Intravesical bacillus calmette-gueÈrin for the treatment of superficial bladder cancer in renal transplant patients

Palou, Juan; Angerri, Oriol; Segarra, José; Caparrós, Juan; Guirado, Luís; Dı́az, Juan; Salvador-Bayarri, J.; Villavicencio-Mavrich, H.

doi:10.1097/01.tp.0000090748.32764.0f

Cited by 72 publications

(52 citation statements)

References 7 publications

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“…Some studies have shown that BCG is a viable therapeutic option in patients with high risk non-muscle invasive UCB and concomitant lymphoma, chonic lymphocytic leukemia, treatment with low dose oral steroids, treatment with inhaled steroids, or renal transplant. 101,102 Advanced age, however, is considered a risk factor for complications in patients receiving BCG therapy 103 and there are numerous reports of serious complications of BCG therapy in elderly individuals. 104-108 In a retrospective study of 58 patients, Heiner et al found that the complication rate of BCG therapy was higher in patients older than 70 years (48.6% vs 17.6% for those younger than 70 years) with the peak incidence occurring with the third dose of BCG therapy.…”

Section: Age and Treatment Outcomes Of Non-muscle-invasive Bladdementioning

confidence: 99%

Bladder cancer in the elderly

Shariat¹,

Milowsky²,

Droller³

2009

Urologic Oncology: Seminars and Original Investigations

180

126

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Introduction Age is now widely accepted as the greatest single risk factor for developing bladder cancer, and bladder cancer is considered as primarily a disease of the elderly. Because of the close link between age and incidence of bladder cancer, it can be expected that this disease will become an enormous challenge with the growth of an aging population in the years ahead. Methods Using MEDLINE, a search of the literature between January 1966 and July 2007 was performed to describe normative physiologic changes associated with aging, elucidate genetic and epigenetic alterations that associate aging with bladder cancer and its phenotypes; and to characterize how aging influences efficacies, risks, side effects and potential complications of the treatments needed for the various stages of bladder cancer.. Results We discuss influence of aging on host physiology, genetic and epigenetic changes, environmental influences, and host factors in the development and treatment of bladder cancer. Treatments with intravesical Bacille Calmette Guerin, radical cystectomy, and perioperative chemotherapy are less well tolerated and have poorer response in elderly patients compared to their younger counterparts. Elderly patients face both clinical and broader institutional barriers to appropriate treatment and may receive less aggressive treatment and sub-therapeutic dosing. However, when appropriately selected, elderly patients tolerate and respond well to cancer treatments. Conclusions The decision to undergo treatment for cancer is a tradeoff between loss of function and/or independence and extension of life which is complicated by a host of concomitant issues such as co-morbid medical conditions, functional declines and “frailty”, family dynamics, and social and psychological issues. Chronological age should not preclude definitive surgical therapy. It is imperative that healthcare practitioners and researchers from disparate disciplines collectively focus efforts towards gaining a better understanding of what the consequences of bladder cancer and its treatments are for older adults and how to appropriately meet the multifaceted medical and psychosocial needs of this growing population.

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Section: Age and Treatment Outcomes Of Non-muscle-invasive Bladdementioning

confidence: 99%

Bladder cancer in the elderly

Shariat¹,

Milowsky²,

Droller³

2009

Urologic Oncology: Seminars and Original Investigations

180

126

View full text Add to dashboard Cite

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“…However systemic immunosuppression may not always induce a local immunosuppressive effect, and therefore the bladder immunologic-inflammatory reaction obtained with BCG may maintain its efficacy [27, 37]. While Buzzeo et al [4] refrained from using BCG in immunosuppressed patients, Palou et al [27] reported safe administration of intravesical BCG in 3 renal transplant recipients. It should be noted that while there were no adverse reactions to BCG, all 3 patients were treated with prophylactic isoniazid and rifampin [27].…”

Section: Discussionmentioning

confidence: 99%

“…While Buzzeo et al [4] refrained from using BCG in immunosuppressed patients, Palou et al [27] reported safe administration of intravesical BCG in 3 renal transplant recipients. It should be noted that while there were no adverse reactions to BCG, all 3 patients were treated with prophylactic isoniazid and rifampin [27]. The safe administration of intravesical BCG without concomitant antituberculin prophylaxis has also been reported in 3 immunosuppressed renal transplant recipients [3, 28].…”

Section: Discussionmentioning

confidence: 99%

Management of Bladder Cancer following Solid Organ Transplantation

Tomaszewski

Larson

Smaldone

et al. 2011

Advances in Urology

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Objective. Present our experience managing bladder cancer following liver and renal transplantation. Methods. Single institution retrospective review of patients diagnosed with bladder urothelial carcinoma (BUC) following solid organ transplantation between January 1992 and December 2007. Results. Of the 2,925 renal and 2,761 liver transplant recipients reviewed, we identified eleven patients (0.2%) following transplant diagnosed with BUC. Two patients with low grade T1 TCC were managed by TURBT. Three patients with CIS and one patient with T1 low grade BUC were treated by TURBT and adjuvant BCG. All four are alive and free of recurrence at a mean follow-up of 51 ± 22 months. One patient with T1 high grade BUC underwent radical cystectomy and remains disease free with a follow-up of 98 months. Muscle invasive TCC was diagnosed in four patients at a median of 3.6 years following transplantation. Two patients are recurrence free at 24 and 36 months following radical cystectomy. Urinary diversion and palliative XRT were performed in one patient with un-resectable disease. Conclusions. Bladder cancer is uncommon following renal and liver transplantation, but it can be managed successfully with local and/or extirpative therapy. The use of intravesical BCG is possible in select immunosuppressed patients.

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“…However, it is associated with frequent local and/or systemic adverse effects including BCG sepsis (10,11). The incidence of local and systemic adverse effects is significantly lower with chemotherapeutic agents.…”

Section: Introductionmentioning

confidence: 99%

In vivo Evaluation of Mucoadhesive Nanoparticulate Docetaxel for Intravesical Treatment of Non–Muscle-Invasive Bladder Cancer

Mugabe

Matsui

et al. 2011

Clinical Cancer Research

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Purpose: The present work describes the development and in vitro and in vivo evaluation of a mucoadhesive nanoparticulate docetaxel (DTX) formulation for intravesical bladder cancer therapy.Experimental Design: Mucoadhesive formulations based on hyperbranched polyglycerols (HPG), hydrophobically derivatized with C 8 /C 10 alkyl chains in the core and modified with methoxy-polyethylene glycol (MePEG) and amine groups in the shell (HPG-C 8/10 -MePEG-NH 2 ) were synthesized and DTX was loaded into these by a solvent evaporation method. Both low-grade (RT4, MGHU3) and high-grade (UMUC3) human urothelial carcinoma cell lines were treated with various concentrations of DTX formulations in vitro. KU7 cells that stably express firefly luciferase (KU7-luc) were inoculated in female nude mice by intravesical instillation and quantified using bioluminescence imaging. Mice with established KU7-luc tumors were given a single intravesical instillation with PBS, Taxotere (DTX from Sanofiaventis), and DTX-loaded HPG-C 8/10 -MePEG and/or HPG-C 8/10 -MePEG-NH 2 . Drug uptake was conducted using LC/MS-MS (liquid chromatography/tandem mass spectrometry) and tumor microenvironment and uptake of rhodamine labeled HPGs was assessed.Results: In vitro, all DTX formulations potently inhibited bladder cancer proliferation. However, in vivo, DTX-loaded HPG-C 8/10 -MePEG-NH 2 (mucoadhesive DTX) was the most effective formulation to inhibit tumor growth in an orthotopic model of bladder cancer. Furthermore, mucoadhesive DTX significantly increased drug uptake in mouse bladder tissues. In addition, rhodamine labeled HPG-C 8/10 -MePEG-NH 2 showed enhanced uptake of these nanoparticles in bladder tumor tissues.Conclusions: Our data show promising in vivo antitumor efficacy and provide preclinical proof of principle for the intravesical application of mucoadhesive nanoparticulate DTX formulation in the treatment of bladder cancer. Clin Cancer Res; 17(9); 2788-98. Ó2011 AACR.

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Intravesical bacillus calmette-gueÈrin for the treatment of superficial bladder cancer in renal transplant patients

Abstract: Intravesical BCG in superficial bladder cancer and/or CIS is a valid option, with no added morbidity to renal transplant patients.

Cited by 72 publications

References 7 publications

Bladder cancer in the elderly

Bladder cancer in the elderly

Management of Bladder Cancer following Solid Organ Transplantation

In vivo Evaluation of Mucoadhesive Nanoparticulate Docetaxel for Intravesical Treatment of Non–Muscle-Invasive Bladder Cancer

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