Christopher Blick

Accelerated Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (AMVAC) as Neoadjuvant Chemotherapy for Patients With Muscle-Invasive Transitional Cell Carcinoma of the Bladder

Meta‐analysis data demonstrate a 5% absolute survival benefit for neoadjuvant chemotherapy (NAC) using cisplatin‐based combination regimens in the radical treatment of muscle‐invasive bladder cancer (MIBC). However, there are no randomized, controlled trial data on the optimum regimen. Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin (AMVAC) is a dose‐intense regimen that has the potential to minimize delays to definitive, potentially curative therapy. A retrospective analysis is presented of the efficacy and toxicity of AMVAC as NAC in patients with MIBC and its impact on the patient pathway.

Targeting Vascular Endothelial Growth Factor in Renal Cell Carcinoma

Renal cancer is the most lethal of all urological malignancies with overall 5-year survival rates of around 60%. The predominant reason for the poor prognosis of this cancer has been the relative lack of effective systemic therapy for advanced metastatic disease. Until recently immunotherapy with interleukin-2 or interferon-α has been the standard of care for metastatic renal cell carcinoma (RCC); however, the response rates for these treatments were at best only 3–21%. The use of molecular biological techniques has led to a greater understanding of the genetic basis of RCC. Mutations of the von Hippel-Lindau (VHL) gene on chromosome 3p25 with the resultant overexpression of hypoxia-inducible factors (HIFs) have been shown to lead to the development of clear-cell RCC. The unearthing of the pathways downstream of VHL has led to the development of numerous novel therapies that specifically target HIF-related genes such as vascular endothelial growth factor (VEGF). In this article, we explore the VHL-HIF-VEGF pathway that plays a fundamental role in the development of renal cancer. In addition, we review the evidence base for the use of these new targeted therapies for advanced RCC and uniquely include the latest practice guidelines from the European Association of Urology, the United States National Comprehensive Cancer Network and the National Institute for Health and Clinical Excellence.

The diagnostic value of abdominal ultrasound, urine cytology and prostate-specific antigen testing in the lower urinary tract symptoms clinic.

Introduction:  Lower urinary tract symptoms (LUTS) affect 18–26% of men aged 40–79 years, many of whom present with a fear of having cancer. Current guidelines for the assessment of LUTS focus mainly upon benign prostatic hypertrophy. It has been our practice to perform an abdominal ultrasound scan (USS), a prostate‐specific antigen (PSA) blood test and urine cytology during the assessment of males presenting with LUTS to investigate the alternative potentially life‐threatening causes for LUTS. We report on the added value of these tests during the assessment of men with LUTS.

Surgery in renal cell cancer

The incidence of renal cancer has increased over the past 30 years, with renal cell carcinoma being the most common form. In this article, the authors discuss the surgical options for treatment of both localised and metastatic renal cell carcinoma.

The contemporary management of primary urethral carcinoma

Primary urethral cancer is a rare malignancy; the most common histological subtype is squamous cell carcinoma. The aetiology of this cancer is similar to penile cancer and the human papilloma virus (HPV) is thought to be an important factor in tumourigenesis. Surgery with or without chemoradiotherapy is the accepted treatment for primary urethral cancer. Current practice supports penile-sparing surgery, to maximise functional and psychological outcomes. We have reviewed the literature to summarise the pathogenesis and management of primary urethral cancer.

Early Recurrence of Non-Muscle Invasive Bladder Cancer as a Clinical Marker of a Poor Prognosis and Cancer-Specific Survival

Objective To determine whether early recurrence of non-muscle invasive bladder cancer confers prognostic value with respect to bladder cancer-specific survival. Patients and methods: Following local ethics committee approval, all patients that underwent TURBT for a bladder tumour within the Oxford Radcliffe Trust between 1997 and 2007 were entered into the local Cancer Research Uro-Oncology Database (CRUD©). The rate of positive histological recurrence of non-muscle invasive bladder cancer at first cystoscopy (<4 months) following the index TURBT was calculated and the cancer-specific survival calculated using data from the National Cancer Intelligence Network. Results Median positive early recurrence of (NMIBC) non-muscle invasive bladder cancer was 18.9% for the period of 1997 to 2007 (mean 20.3%; range 13.9–-28.3%). Positive early recurrence was associated with significantly worse survival, with 5-year cancer specific survival falling from 82.3% (first cystoscopy negative) to 69.4%, (first cystoscopy positive), Log Rank p = 0.02. Conclusions Our results suggest that if histological recurrence is present at first cystoscopy then the patient is more likely to die from bladder cancer, with 5-year cancer specific mortality of 18% if first cystoscopy clear, compared to 31% if histological recurrence (relative risk 1.7). With the growing demand for surgical outcome measures, our study suggests that ‘positive recurrence at first cystoscopy’ is both simple to measure and a valid predictor of patient outcome.

Contents Vol. 30, 2009

G. Abelev, Moscow V. Barak, Jerusalem R. Begent, London H. Biran, Tel Aviv E. Bombardieri, Milan O.P. Børmer, Oslo R.R. Brentani, São Paulo K. Chester, London E.P. Diamandis, Toronto A. Epenetos, London H.A. Fritsche, Houston, Tex. A. Fuks, Montreal P. Gold, Montreal S. Hammarström, Umeå F. Itoh, Kanagawa J.M. Jessup, Washington, D.C. H. Kato, Ube Y.S. Kim, San Francisco, Calif. M. Kuroki, Fukuoka J.P. Mach, Epalinges s./Lausanne R. Molina, Barcelona B. Pedley, London M.F. Rajewsky, Essen J. Schlom, Bethesda, Md. J.E. Shively, Duarte, Calif. U.-H. Stenman, Helsinki M. Toyota, Sapporo J. Uriel, Paris C. Wittekind, Leipzig H. zur Hausen, Heidelberg Tumor Markers, Tumor Targeting and Translational Cancer Research