Predicting Recurrence and Progression in Patients with Non-Muscle-Invasive Bladder Cancer : Systematic Review on the Performance of Risk Stratification Models

BACKGROUND: Several classifications have been reported to stratify non-muscle-invasive bladder cancer (NMIBC) in risk groups according to the probability of recurrence and progression. OBJECTIVE: To systematically review the current evidence regarding risk stratification of NMIBC. METHODS: The systematic review was performed in accordance with the PRISMA statement. Studies providing data on development and/or external validation cohorts of models and risk stratification tables for recurrence and/or progression for patients with NMIBC, reporting at least one discrimination measure (AUC or C-Index) were included. RESULTS: Twenty-five studies involving 22,737 patients were included. Six classifications were identified, three of them were predictive models (EORTC, CUETO, EAU 2021) and three were based on expert opinion (EAU 2020, AUA, NCCN). A high risk of bias was present in the majority of the studies. Certain heterogenicity was found among the studies regarding adjuvant therapy, postoperative instillation or second resection. The definition of oncological outcomes was not standardized in the included studies. CUETO and EORTC scoring systems are the most validated. In general, validations showed a poor discrimination capability to predict recurrence, slightly better for progression. The EAU 2021 model overestimates the risk of progression in patients treated with BCG. Carcinoma in situ is underrepresented in all the studies analyzed. CONCLUSIONS: The existing classifications show poor discrimination capability for recurrence and possibly helpful discrimination capability for progression in NMIBC patients. These results highlight the unmet need to develop novel accurate risk models for patients with NMIBC, which could be improved with the combination of clinicopathological and molecular information

Immunotherapy moves to the early-stage setting in non-small cell lung cancer: emerging evidence and the role of biomarkers

Despite numerous advances in targeted therapy and immunotherapy in the last decade, lung cancer continues to present the highest mortality rate of all cancers. Targeted therapy based on specific genomic alterations, together with PD-1 and CTLA-4 axis blocking-based immunotherapy, have significantly improved survival in advanced non-small cell lung cancer (NSCLC) and both therapies are now well-established in this clinical setting. However, it is time for immunotherapy to be applied in patients with early-stage disease, which would be an important qualitative leap in the treatment of lung cancer patients with curative intent. Preliminary data from a multitude of studies are highly promising, but therapeutic decision-making should be guided by an understanding of the molecular features of the tumour and host. In the present review, we discuss the most recently published studies and ongoing clinical trials, controversies, future challenges and the role of biomarkers in the selection of best therapeutic options

3T Multiparametric Magnetic Resonance Imaging-Guided High-Dose Salvage Radiotherapy in Prostate Cancer

Purpose/Objective(s) To analyze the efficacy and toxicity of high-dose salvage intensity-modulated radiotherapy (IMRT) in patients with tumor pelvic recurrence detected by 3T multiparametric magnetic resonance imaging (mpMRI). Materials/Methods Between 2009 and 2014, 55 consecutive patients with biochemical recurrence of prostate cancer after radical prostatectomy who were considered for salvage IMRT were included. mpMRI was carried out in all patients before treatment. Salvage IMRT doses were escalated on macroscopic recurrence detected by mpMRI. Biochemical failure after IMRT was defined using PSA nadir plus 0.2 ng/mL definition. Treatment-related complications were evaluated using Common Terminology Criteria for Adverse Events (CTCAE v4.03). Results mpMRI was positive in 19/55 (34.5%) patients. Local recurrence and pelvic lymph node and bone metastases were found in 13, 4 and 2 patients respectively. Median pre-IMRT PSA was 0.4 ng/mL (interquartile range 0.30–1.93 ng/mL). Patients with a positive mpMRI showed PSA level significantly higher compared to those with a negative mpMRI (0.4 [0.4] vs 2.2 [4.1] ng/mL, p=0.003). Median doses of IMRT in patients with negative and positive mpMRI were 70 (64-74) vs 76 (64-80) Gy, respectively. Seventeen patients (31.5%) received androgen-deprivation therapy as a component of their salvage treatment and eight of these had positive MRI. The mean follow-up was 41 months (range 6-81 months). The 3-year cancer specific survival was 98% (95%CI 94.1-100%) and overall survival was 92.5% (95%CI 85.3-99.6%). Global 3-year biochemical disease-free survival (bDFS) was 82.3% (95%CI 71.7-92.9%). In patients with a negative and positive mpMRI, the 3-year bDFS was similar (82.3% vs 82.5%). The 3-year incidence of grade ≥ 2 rectal and urinary late toxicity was 1.9 % and 14.8 %, respectively. The late grade ≥2 toxicity was resolved without sequelae in 8 of these 9 patients. Conclusion High-dose salvage IMRT on macroscopic mpMRI recurrence was an effective and safe treatment. High doses salvage radiation could explain the good biochemical control observed in patients with high PSA levels and positive mpMRI.Sin financiación5.554 JCR (2017) Q1, 11/129 Radiology, Nuclear Medicine & Medical Imaging, 41/223 OncologyUE

Immunotherapy moves to the early-stage setting in non-small cell lung cancer: emerging evidence and the role of biomarkers

Despite numerous advances in targeted therapy and immunotherapy in the last decade, lung cancer continues to present the highest mortality rate of all cancers. Targeted therapy based on specific genomic alterations, together with PD-1 and CTLA-4 axis blocking-based immunotherapy, have significantly improved survival in advanced non-small cell lung cancer (NSCLC) and both therapies are now well-established in this clinical setting. However, it is time for immunotherapy to be applied in patients with early-stage disease, which would be an important qualitative leap in the treatment of lung cancer patients with curative intent. Preliminary data from a multitude of studies are highly promising, but therapeutic decision-making should be guided by an understanding of the molecular features of the tumour and host. In the present review, we discuss the most recently published studies and ongoing clinical trials, controversies, future challenges and the role of biomarkers in the selection of best therapeutic options