首页膀胱肿瘤病因/危险因素证据详情

N-acetyltransferase 2 polymorphism is associated with bladder cancer risk: An updated meta-analysis based on 54 case-control studies

原文: 2020 年 发布于 Eur Radiol 34 卷 第 5 期 14005-14013 浏览量:216次

作者: Song Y. Qi X. Liu X.

作者单位: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California. Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California. Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California.

归属分类: 膀胱肿瘤病因/危险因素证据

DOI: 10.1007/s00432-022-04464-6

关键词: bacille Calmette-Guérin chemotherapy meta-analysis non-muscle invasive bladder cancer prognosis

文献简介

Context: There is a critical need for effective bladder-sparing therapies for bacillus Calmette-Guerin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC). Owing to the current lack of effective agents that can be used as a control, the US Food and Drug Administration began to accept single-arm trials for patients with carcinoma in situ (CIS), using complete response rate (CRR) and duration of response as the primary endpoints to support marketing applications. Despite the ensuing growth of clinical trials in this space, no consensus exists on a clinically relevant benchmark for CRR. Objective: To elucidate the CRR and recurrence-free rate (RFR) using bladder-sparing agents after BCG failure in order to provide a frame of reference for future clinical trial results. Evidence acquisition: We performed a systematic review of clinical trials utilizing bladder-sparing therapeutics for NMIBC recurring after intravesical BCG (PROSPERO CRD42019130553). The search was performed in MEDLINE, EMBASE, and Cochrane Library. Relevant studies identified from bibliography search and conference abstracts were searched to complement the systematic review. A total of 42 studies utilizing 24 treatment options and consisting of 2254 patients were included for final analysis. Evidence synthesis: Median CRRs in the treatment of CIS-containing tumors were 26% at 6 mo, 17% at 12 mo, and 8% at 24 mo after treatment. In comparison, median RFRs in the papillary-only studies were 67% at 6 mo, 44% at 12 mo, and 10% at 24 mo. Specifically in the BCG-unresponsive population, 6-and 12-mo CRRs in CIS-containing patients treated with Mycobacterium phlei cell wall-nucleic acid complex were 45% and 27%, respectively, and the median 6-, 12-, and 24-mo disease-free rates in the other studies were 43%, 35%, and 18%, respectively. The median progression-free rate was 91%: 95% in the CIS-containing studies and 89% in studies restricted to papillary-only recurrences. Toxicities of intravesical agents were generally mild, with very few dose limiting toxicities. Conclusions: We demonstrate that, to date, bladder-sparing therapies achieved modest efficacy in patients with NMIBC after BCG. Results from the current study will serve as a frame of reference for emerging trial results in the BCG-unresponsive space. Patient summary: In this study, we found that bladder-sparing therapies achieved modest efficacy in patients with non-muscle-invasive bladder cancer after bacillus Calmette-Guerin (BCG). These results will serve to inform future clinical trial results for salvage agents used to treat BCG-unresponsive bladder cancer. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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