RESUMO
BACKGROUND: The studies IMvigor 210 cohort 2 and IMvigor211 evaluated the efficacy of atezolizumab in patients with locally advanced or metastatic urothelial cancer (mUC) upon progression to platinum-based chemotherapy worldwide. Yet, the real impact of this drug in specific geographical regions is unknown. MATERIALS AND METHODS: We combined individual-level data from the 131 patients recruited in Spain from IMvigor210 cohort 2 and IMvigor211 in a pooled analysis. Efficacy and safety outcomes were assessed in the overall study population and according to PD-L1 expression on tumour-infiltrating immune cells. RESULTS: Full data were available for 127 patients; 74 (58%) received atezolizumab and 53 (42%) chemotherapy. Atezolizumab patients had a numerically superior median overall survival although not reaching statistical significance (9.2 months vs 7.7 months). No statistically significant differences between arms were observed in overall response rates (20.3% vs 37.0%) or progression-free survival (2.1 months vs 5.3 months). Nonetheless, median duration of response was superior for the immunotherapy arm (non-reached vs 6.4 months; p = 0.005). Additionally, among the responders, the 12-month survival rates seemed to favour atezolizumab (66.7% vs 19.9%). When efficacy was analyzed based on PD-L1 expression status, no significant differences were found. Treatment-related adverse events of any grade occurred more frequently in the chemotherapy arm [46/57 (81%) vs 44/74 (59%)]. CONCLUSION: Patients who achieved an objective response on atezolizumab presented a longer median duration of response and numerically superior 12 month survival rates when compared with chemotherapy responders along with a more favorable safety profile. PD-L1 expression did not discriminate patients who might benefit from atezolizumab.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma de Células de Transição/tratamento farmacológico , Neoplasias Ureterais/tratamento farmacológico , Neoplasias Uretrais/tratamento farmacológico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos/efeitos adversos , Antígeno B7-H1/metabolismo , Carcinoma de Células de Transição/metabolismo , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/secundário , Estudos de Coortes , Feminino , Humanos , Linfócitos do Interstício Tumoral/metabolismo , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Espanha , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias Ureterais/metabolismo , Neoplasias Ureterais/mortalidade , Neoplasias Ureterais/patologia , Neoplasias Uretrais/metabolismo , Neoplasias Uretrais/mortalidade , Neoplasias Uretrais/patologia , Neoplasias da Bexiga Urinária/metabolismo , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologiaRESUMO
PURPOSE: Urethral carcinoma in situ (CIS) is an uncommon malignancy that is poorly described in the published literature and is often under-recognized in the clinical setting. This short case series reports some challenges associated with the recognition and management of this disease. METHODS: A retrospective chart review was done over a 12-year period of patients presenting with urethral cancer to the Johns Hopkins Hospital. Four patients were identified with CIS of the anterior urethra, and their demographic and clinical data were recorded. RESULTS: Three patients presented with meatal lesions that were initially treated as infectious/inflammatory diseases before diagnoses of malignancy were determined following lesion biopsy. The fourth patient presented with painless hematuria and had a cystoscopy and biopsy of urethral polyps. All patients were treated surgically by sequential distal urethrectomy and various reconstructive procedures. Concurrent lymph node dissections were undertaken in two patients who had clinical or radiologic evidence of lymphadenopathy. One patient had persistent disease even after aggressive urethral resection, and he succumbed to his illness 2 years later. CONCLUSION: This is the largest series of urethral CIS, a disease with potentially serious consequences. A high index of suspicion should be maintained when evaluating and managing these patients.
Assuntos
Carcinoma in Situ/diagnóstico , Excisão de Linfonodo , Recidiva Local de Neoplasia , Neoplasias Uretrais/diagnóstico , Idoso , Carcinoma in Situ/tratamento farmacológico , Carcinoma in Situ/cirurgia , Erros de Diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Uretrais/tratamento farmacológico , Neoplasias Uretrais/cirurgiaRESUMO
PURPOSE: The authors present here 5 cases of continent urinary diversion in rhabdomyosarcoma applying a recently described technique for the Mitrofanoff Principle devised by the authors. METHODS: Two previously irradiated rhabdomyosarcoma patients presenting with residual bladder disease and massive sensitive urinary urgency underwent a transverse colonic reservoir with catheterizable stoma. Two other patients presenting with a Bricker conduit underwent conversion into an ileal reservoir. One patient underwent reconstruction after a cystectomy. RESULTS: All patients were continent and able to perform continent intermittent catheterization. CONCLUSIONS: The technique proved to be feasible for this group of patients. The authors believe that because of its simplicity, it should be an option of continent urinary diversion when the Mitrofanoff Principle is considered.
Assuntos
Rabdomiossarcoma/cirurgia , Derivação Urinária/métodos , Neoplasias Urogenitais/cirurgia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante/efeitos adversos , Criança , Pré-Escolar , Colo Transverso/cirurgia , Bolsas Cólicas , Terapia Combinada , Ciclofosfamida/administração & dosagem , Cistectomia , Dactinomicina/administração & dosagem , Evolução Fatal , Feminino , Seguimentos , Humanos , Lactente , Masculino , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Radioterapia Adjuvante , Rabdomiossarcoma/tratamento farmacológico , Rabdomiossarcoma/radioterapia , Rabdomiossarcoma Alveolar/tratamento farmacológico , Rabdomiossarcoma Alveolar/radioterapia , Rabdomiossarcoma Alveolar/cirurgia , Sepse/etiologia , Neoplasias Uretrais/tratamento farmacológico , Neoplasias Uretrais/radioterapia , Neoplasias Uretrais/cirurgia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/radioterapia , Neoplasias da Bexiga Urinária/cirurgia , Cateterismo Urinário , Infecções Urinárias/etiologia , Neoplasias Urogenitais/tratamento farmacológico , Neoplasias Urogenitais/radioterapia , Neoplasias Vaginais/tratamento farmacológico , Neoplasias Vaginais/radioterapia , Neoplasias Vaginais/cirurgia , Vincristina/administração & dosagemRESUMO
OBJECTIVE: Describe the results of surgery, radiation therapy and chemotherapy for treatment of primary malignant neoplasms of female urethra. PATIENTS AND METHODS: Since 1982, 31 patients with urethral cancer were evaluated at our institution (follow-up ranging from 0 to 127 months). Ten patients were treated with external beam irradiation and 1 patient received preoperative therapy after surgery. Two patients refused treatment and 1 received chemotherapy. Three patients presented with disseminated metastatic disease at the first examination received exclusively palliative treatment. RESULTS: Five patients have survived from 3 to 10 years following treatment without recurrence. Of 31 patients 18 developed distant metastases during the first 24 months of follow-up irrespective of treatment employed. CONCLUSION: With exception of primary melanoma, prognosis was not related to histologic features. Patients who underwent surgery and radiotherapy had a better survival rate than did those who received radiotherapy alone. Total urethrectomy with appendico-vesicostomy can be an alternative surgical method for entire urethral ivnasive lesions without cystourethrectomy and preserving urinary continence.