Clinical genitourinary cancer最新文献

{"title":"Sarcomatoid Differentiation as a Predictor of Recurrence in Intermediate- and High-Risk RCC: Implications for Adjuvant Immunotherapy Selection","authors":"Francisco Tomás Rodriguez-Covarrubias,&nbsp;Horst Emanuel Lagos-Beitz,&nbsp;Jorge Augusto Alcacio-Mendoza,&nbsp;Betsabé Petra Carreño-Hinojosa,&nbsp;Yoztinn Bernal-Benitez,&nbsp;Guillermo Martínez-Delgado,&nbsp;Guillermo Trujillo-Martínez","doi":"10.1016/j.clgc.2025.102430","DOIUrl":"10.1016/j.clgc.2025.102430","url":null,"abstract":"<div><h3>Background</h3><div>Adjuvant pembrolizumab improves survival in clear cell renal cell carcinoma (ccRCC) at elevated recurrence risk. However, broad application may lead to overtreatment. Sarcomatoid differentiation, a histologic feature associated with poor prognosis, is not currently used to guide adjuvant decisions.</div></div><div><h3>Objective</h3><div>To evaluate whether sarcomatoid differentiation can refine patient selection for adjuvant immunotherapy in intermediate- and high-risk ccRCC.</div></div><div><h3>Methods</h3><div>Retrospective analysis of 136 patients with localized/locally advanced ccRCC who underwent nephrectomy (2000-2023) meeting modified KEYNOTE-564 criteria. Recurrence-free survival (RFS) and predictive factors were analyzed using Kaplan-Meier estimates, logistic regression, and Cox models. Clinical utility was assessed via the number needed to treat (NNT) and cost-effectiveness modeling.</div></div><div><h3>Results</h3><div>At median follow-up of 55 months, recurrence occurred in 26 patients (19.1%). Sarcomatoid differentiation was significantly associated with recurrence (HR = 2.31; 95% CI, 1.03-5.18; <em>P</em> = .042). Among intermediate-risk patients, those with sarcomatoid features had 50.0% recurrence versus 16.7% without (<em>P</em> = .007). number needed to treat (NNT) improved from 5 (treating all) to 2 (treating sarcomatoid-positive only). Combining sarcomatoid status and ECOG 0 allowed 39.1% of patients to avoid therapy with 7.0% recurrence rate. This strategy could theoretically save $11.4 million USD.</div></div><div><h3>Conclusions</h3><div>Sarcomatoid differentiation was independently associated with recurrence and may help inform adjuvant therapy decisions. Selective immunotherapy based on histologic features may optimize outcomes while avoiding overtreatment.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102430"},"PeriodicalIF":2.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Health and Body Composition as Predictive and Prognostic Markers in Metastatic Castration-resistant Prostate Cancer: A Meet-URO Narrative Review","authors":"Anna Amela Valsecchi ,&nbsp;Maria Concetta Cursano ,&nbsp;Francesco Pantano ,&nbsp;Ugo De Giorgi ,&nbsp;Giuseppe Procopio ,&nbsp;Daniele Santini ,&nbsp;Massimo Di Maio ,&nbsp;Meet-URO group","doi":"10.1016/j.clgc.2025.102433","DOIUrl":"10.1016/j.clgc.2025.102433","url":null,"abstract":"<div><div>Metastatic castration-resistant prostate cancer (mCRPC) presents several challenges, including identifying predictive and prognostic markers for available therapies in order to guide the best clinical choice. Alongside well-known markers such as prostate specific antigen, researchers are trying to understand the role of bone health assessment and body composition in this context. Bone turnover markers, measurable in blood or urine, provide insights into bone formation and resorption dynamics, while body composition metrics derived from radiological imaging (e.g., CT or MRI) can quantify muscle mass, fat distribution, and obesity-related parameters.</div><div>This narrative review examines current evidence on the relationship between bone health, body composition, and clinical outcomes in mCRPC. We synthesize findings from recent studies evaluating their association with treatment response, adverse event profiles, and survival, highlighting potential mechanisms linking skeletal and metabolic status with disease progression.</div><div>Although preliminary data suggest that selected bone and body composition markers may inform risk stratification and therapeutic decision-making, evidence remains heterogeneous and largely derived from retrospective or small prospective cohorts. Standardization of measurement methods and thresholds is lacking, limiting their immediate clinical application.</div><div>Future prospective trials incorporating these parameters as secondary endpoints are warranted to clarify their independent prognostic value and predictive utility. A better understanding of these markers could support more personalized treatment strategies, improve monitoring of therapy-related toxicities, and ultimately enhance both survival and quality of life in patients with mCRPC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102433"},"PeriodicalIF":2.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145263068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of Secondary Bladder and Rectal Cancers After External Beam Radiation for Prostate Cancer According to Age and D’amico Risk Groups in A Contemporary Cohort","authors":"Mario de Angelis ,&nbsp;Carolin Siech ,&nbsp;Letizia Maria Ippolita Jannello ,&nbsp;Francesco Di Bello ,&nbsp;Natali Rodriguez Peñaranda ,&nbsp;Pietro Scilipoti ,&nbsp;Mattia Longoni ,&nbsp;Jordan A. Goyal ,&nbsp;Zhe Tian ,&nbsp;Nicola Longo ,&nbsp;Ottavio de Cobelli ,&nbsp;Gennaro Musi ,&nbsp;Felix K.H. Chun ,&nbsp;Stefano Puliatti ,&nbsp;Fred Saad ,&nbsp;Shahrokh F. Shariat ,&nbsp;Giorgio Gandaglia ,&nbsp;Marco Moschini ,&nbsp;Francesco Montorsi ,&nbsp;Alberto Briganti ,&nbsp;Pierre I. Karakiewicz","doi":"10.1016/j.clgc.2025.102429","DOIUrl":"10.1016/j.clgc.2025.102429","url":null,"abstract":"<div><h3>Background</h3><div>External beam radiation therapy (EBRT) predisposes to radiation-induced bladder (BCa) and/or rectal cancer (RCa). This risk may have declined with modern radiation techniques. Moreover, it remains unclear whether the risk varies by age or D’Amico risk classification.</div></div><div><h3>Materials and Methods</h3><div>Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified patients who were treated with either EBRT or radical prostatectomy (RP) for prostate cancer. Cumulative incidence plots and competing risks regression (CRR) models were fitted. Subgroup analyses were performed according to year of diagnosis (contemporary: 2012-2020 vs. historical: 2004-2011 cohorts), age (&lt; 65 vs. ≥ 65) and D’Amico risk groups.</div></div><div><h3>Results</h3><div>Of 251,838, 110,239 (44%) underwent EBRT versus 141,599 RP (56%). Relative to RP patients, EBRT was associated with a two-fold higher 10-year incidence of secondary BCa (0.9 versus 1.9%, respectively). In multivariable CRR models, EBRT was associated with higher risk of BCa (HR: 1.5, 95% CI: 1.3-1.6, <em>P</em> &lt; .001). Similarly, relative to RP, EBRT was also associated with two-fold higher 10-year incidence of secondary RCa (0.8 versus 1.5%, respectively). In multivariable CRR models, EBRT was associated with higher risk of RCa (HR: 1.4, 95% CI: 1.2-1.5, <em>P</em> &lt; .001). In subgroup analyses, the 5-year EBRT–RP absolute difference in secondary RCa was lower in the contemporary cohort (0.2%) than in the historical cohort (0.5%), whereas no such reduction was observed for BCa. In subgroup analyses according to D’Amico risk groups and age, no clinically significant differences were recorded.</div></div><div><h3>Conclusion</h3><div>EBRT is associated with higher risk of both BCa and RCa as compared to RP. In contemporary EBRT patients, secondary RCa rate is lower, but not BCa rate. D’Amico risk groups as well as age categories did not affect either secondary BCa or secondary RCa rates.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102429"},"PeriodicalIF":2.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CABOSEQ 3—Comparison of Cabozantinib versus Sunitinib Following First-Line Nivolumab- Ipilimumab for Metastatic Renal Cell Carcinoma: A Target Trial Emulation Using Real-World Data from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC)","authors":"Audreylie Lemelin ,&nbsp;David Maj ,&nbsp;Kosuke Takemura ,&nbsp;Devon J. Boyne ,&nbsp;Matthew T. Warkentin ,&nbsp;Darren R. Brenner ,&nbsp;Winson Y. Cheung ,&nbsp;Connor Wells ,&nbsp;Chris Labaki ,&nbsp;Bradley A. McGregor ,&nbsp;Luis Meza Contreras ,&nbsp;Sumanta K. Pal ,&nbsp;Benoit Beuselinck ,&nbsp;Rana R. McKay ,&nbsp;Bernadett Szabados ,&nbsp;Thomas Powles ,&nbsp;Takeshi Yuasa ,&nbsp;Lisa Ludwig ,&nbsp;Toni K. Choueiri ,&nbsp;Daniel Y.C. Heng","doi":"10.1016/j.clgc.2025.102431","DOIUrl":"10.1016/j.clgc.2025.102431","url":null,"abstract":"<div><h3>Background and Objective</h3><div>While the benefit of cabozantinib in metastatic renal cell carcinoma (mRCC) is well established post-tyrosine kinase inhibitor therapy, its comparative effectiveness versus sunitinib after first-line (1L) nivolumab-ipilimumab is uncertain.</div></div><div><h3>Methods</h3><div>A target trial emulation was designed using data from the IMDC to estimate the effect of second-line (2L) cabozantinib versus sunitinib within 18 months of discontinuing 1L nivolumab-ipilimumab on overall survival (OS). Patients diagnosed after January 1, 2017 were followed from initiation of 2L until death or last known contact. Inverse-probability of treatment weighting was used to adjust for hemoglobin, calcium, platelets, and neutrophils at 2L, Karnofsky performance score (KPS) at 2L, time from diagnosis to initiation of 2L, and response to 1L nivolumab-ipilimumab. Treatments were compared using adjusted Kaplan-Meier curves and adjusted hazard ratios (HR) from a Cox regression model. Missing data were addressed with multiple imputation by chained equations. E-values were used to assess the likelihood findings could be explained by residual confounding.</div></div><div><h3>Key Findings and limitations</h3><div>A total of 120 and 121 patients who received cabozantinib or sunitinib after 1L nivolumab-ipilimumab were included. The proportion with a KPS &lt; 80% at 2L (21% vs. 46% <em>P</em> = .001) and the overall response rate to first line therapy (12.7% vs. 17.9% <em>P</em> = .002) differed significantly between cabozantinib and sunitinib. The objective response was 27% for cabozantinib versus 20% for sunitinib with a median time to treatment failure of 8.5 (95% CI: 6.9-12.9) and 4.5 (95% CI: 3.7-5.8) months. Median OS was 21.4 (95% CI: 17.9-NA) months from initiation of cabozantinib and 10.1 (95% CI: 7.6-17.7) months for sunitinib (Adjusted HR 0.44 (95% CI: 0.22-0.86)). The E-value was 2.92, suggesting a low likelihood of findings being due to residual confounding alone.</div></div><div><h3>Conclusions</h3><div>These data provide real-world evidence supporting cabozantinib as a second-line treatment option in mRCC following 1L nivolumab-ipilimumab.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102431"},"PeriodicalIF":2.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Mortality Trends From Prostate Cancer and Associated Second Malignancies in the U.S., 1999 to 2023: Implications for Survivorship Care","authors":"Shree Rath ,&nbsp;Amar Lal ,&nbsp;Ahmed Hasan ,&nbsp;Muhammad Ali ,&nbsp;Laiba Sultan ,&nbsp;Mishaim Khan ,&nbsp;Umama Alam","doi":"10.1016/j.clgc.2025.102428","DOIUrl":"10.1016/j.clgc.2025.102428","url":null,"abstract":"<div><h3>Introduction</h3><div>Prostate cancer remains the most commonly diagnosed malignancy among men in the United States. However, the risk and burden of secondary malignancies (SMs) among this group are not well characterized. This study examines national trends in mortality attributable to SMs among prostate cancer survivors, with an emphasis on demographic and geographic disparities.</div></div><div><h3>Methods</h3><div>Utilizing data from the CDC WONDER, we conducted a population-based analysis of mortality rates linked to SPMs in individuals aged 65 and older with a prior prostate cancer diagnosis, spanning 1999 to 2023. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population and stratified by age, race/ethnicity, region, and urbanization. Joinpoint regression was used to assess changes in trends and annual percent change (APC).</div></div><div><h3>Results</h3><div>From 1999 to 2023, a total of 115,041 deaths were attributed to SMs in prostate cancer, with an overall Age-adjusted mortality rate (AAMR) of 26.21 (95% CI, 25.43-26.99). Trends showed a significant decline from 1999 to 2006, followed by a significant rise in the periods of 2013 to 2017 (APC = 8.17%) and 2017 to 2023 (APC = 4.71; 95% CI, 3.03-5.5.75). Racial disparities were evident, with non-Hispanic White individuals exhibiting an overall incline in contrast to non-Hispanic Black individuals, who experienced a decrease. Notably, men aged 85 years and older had a statistically significant long-term rise in mortality (AAPC = 0.92), in contrast with younger groups, which demonstrated early declines and nonsignificant long-term trends.</div></div><div><h3>Conclusions</h3><div>Mortality from SMs among U.S. prostate cancer survivors has increased in complexity over the past 24 years, with pronounced disparities by race, region, urbanization, and age group. These findings highlight the need for enhanced survivorship care, targeted screening, and public health interventions to address growing risks and ensure equitable outcomes for all affected populations.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102428"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Impaired Renal Function on the Efficacy and Safety of Enfortumab Vedotin Monotherapy in a Multicenter Real-World Cohort of Patients With Metastatic Urothelial Cancer: YUSHIMA Study","authors":"Hiroshi Fukushima ,&nbsp;Yuki Nakamura ,&nbsp;Hajime Tanaka ,&nbsp;Noboru Numao ,&nbsp;Atsushi Yoshinaga ,&nbsp;Naoko Kawamura ,&nbsp;Kenji Tanabe ,&nbsp;Keita Izumi ,&nbsp;Takanobu Yamamoto ,&nbsp;Sho Uehara ,&nbsp;Yuya Maezawa ,&nbsp;Takahiko Soma ,&nbsp;Ryoji Takazawa ,&nbsp;Saori Araki ,&nbsp;Soichiro Yoshida ,&nbsp;Yasuhisa Fujii","doi":"10.1016/j.clgc.2025.102426","DOIUrl":"10.1016/j.clgc.2025.102426","url":null,"abstract":"<div><h3>Introduction</h3><div>Enfortumab vedotin (EV) has become a standard of care for patients with metastatic urothelial cancer (mUC). However, the impact of impaired renal function on its efficacy and safety remains unclear, especially in patients with severe renal impairment who are considered unfit for platinum-based chemotherapy.</div></div><div><h3>Patients and Methods</h3><div>This multicenter retrospective study included 115 patients with mUC who were treated with EV monotherapy after progression on platinum-based chemotherapy and immune checkpoint inhibitors. Patients were stratified into 3 groups based on pretreatment estimated glomerular filtration rate (eGFR, mL/min/1.73 m²): Preserved (eGFR ≥ 45, <em>n</em> = 65), Moderately Impaired (30 ≤ eGFR &lt; 45, <em>n</em> = 36), and Severely Impaired (eGFR &lt; 30, <em>n</em> = 14). Objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs) were compared among the 3 groups.</div></div><div><h3>Results</h3><div>The median follow-up time following after the initiation of EV treatment was 7.2 months. Although relative dose intensity (RDI) was lower in the Severely Impaired group, ORR (<em>P</em> = .62), PFS (<em>P</em> = .33), and OS (<em>P</em> = .81) were not significantly different among the 3 groups. There was no significant difference in the incidence of any grade TRAEs among the 3 groups (<em>P</em> = .22). For grade ≥ 3 TRAEs, its incidence was significantly different overall (<em>P</em> = .040), but no pairwise differences were found after Bonferroni correction. Among patients with RDI ≥ 80%, impaired renal function was not significantly associated with the incidence of TRAEs.</div></div><div><h3>Conclusions</h3><div>EV monotherapy demonstrated comparable efficacy and safety regardless of renal function in patients with mUC. Our findings suggest that impaired renal function alone may not warrant avoiding EV monotherapy or routinely reducing its dose. Moreover, EV monotherapy can be effective and well-tolerated even in patients with eGFR &lt; 30 who are considered unfit for platinum-based chemotherapy.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102426"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Resource Use and Costs of Localized Prostate Cancer Patients in Finland","authors":"Teemu J. Murtola ,&nbsp;Tuukka Hakkarainen ,&nbsp;Mari Lahelma ,&nbsp;Paula Pennanen ,&nbsp;Riikka-Leena Leskelä ,&nbsp;Mika Pietilä ,&nbsp;Petteri Hervonen ,&nbsp;Okko-Sakari Kääriäinen ,&nbsp;Heikki Minn ,&nbsp;Timo K. Nykopp ,&nbsp;Hanna Ronkainen ,&nbsp;Otto Ettala ,&nbsp;Antti Rannikko","doi":"10.1016/j.clgc.2025.102427","DOIUrl":"10.1016/j.clgc.2025.102427","url":null,"abstract":"<div><h3>Background</h3><div>Prostate cancer is the most prevalent cancer among men in Finland, causing significant healthcare costs. Understanding the economic burden of various treatment pathways is vital for optimizing healthcare strategies. This study aimed at estimating healthcare resource utilization and associated costs for patients with localized prostate cancer (LPC) and locally advanced prostate cancer (LAPC) based on initial treatment decisions in Finland.</div></div><div><h3>Patients and Methods</h3><div>A retrospective, noninterventional study was conducted using pseudonymized patient-level data from the 5 University Hospitals and the Social Insurance Institution of Finland. The cohort included 16,212 adults diagnosed with localized prostate cancer (LPC) or locally advanced prostate cancer (LAPC) between 1 July 2010 and 30 June 2021. Patients were categorized into 4 groups: no immediate treatment (NIT), radiotherapy only (RT), radiotherapy combined with androgen deprivation therapy (RT+ADT), and radical prostatectomy (RP). Healthcare resource utilization and costs were analyzed on a per-patient-year basis, considering inpatient admissions, outpatient visits, emergency department visits, and outpatient medication costs.</div></div><div><h3>Results</h3><div>The first-year costs were highest for RP (€11,766) and RT+ADT (€10,421), reflecting intensive treatment, followed by RT only (€9,014) and no immediate treatment (NIT) (€4,129). Over time, costs decreased for RP and RT+ADT groups. Emergence of metastatic disease significantly increased costs, particularly due to outpatient medication. Costs began rising 1-2 years before metastasis, indicating early health deterioration.</div></div><div><h3>Conclusion</h3><div>This study highlights significant cost variations across different treatment pathways for prostate cancer in Finland and underscores the economic impact of metastatic disease. Early detection and effective management are essential for cost containment.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102427"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymphovascular Invasion is Predictive for Adjuvant Platinum Therapy Benefit in Urothelial Bladder Cancer","authors":"Dániel Juhász MD ,&nbsp;Anita Csizmarik PhD ,&nbsp;Melinda Váradi PhD ,&nbsp;Dániel Bacsó MD ,&nbsp;András Kubik MD ,&nbsp;Miklós Szűcs MD, PhD ,&nbsp;Eszter Székely MD, PhD ,&nbsp;Mulham Al-Nader MD ,&nbsp;Osama Mahmoud MD ,&nbsp;Ulrich Krafft MD, DSc ,&nbsp;Boris Hadaschik MD, DSc ,&nbsp;Péter Nyirády MD, DSc ,&nbsp;Tibor Szarvas PhD, DSc","doi":"10.1016/j.clgc.2025.102421","DOIUrl":"10.1016/j.clgc.2025.102421","url":null,"abstract":"<div><h3>Introduction</h3><div>Perioperative platinum-based chemotherapy remains the standard systemic treatment for nonmetastatic muscle-invasive bladder cancer (MIBC). Adjuvant chemotherapy (AC) is recommended for patients with pT3/4 (stage IIIA) or lymph node-positive (LN+, stage IIIB) disease following radical cystectomy (RC). However, not all patients benefit equally, highlighting the need for predictive biomarkers. Lymphovascular invasion (LVI) is a known risk-factor in several cancers, including MIBC, but its predictive value for AC benefit remains unclear. Therefore, we aimed to assess whether LVI can predict response to platinum-based AC in MIBC.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study involving MIBC patients who underwent RC between 2005 and 2023 at two academic centers. Inclusion criteria were pT3/T4M0 or LN+ disease, with available LVI status and survival data. Patients were divided into a treatment (AC) and a control group (RC without AC). Overall survival (OS) was the primary endpoint; cancer-specific survival (CSS) was secondary. Statistical analysis was performed using Kaplan-Meier estimates, Cox proportional hazards models, and propensity score matching (PSM) to adjust for potential confounders.</div></div><div><h3>Results</h3><div>A total of 345 patients fulfilled the inclusion criteria of whom 92 (27%) received and 253 (73%) did not receive AC. LVI-positive patients demonstrated significantly improved OS and CSS when treated with AC (both <em>P</em> &lt; .001), while no significant OS or CSS benefit was observed for AC-treated LVI-negative patients (<em>P</em> = .146 for OS, <em>P</em> = .975 for CSS). Results remained similar after PSM correction revealing survival benefit for AC treatment in LVI-positive but not in LVI-negative patients.</div></div><div><h3>Conclusions</h3><div>This study demonstrates, for the first time, LVI status as a predictor of treatment benefit from platinum-based AC. Our results suggest that LVI status is an easily assessable biomarker to identify those patients who derive greater benefit from the treatment, while LVI-negative patients might be spared unnecessary chemotherapy and its associated toxicity.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102421"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Titrating Cabozantinib in Metastatic Renal Cell Carcinoma Patients Using Goldilocks Principle: A Real-World Evidence Study","authors":"Malou Aarønæs Thybo ,&nbsp;Johanne Ahrenfeldt ,&nbsp;Iben Lyskjær ,&nbsp;Niels Fristrup","doi":"10.1016/j.clgc.2025.102419","DOIUrl":"10.1016/j.clgc.2025.102419","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of renal cell carcinoma (RCC) continues to rise worldwide, and this malignancy has demonstrated substantial sensitivity to both immunotherapies and targeted agents, particularly tyrosine kinase inhibitors (TKIs). Cabozantinib, a commonly utilized TKI, has shown promising efficacy across multiple clinical trials. This study aims to evaluate the real-world effectiveness of individualized cabozantinib dosing as a later-line treatment in patients with metastatic RCC (mRCC).</div></div><div><h3>Patients and methods</h3><div>Patients with mRCC treated at the Department of Oncology, Aarhus University Hospital, Denmark, were identified to estimate the median progression free survival (mPFS) and median overall survival (mOS) from treatment initiation. Best radiological response was evaluated using RECIST 1.1. Multivariable cox regression analyses were performed, including covariates such as brain metastasis, first-line treatment, line of treatment, ECOG Performance Status, IMDC risk group, nephrectomy status, and toxicity.</div></div><div><h3>Results</h3><div>A total of 179 patients were included, of which 139 patients received second-line (2L) treatment, and 40 patients received third+-line (3+L) treatment. We found a mPFS of 11.2 months for 2L treatment and 11.6 months for 3+L treatment. The mOS was 15.6 months for the 2L group and 17.1 months for the 3+L group. The mPFS and mOS in the IMDC favourable risk group were 28.5 and 52.1 months, respectively. No significant differences in mPFS or mOS were observed based on prior 1L treatment or the presence of brain metastases. The mOS and mPFS found in this study are comparable to, and in some cases exceed, those reported in other real-world cohorts. Interestingly, we found treatment-related toxicity to correlate significantly with an increased survival (mOS 66.8 vs. 32.8 months, <em>P</em> = .016) (mPFS 14,7 vs. 8,5 months, P = .013).</div></div><div><h3>Conclusion</h3><div>This study reinforces the existing data on effectiveness of cabozantinib as a later-line treatment for mRCC in real-world settings. We report 40 mg as the preferred landing zone. Furthermore we identify patients needing dose reductions due to toxicity as a subgroup carrying a significantly better prognosis. The results emphasize the importance of individual dosage for optimizing treatment outcomes and points out treatment-related toxicity as a surrogate marker for sufficient serum concentration of the active substance.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102419"},"PeriodicalIF":2.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Treatment Patterns and Outcomes Among Patients Diagnosed With Nonmuscle-Invasive Bladder Cancer in the United States","authors":"Bernard Bright Davies-Teye ,&nbsp;Dominique Seo ,&nbsp;Abree Johnson ,&nbsp;Jennifer Stuart ,&nbsp;Mehmet Burcu ,&nbsp;Nader Hanna ,&nbsp;Eberechukwu Onukwugha ,&nbsp;M. Minhaj Siddiqui","doi":"10.1016/j.clgc.2025.102424","DOIUrl":"10.1016/j.clgc.2025.102424","url":null,"abstract":"<div><h3>Introduction</h3><div>Heterogeneity in disease presentation in nonmuscle invasive bladder cancer (NMIBC) creates significant variability in treatment patterns and outcomes across risk and clinical subgroups.</div></div><div><h3>Methods</h3><div>A descriptive analysis of NMIBC patients diagnosed between 2004 and 2017 using the National Cancer Database (NCDB), examined trends and patterns in treatment practices, postradical cystectomy (RC) outcomes, and survival overall and by subgroups. The American Urological Association/Society of Urologic Oncology risk stratification guideline was used to categorize patients into low-intermediate (LIR) and high-risk groups.</div></div><div><h3>Results</h3><div>Among newly diagnosed NMIBC patients (N = 324,646), 78.6% received TURBT without BCG, and 17.4% received BCG as part of their first course of treatment. Treatment patterns differed by risk groups. The high-risk group had lower TURBT without BCG than LIR (64.7% vs. 90.8%), but higher BCG (28.3% vs. 8.0%) and RC (5.5% vs. 0.5%). In the high-risk group, BCG and RC rates were higher in cT1/cTs than cTa patients. Over time, from 2004-2008 to 2013-2017, the use of BCG (12.6%-21.3%) and RC (2.2%-3.0%) increased, while TURBT-without BCG (84.3%-74.5%) decreased. Post-RC 90-day mortality was higher in high-risk than in LIR patients (4.6% vs. 2.8%). Five-year survival probabilities were unchanged over time. A post-hoc analysis revealed that 14% of patients received postoperative intravesical chemotherapy, with no notable differences in patient characteristics between this subgroup and the overall population.</div></div><div><h3>Conclusion</h3><div>Unmet medical needs for NMIBC patients persist, as many high-risk patients do not receive guideline-recommended care, and survival outcomes remain largely unchanged.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102424"},"PeriodicalIF":2.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}