Peter A Reisz1, Aaron A Laviana2, Sam S Chang2. 1. Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA. peter.a.reisz@vanderbilt.edu. 2. Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA.
Abstract
PURPOSE OF REVIEW: The optimal management of high-grade T1 (HGT1) urothelial carcinoma (UC) is complex given its high rate of recurrence, progression, and cancer-specific mortality as well as its clinical variability. Our current treatment paradigm has been supplemented by recent data describing the expanding options for salvage intravesical therapy, bladder preservation, and the promising role of molecular epidemiology. In the current review, we attempt to summarize and critically analyze these studies. RECENT FINDINGS: Evidence describing new intravesical therapies has demonstrated an adequate safety profile and some efficacy in BCG-unresponsive patients who desire bladder preservation. However, response rates are still poor in this high-risk patient population, and it is important to keep these data in perspective when counseling patients. Concomitantly, the continued molecular characterization of non-muscle-invasive bladder cancer may suggest potential therapeutic targets as well as predictors of treatment response in the future. The integration of new intravesical therapies and molecular data into the current treatment paradigm for HGT1 urothelial carcinoma will be critical to improving oncologic outcomes in this particularly high-risk population.
PURPOSE OF REVIEW: The optimal management of high-grade T1 (HGT1) urothelial carcinoma (UC) is complex given its high rate of recurrence, progression, and cancer-specific mortality as well as its clinical variability. Our current treatment paradigm has been supplemented by recent data describing the expanding options for salvage intravesical therapy, bladder preservation, and the promising role of molecular epidemiology. In the current review, we attempt to summarize and critically analyze these studies. RECENT FINDINGS: Evidence describing new intravesical therapies has demonstrated an adequate safety profile and some efficacy in BCG-unresponsive patients who desire bladder preservation. However, response rates are still poor in this high-risk patient population, and it is important to keep these data in perspective when counseling patients. Concomitantly, the continued molecular characterization of non-muscle-invasive bladder cancer may suggest potential therapeutic targets as well as predictors of treatment response in the future. The integration of new intravesical therapies and molecular data into the current treatment paradigm for HGT1urothelial carcinoma will be critical to improving oncologic outcomes in this particularly high-risk population.
Authors: Richard J Sylvester; Willem Oosterlinck; Sten Holmang; Matthew R Sydes; Alison Birtle; Sigurdur Gudjonsson; Cosimo De Nunzio; Kikuo Okamura; Eero Kaasinen; Eduardo Solsona; Bedeir Ali-El-Dein; Can Ali Tatar; Brant A Inman; James N'Dow; Jorg R Oddens; Marek Babjuk Journal: Eur Urol Date: 2015-06-16 Impact factor: 20.096
Authors: Peter E Clark; Neeraj Agarwal; Matthew C Biagioli; Mario A Eisenberger; Richard E Greenberg; Harry W Herr; Brant A Inman; Deborah A Kuban; Timothy M Kuzel; Subodh M Lele; Jeff Michalski; Lance C Pagliaro; Sumanta K Pal; Anthony Patterson; Elizabeth R Plimack; Kamal S Pohar; Michael P Porter; Jerome P Richie; Wade J Sexton; William U Shipley; Eric J Small; Philippe E Spiess; Donald L Trump; Geoffrey Wile; Timothy G Wilson; Mary Dwyer; Maria Ho Journal: J Natl Compr Canc Netw Date: 2013-04-01 Impact factor: 11.908
Authors: Jesus Fernandez-Gomez; Rosario Madero; Eduardo Solsona; Miguel Unda; Luis Martinez-Piñeiro; Marcelino Gonzalez; Jose Portillo; Antonio Ojea; Carlos Pertusa; Jesus Rodriguez-Molina; Jose Emilio Camacho; Mariano Rabadan; Ander Astobieta; Manuel Montesinos; Santiago Isorna; Pedro Muntañola; Anabel Gimeno; Miguel Blas; Jose Antonio Martinez-Piñeiro Journal: J Urol Date: 2009-09-16 Impact factor: 7.450
Authors: Sunanda J Chatterjee; Ben George; Peter J Goebell; Mohammad Alavi-Tafreshi; Shan-Rong Shi; Yuen Kai Fung; Peter A Jones; Carlos Cordon-Cardo; Ram H Datar; Richard J Cote Journal: J Pathol Date: 2004-07 Impact factor: 7.996
Authors: Jacques Ferlay; Isabelle Soerjomataram; Rajesh Dikshit; Sultan Eser; Colin Mathers; Marise Rebelo; Donald Maxwell Parkin; David Forman; Freddie Bray Journal: Int J Cancer Date: 2014-10-09 Impact factor: 7.396