Bladder perivascular epithelioid cell tumors

Introduction: Perivascular epithelioid cell tumors (PEComas) of the bladder are infrequent localisation of this mesenchymal cancer with uncertain malignant behavior.Case report: We report the case of a 74 years old women who was diagnosed a malignant PEComa of the bladder. She necessited radical cystectomy with orthotopic ileocaecal pouch reconstruction. Histology and immunohistochemistry confirmed the diagnosis of a malignant PEComa of the bladder. We evaluate the literature cases to adjust the prognosis criteria.Conclusion: Evolution and prognosis evaluation remain hard and could necessitate a radical surgery. Prognosis criteria for the bladder PEComas have to be clarified

Percutaneous MR-guided whole-gland prostate cancer cryoablation: safety considerations and oncologic results in 30 consecutive patients.

To assess the safety and oncological efficacy of percutaneous MR-guided whole-gland prostate cancer (PCa) cryoablation (CA). Between July 2009 and January 2018, 30 patients (mean age 72.9 ± 5.13 years) with histologically proven, organ-confined (≤ T2cN0M0), predominantly low/intermediate-risk PCa (median Gleason score 7; mean prostate specific antigen 6.05 ± 3.74 ng ml <sup>-1</sup> ) underwent MR-guided whole-gland CA. Patients were selected on the basis of prior pelvic radiotherapy (n = 16; 12 for previous PCa), or contra indication/refusal of surgery or radiotherapy. Complications, local progression-free survival (LPFS) and overall survival (OS) were retrospectively investigated. Eighteen [60%] patients reported procedure-related complications: 5/18 [28%] needed surgical/interventional treatments and 13 [72%] conservative or pharmacological treatment. Eleven [73%] complications were noted in the first 15 patients and 7 [47%] in the last 15 patients (p = 0.26). Mean nadir prostate specific antigen was 0.24 ± 1.5 ng ml <sup>-1</sup> (mean follow-up 3.8 years; range: 2 - 2915 days). Seven [23%] patients developed histologically proven local progression (mean time to recurrence 775 days, range: 172 - 2014). Mean clinical follow-up was 3.8 years (range 1-2915 days). LPFS was 92.0, 75.7 and 69.4 % at 1-, 3- and 5 year follow-up, respectively. For patients in salvage treatment, LPFS was 100%, 75%, and 75% at 1-, 3- and 5 year follow-up. OS was 100%, 94.4 and 88.5 % at 1-, 3- and 5 year follow-up respectively, with no patients dying from PCa. Whole-gland PCa CA offers good oncological efficacy, particularly in post-radiotherapy cases. Although the complication rate is significant, the majority is minor and is managed with conservative or pharmacologic management. MRI-guided whole-gland prostate cancer cryoablation offers good oncological efficacy, particularly in post-radiotherapy cases with a contained complication rate

Avelumab as neoadjuvant therapy in patients with urothelial non-metastatic muscle invasive bladder cancer: a multicenter, randomized, non-comparative, phase II study (Oncodistinct 004 - AURA trial)

Introduction Cisplatin-based neoadjuvant chemotherapy (NAC) followed by surgery is the standard treatment for patients with non-metastatic muscle invasive bladder cancer (MIBC). Unfortunately, many patients are not candidates to receive cisplatin due to renal impairment. Additionally, no predictive biomarkers for pathological complete response (pCR) are currently validated in clinical practice. Studies evaluating immune checkpoint inhibitors in the peri-operative setting are emerging with promising results. Clinical trials are clearly required in the neoadjuvant setting in order to improve therapeutic strategies. Methods and analysis Oncodistinct 004 - AURA is an ongoing multicenter phase II randomized trial assessing the efficacy and safety of avelumab single-agent or combined to different NAC regimens in patients with non-metastatic MIBC. Patients are enrolled in two distinct cohorts according to their eligibility to receive cisplatin-based NAC. In the cisplatin eligible cohort, patients are randomized in a 1:1 fashion to receive avelumab combined with cisplatin-gemcitabine or with dose-dense methotrexate-vinblastine-doxorubicin-cisplatin. In the cisplatin ineligible cohort, patients are randomized at a 1:1 ratio to paclitaxel-gemcitabine associated to avelumab or avelumab alone. Primary endpoint is pCR. Secondary endpoints are pathological response and safety. Ethics and dissemination The study is approved by ethics committee from all participating centers. All participants provide informed consent prior inclusion to the study. Once completed, results will be published in peer-reviewed journals