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New developments in the management of nonmuscle invasive bladder cancer.

ABSTRACT: PURPOSE OF REVIEW:In this review, we summarize the core principles in the management of nonmuscle invasive bladder cancer (NMIBC) with an emphasis on new developments that have emerged over the last year. RECENT FINDINGS:NMIBC has a propensity to recur and progress. Risk stratification has facilitated appropriate patient selection for treatment but improved tools, including biomarkers, are still needed. Enhanced cystoscopy with photodynamic imaging and narrow band imaging show promise for diagnosis, risk stratification, and disease monitoring and has been formally recommended this year by the American Urological Association. Attempts at better treatment, especially in refractory high-risk cases, include the addition of intravesical hyperthermia, combination and sequential therapy with existing agents, and the use of novel agents such as mycobacterial cell wall extract. New data are emerging regarding the potential role of early cystectomy in bacillus Calmette-Guerin-refractory NMIBC patients. SUMMARY:NMIBC represents an assortment of disease states and continues to pose management challenges. Continued research is needed to bolster the evidence needed for patients and providers to make data-driven treatment decisions.

SUBMITTER: Tyson MD

PROVIDER: S-EPMC5665722 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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New developments in the management of nonmuscle invasive bladder cancer.

Tyson Mark D MD Lee Daniel D Clark Peter P

Current opinion in oncology 20170501 3

<h4>Purpose of review</h4>In this review, we summarize the core principles in the management of nonmuscle invasive bladder cancer (NMIBC) with an emphasis on new developments that have emerged over the last year.<h4>Recent findings</h4>NMIBC has a propensity to recur and progress. Risk stratification has facilitated appropriate patient selection for treatment but improved tools, including biomarkers, are still needed. Enhanced cystoscopy with photodynamic imaging and narrow band imaging show pro ...[more]

PMID: 28282341

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Project description:BackgroundNonmuscle-invasive bladder cancer (NMIBC) disproportionately affects older adults who often have coexisting chronic conditions such as metabolic syndrome (MetS). Although prior research suggests that MetS is a risk factor for NMIBC, limited data exists on whether MetS is associated with NMIBC recurrence. Our objective was to evaluate the association between MetS and recurrence in older adults treated for NMIBC.MethodsWe identified 1,485 older (age ≥60 years) NMIBC patients (American Joint Committee on Cancer Stage ≤1) from 2community-based health systems. Using data from the health systems' electronic medical record, MetS was defined as the presence of three of the following: diagnosis codes indicating hypertension, hyperlipidemia, diabetes, or body mass index >30. Follow up time was determined by date of the last follow up in the tumor registry and censored at 10 years. Cox proportional hazards regression of time to recurrence that accounts for the competing risk of death included adjustment for age, sex, smoking status, health system, NMIBC stage/grade, tumor size, and number of specimens with cancer.ResultsOverall, 341 patients (23%) met MetS criteria. Median follow up was 5.9 years and 582 patients (39.2%) died. Patients with MetS were more frequently male (84.2%), and mostly current/former smokers (82.6%). By 10 years, 34.1% of the cohort had experienced a recurrence. After accounting for the competing risk of death, there was no association between MetS and time to recurrence (adjusted hazard ratio, 0.88, 95% confidence interval 0.70-1.11, P = 0.28). Patients without MetS had more 0a/low grade recurrences (49.1% vs. 41.4%), though differences were not significant.ConclusionWe found no association between MetS and risk of NMIBC recurrence in this large, multisite cohort of older adults with NMIBC. In order to design personalized care for older NMIBC patients, future research is needed to evaluate associations between common chronic conditions and a variety of oncologic outcomes.

Project description:PurposePrior reports suggest that renin-angiotensin system inhibition may decrease nonmuscle invasive bladder cancer recurrence. We evaluated whether angiotensin converting enzyme inhibitor or angiotensin receptor blocker treatment at initial surgery was associated with decreased recurrence or progression in patients with nonmuscle invasive bladder cancer.Materials and methodsUsing an institutional bladder cancer database we identified 340 patients with data available on initial transurethral resection of bladder tumor. Progression was defined as an increase to stage T2. Cox proportional hazards models were used to evaluate associations with recurrence-free and progression-free survival.ResultsMedian patient age was 69.6 years. During a median followup of 3 years (IQR 1.3-6.1) 200 patients (59%) had recurrence and 14 (4.1%) had stage progression. Of those patients 143 were receiving angiotensin converting enzyme inhibitor/angiotensin receptor blockers at the time of the first transurethral resection. On univariate analysis factors associated with improved recurrence-free survival included carcinoma in situ (p = 0.040), bacillus Calmette-Guérin therapy (p = 0.003) and angiotensin converting enzyme inhibitor/angiotensin receptor blocker therapy (p = 0.009). Multivariate analysis demonstrated that patients treated with bacillus Calmette-Guérin therapy (HR 0.68, 95% CI 0.47-0.87, p = 0.002) or angiotensin converting enzyme inhibitor/angiotensin receptor blocker therapy (HR 0.61, 95% CI 0.45-0.84, p = 0.005) were less likely to experience tumor recurrence. The 5-year recurrence-free survival rate was 45.6% for patients treated with angiotensin converting enzyme inhibitor/angiotensin receptor blockers and 28.1% in those not treated with angiotensin converting enzyme inhibitor/angiotensin receptor blockers (p = 0.009). Subgroup analysis was performed to evaluate nonmuscle invasive bladder cancer pathology (Ta, T1 and carcinoma in situ) in 85 patients on bacillus Calmette-Guérin therapy alone and in 52 in whom it was combined with angiotensin converting enzyme inhibitor/angiotensin receptor blocker. Multivariate analysis revealed that patients treated with bacillus Calmette-Guérin alone (HR 2.19, 95% CI 1.01-4.77, p = 0.04) showed worse recurrence-free survival compared to patients treated with bacillus Calmette-Guérin and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (stage Ta HR 0.45, 95% CI 0.21-0.98, p = 0.04).ConclusionsPharmacological inhibition of the renin-angiotensin system is associated with improved outcomes in patients with bladder cancer. Renin-angiotensin system inhibitor administration in nonmuscle invasive bladder cancer cases should be studied in a prospective randomized trial.

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New developments in the management of nonmuscle invasive bladder cancer.

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New developments in the management of nonmuscle invasive bladder cancer.

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