How to optimally manage elderly bladder cancer patients?

Soria, Francesco; Moschini, Marco; Korn, Stephan; Shariat, Shahrokh F.

doi:10.21037/tau.2016.04.08

Cited by 20 publications

(17 citation statements)

References 52 publications

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“…8 Although surgical procedures can be numerous (73 non-local anaesthetic procedures in addition to the first resection in our series) in the management of NMIBC, with appropriate anaesthetic support it is possible to manage the co-morbid elderly patient safely during general anaesthetics. 9 However, risk-benefit discussions and an anaesthetic review are particularly important in this cohort. 10 The impact on NMIBC patients in terms of economics, quality of life and activities of daily living when they are on an intensive surveillance protocol, having repeated anaesthetics for recurrent tumours and intravesical treatments has not been established.…”

Section: Discussionmentioning

confidence: 99%

Bladder cancer in the elderly: A retrospective analysis of bladder cancer in individuals older than 85 years

Parsons

Hill

et al. 2019

Journal of Clinical Urology

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Introduction: Current life expectancy in the United Kingdom is 79.2 years in men and 82.9 years in women. Average age at diagnosis of bladder cancer is 73 years, but incidence continues to rise with age. Elderly patients represent a unique cohort of patients; they often have multiple medical co-morbidities, and may have different wishes and treatment aims as opposed to younger patients. We describe our current bladder cancer practice in patients older than 85 years. Methods: A retrospective review was conducted of patients older than 85 years, first diagnosed with bladder cancer between December 2012 and June 2016. Results: A total of 102 patients were analysed from our database. Mean age at diagnosis was 88.34 years. Staging at diagnosis was: 75 non–muscle-invasive bladder cancer (NMIBC) (17 low, 13 intermediate, 45 high risk), 23 muscle-invasive bladder cancer (MIBC), and four metastatic disease. Of patients with NMIBC, 29/75 patients had a recurrence, 4/75 were upstaged, and 9/75 progressed to MIBC. Twenty-nine of 75 of the NMIBC patients declined treatment or ongoing surveillance. Overall, 53% (53/102) have died of any cause, with a mean of 2.0 years since diagnosis, 31 of bladder cancer. In NMIBC patients, 38.7% (29/102) have died of any cause since diagnosis, at a mean interval of 1.8 years following diagnosis. Conclusion: In our cohort of bladder cancer patients older than 85 years, there is a high all-cause mortality rate within a relatively short time period following diagnosis. These data should aid well-informed discussions with our elderly bladder cancer patients and their relatives when considering treatment and surveillance options. Level of evidence: Not applicable for this single centre audit.

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Section: Discussionmentioning

confidence: 99%

Bladder cancer in the elderly: A retrospective analysis of bladder cancer in individuals older than 85 years

Parsons

Hill

et al. 2019

Journal of Clinical Urology

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“…19 Patients unfit for surgical intervention could be eligible for bladder-sparing techniques. 19 Molecular biology advancements have increased the variety of potential candidate biomarkers that may be considered as biological age predictors. 3,20 Sun and colleagues characterized the heterogeneity of MIBC using whole genome mRNA expression data from 372 MIBC patients from the Cancer Genome Atlas.…”

Section: Discussionmentioning

confidence: 99%

“…18 For muscle-invasive bladder cancer (MIBC), the curative treatment remains as radical cystectomy and elderly patients should not be withheld a potentially life-saving intervention based only on chronological age. 19 Patients unfit for surgical intervention could be eligible for bladder-sparing techniques. 19 Molecular biology advancements have increased the variety of potential candidate biomarkers that may be considered as biological age predictors.…”

Section: Discussionmentioning

confidence: 99%

Risk stratification by means of biological age-related factors better predicts cancer-specific survival than chronological age in patients with upper tract urothelial carcinoma: a multi-institutional database study

Inamoto

Matsuyama

Ibuki

et al. 2018

Therapeutic Advances in Urology

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Background:Chronological age is an important factor in determining the treatment options and clinical response of patients with upper tract urothelial carcinoma (UTUC). Much evidence suggests that chronological age alone is an inadequate indicator to predict the clinical response to radical nephroureterectomy (RNU).Patients and methods:We retrospectively reviewed the data from 1510 patients with UTUC (Ta-4) treated by surgery. White blood cell (WBC) count, neutrophil-to-lymphocyte ratio, hemoglobin (Hb), platelets, albumin, alkaline phosphatase, lactate dehydrogenase, creatinine, and corrected calcium were tested by the Spearman correlation to indicate the direction of association with chronological age, which yielded significant, negative associations of Hb (p < 0.001) and WBC (p = 0.010) with chronological age. For scoring, we assigned points for these categories as follows; point ‘0’ for Hb >14 (reference) and 13–13.9 [odds ratio (OR): 1.533], point ‘1’ for 12–12.9 (OR: 2.391), point ‘2’ for 11–11.9 (OR: 3.015), and point ‘3’ for <11 (OR: 3.584). For WBC, point ‘1’ was assigned for >9200 (OR: 2.541) and ‘0’ was assigned for the rest; 9200–8500 (reference), 8499–6000 (OR: 0.873), 5999–4500 (OR: 0.772), 4499–3200 (OR: 0.486), and <3200 (OR: 1.277).Results:The 10-year cancer-specific survival (CSS) in the higher risk group with scores of 4 or higher in patients age <60 years was worse than a score of 0, or 1 in age >80 years [mean estimated survival 69.7 months, confidence interval (CI): 33.3–106 versus 103.5. CI: 91–115.9]. The concordance index between biological age scoring and chronological age was 0.704 for CSS and 0.798 for recurrence-free survival. The limitation of the present study is the retrospective nature of the cohort included.Conclusions:The biological age scoring developed for patients with UTUC undergoing RNU. It was applicable to those with localized disease and performed well in diverse age populations.

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“…In addition, the relative lack of approved treatment options for NMIBC and the fact that no new therapies have been approved for NMIBC in the twenty-first century graphically illustrates the need to develop new drugs for the management of NMIBC [18]. Finally, NMIBC is a nonlethal disease and as most patients are old with other comorbid conditions such as cardiovascular and pulmonary diseases [27,28], the safety of drugs used after TURBT is also of paramount importance. The toxicity profile of novel therapeutics is also therefore an important consideration in the management of these patients.…”

Section: Overview Of Nmibc and Available Therapiesmentioning

confidence: 99%

Efficacy, pharmacokinetic and pharmacodynamic evaluation of apaziquone in the treatment of non-muscle invasive bladder cancer

Phillips

Hendriks²,

Sweeney

et al. 2017

Expert Opinion on Drug Metabolism & Toxicology

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Introduction: Apaziquone (also known as EO9 and Qapzola TM ) is a prodrug that is activated to DNA damaging species by oxidoreductases (particularly NQO1) and has the ability to kill aerobic and/or hypoxic cancer cells. Areas covered: Whilst its poor pharmacokinetic properties contributed to its failure in phase II clinical trials when administered intravenously, these properties were ideal for loco-regional therapies. Apaziquone demonstrated good anti-cancer activity against non-muscle invasive bladder cancer (NMIBC) when administered intravesically to marker lesions and was well tolerated with no systemic side effects. However, phase III clinical trials did not reach statistical significance for the primary endpoint of 2-year recurrence in apaziquone over placebo although improvements were observed. Post-hoc analysis of the combined study data did indicate a significant benefit for patients treated with apaziquone, especially when the instillation of apaziquone was given 30 min or more after surgery. A further phase III study is ongoing to test the hypotheses generated in the unsuccessful phase III studies conducted to date. Expert opinion: Because of its specific pharmacological properties, Apaziquone is excellently suited for local therapy such as NMIBC. Future studies should include proper biomarkers. ARTICLE HISTORY

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How to optimally manage elderly bladder cancer patients?

Cited by 20 publications

References 52 publications

Bladder cancer in the elderly: A retrospective analysis of bladder cancer in individuals older than 85 years

Bladder cancer in the elderly: A retrospective analysis of bladder cancer in individuals older than 85 years

Risk stratification by means of biological age-related factors better predicts cancer-specific survival than chronological age in patients with upper tract urothelial carcinoma: a multi-institutional database study

Efficacy, pharmacokinetic and pharmacodynamic evaluation of apaziquone in the treatment of non-muscle invasive bladder cancer

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