (HR: 0.71), and PFS (HR: 0.70). Recently, the NIAGARA trial showed that perioperative durvalumab plus GC outperformed GC alone in terms of pCR rates, OS (HR: 0.75), and EFS (HR: 0.68). Despite the lack of data on overall AE rates in the VESPER trial, differential safety profiles in hematologic toxicity were reported between dd-MVAC and durvalumab plus GC regimens. In the adjuvant setting, no study provided the OS benefit from adjuvant chemotherapy. However, only adjuvant nivolumab had significant DFS and OS benefits compared to placebo.

Conclusion

Neoadjuvant chemotherapy remains the current standard of care for MIBC. Durvalumab shed light on the promising impact of ICIs added to neoadjuvant chemotherapy. Nivolumab is the only ICI recommended as adjuvant therapy in patients who harbored adverse pathologic outcomes. Ongoing trials will provide further information on the impact of combination therapy, including chemotherapy, ICIs, and enfortumab vedotin, in both neoadjuvant and adjuvant settings.
Read More

The importance of maximal TURBT in trimodality therapy for muscle-invasive bladder cancer (MIBC)
​

Abstract: 

Trimodality therapy (TMT), consisting of maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiotherapy, has emerged as a bladder-sparing alternative to radical cystectomy for select patients with muscle-invasive bladder cancer (MIBC). While each component of TMT plays a critical role, maximal TURBT is foundational to its success. This review examines the importance of maximal TURBT in optimizing oncological outcomes in TMT, discusses its technical nuances, and explores the evidence supporting its role in achieving durable local control and improving survival outcomes in MIBC.

Read More

Emerging bladder-sparing treatments for high risk non-muscle invasive bladder cancer

Abstract: 

Bladder cancer (BC) is a significant global health concern, with non-muscle invasive bladder cancer (NMIBC) comprising 75% of cases at diagnosis. High-risk NMIBC (HR-NMIBC) poses a significant therapeutic challenge due to its high recurrence and progression rates despite Bacillus Calmette-Guerin (BCG) therapy. Radical cystectomy remains the gold standard for BCG-unresponsive cases but is often met with considerable morbidity and patient reluctance. This has driven research into alternative bladder-sparing therapies (BSTs). Emerging BSTs include immune checkpoint inhibitors like pembrolizumab and novel agents such as nadofaragene firadenovec and nogapendekin alfa inbakicept (IL-15). These therapies have demonstrated promising response rates in clinical trials, offering potential for disease management while preserving bladder function. Gene therapies and targeted agents like CG0070 and EG-70 are also gaining traction for their innovative mechanisms. However, most data are derived from early-phase, single-arm studies, necessitating larger, randomised trials for validation. Device-assisted strategies, including hyperthermic and electromotive drug delivery systems, show potential to enhance intravesical therapy efficacy. Despite advancements, challenges remain in balancing efficacy, safety, and cost-effectiveness within diverse healthcare settings. This narrative review highlights the evolving landscape of BSTs for HR-NMIBC, emphasising the need for robust clinical evidence to refine patient selection and optimise outcomes.

Read More

ABOUT THE AUTHOR

+ posts