Publications by authors named "Max Kates"
Sarcomatoid urothelial carcinoma (SUC) is a rare histologic subtype with poor prognosis. While there is known intra-tumoral heterogeneity between individual SUC tumors, the relationship between sarcomatoid and conventional urothelial carcinoma (CUC) within the same patient is poorly understood. The objective of this study was to identify differences between the sarcomatoid and CUC tumor microenvironment components that may drive this aggressive phenotype.
View Article and Find Full Text PDFBackground: The Nectin-4 directed antibody drug conjugate enfortumab vedotin (EV) has emerged as frontline systemic therapy in combination with immune checkpoint blockade for urothelial carcinoma (UC), capitalizing on the ubiquitous expression of this protein in UC. There is limited data available regarding expression of Nectin-4 by immunohistochemistry in prostate cancer, but this is of interest as a substantial number of UC patients likely to receive EV have concomitant prostate cancer.
Methods: Nectin-4 protein expression was evaluated by immunohistochemistry in tissue microarrays encompassing a cohort of 302 prostatic adenocarcinomas spanning Grade Groups 1-5.
Purpose: We evaluate the efficacy and safety of UGN-102 chemoablation for the primary treatment of patients with recurrent low-grade intermediate-risk nonmuscle-invasive bladder cancer.
Materials And Methods: ENVISION is an ongoing, multinational, single-arm, phase 3 study in patients with a biopsy-proven recurrence of untreated low-grade intermediate-risk nonmuscle-invasive bladder cancer. Patients received 6 weekly intravesical instillations of UGN-102 (mitomycin; outpatient setting) and were evaluated at 3 months.
Article Synopsis
- CARE is a clinical trial that randomly assigns patients to receive either apixaban or enoxaparin for preventing blood clots after surgery.
- The study aims to evaluate how well patients stick to their medication, their satisfaction with the treatment, and the costs they have to pay out of pocket.
- It also looks at the rates of venous thromboembolism (VTE), which is a serious condition involving blood clots, in patients discharged after radical cystectomy.
Purpose Of Review: To describe patient experiences of transurethral resection of bladder tumor (TURBT) and review recent advances in enhancing clinical outcomes.
Recent Findings: High rates of recurrence and progression of non-muscle invasive bladder tumors expose patients to multiple TURBT procedures throughout their disease process. Understanding the impact of TURBT on quality of life and patient experiences is crucial for shared decision-making, thus enhanced recovery protocol trials are being explored to improve patient outcomes.
Article Synopsis
- The study aimed to compare different surveillance strategies for patients with high-risk non-muscle-invasive bladder cancer, focusing on clinical outcomes, costs, and patient quality of life over 10 years.
- Using a model of 100,000 hypothetical patients aged 70, the research evaluated guideline-recommended regimens and new intensified or reduced surveillance strategies.
- Results showed minimal differences in cancer progression, survival rates, and significant costs associated with higher intensity regimens, suggesting these may not be cost-effective compared to standard approaches.
Background: Sarcomatoid urothelial cancer of the bladder (SBC) is a rare, but aggressive histological subtype for which novel treatments are needed.
Objective: We evaluated the clinical activity and safety of neoadjuvant cisplatin plus gemcitabine plus docetaxel (CGD) in muscle-invasive patients with SBC and assessed SBC tumor biology by whole transcriptome RNA sequencing.
Methods: A single-institution, retrospective analysis of muscle-invasive SBC patients treated with neoadjuvant CGD with molecular analysis.
Background: Despite recent drug development for non-muscle invasive bladder cancer (NMIBC), few therapies have been approved by the US Food and Drug Administration (FDA), and there remains an unmet clinical need. Bacillus Calmette-Guerin (BCG) supply issues underscore the importance of developing safe and effective drugs for NMIBC.
Objective: On November 18-19, 2021, the FDA held a public virtual workshop to discuss NMIBC research needs and potential trial designs for future development of effective therapies.
Introduction: Transurethral resection of bladder tumour (TURBT) is one of the more common procedures performed by urologists. It is often described as an 'incision-free' and 'well-tolerated' operation. However, many patients experience distress and discomfort with the procedure.
View Article and Find Full Text PDFPurpose: Combination intravesical gemcitabine and docetaxel (GemDoce) has demonstrated efficacy as second-line therapy for patients with bacillus Calmette-Guérin (BCG)‒unresponsive nonmuscle-invasive urothelial carcinoma of the bladder (NMIBC). In the context of widespread BCG shortages, we performed a phase 2 prospective trial to assess GemDoce for BCG-naïve NMIBC.
Materials And Methods: This study is a prospective, single-arm, open-label phase 2 trial for patients with BCG-naïve high-risk NMIBC.
Chemoradiation therapy (CRT) is a treatment for muscle-invasive bladder cancer (MIBC). Using a novel transcriptomic profiling panel, we validated prognostic immune biomarkers to CRT using 70 pretreatment tumor samples from prospective trials of MIBC (NRG/RTOG 0524 and 0712). Disease-free survival (DFS) and overall survival (OS) were estimated via the Kaplan-Meier method and stratified by genes correlated with immune cell activation.
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- The study evaluates the effectiveness of blue light cystoscopy (BLC) for detecting bladder tumors among different racial groups, collecting data from the Cysview registry between 2014 and 2021.
- Findings indicate that BLC has a higher sensitivity for detecting malignant lesions compared to white light cystoscopy (WLC), with the combination of both methods increasing detection rates by 10%.
- The results highlight differences in performance among racial groups, with Asian patients experiencing the greatest improvement in detection rates (18%) and the highest positive predictive value (94%) from BLC, while Hispanic patients had the highest negative predictive value (86%).
Article Synopsis
- Researchers studied tiny particles called small extracellular vesicles (sEVs) to find out if they can show different types of bladder cancer.
- They used special techniques to get and check these sEVs from bladder tissue, urine, and blood, finding that urine sEVs are mostly one type and blood sEVs another, even if the tissue says something different.
- Four new important mRNA markers (FAM71E2, OR4K5, FAM138F, KRTAP26-1) were found that might help tell us more about bladder cancer, but more studies are needed to see if these markers work well in more patients.
Despite the introduction of several new agents for the treatment of bladder cancer (BC), intravesical BCG remains a first line agent for the management of non-muscle invasive bladder cancer. In this study we evaluated the antitumor efficacy in animal models of BC of a recombinant BCG known as BCG--OE that releases the small molecule STING agonist c-di-AMP. We found that compared to wild-type BCG (BCG-WT), in both the orthotopic, carcinogen-induced rat MNU model and the heterotopic syngeneic mouse MB-49 model BCG--OE afforded improved antitumor efficacy.
View Article and Find Full Text PDFBackground: Academic and community urology centers participating in a pragmatic clinical trial in non-muscle-invasive bladder cancer completed monthly surveys assessing restrictions in aspects of bladder cancer care due to the COVID-19 Public Health Emergency. Our objective was to describe pandemic-related restrictions on bladder cancer care.
Methods: We invited 32 sites participating in a multicenter pragmatic bladder cancer trial to complete monthly surveys distributed through REDCap beginning in May 2020.
Background: Cytokines are known to be a key a factor in numerous malignancies and to exert an important regulatory role in the tumor microenvironment. Interest has grown in understanding how cytokines modulate the tumor microenvironment and which cytokines may serve as markers of the tumor process; however, a complete picture of the cytokine landscape in bladder cancer remains unclear.
Methods: Fresh urine specimens with sufficient volume were collected at random intervals.
EA8212 BRIDGE is a phase 3 randomized trial comparing BCG vs GemDoce for BCG naïve high-risk non-muscle-invasive bladder cancer. This article provides an explanation for the rationale of the clinical trial and details the study design.
View Article and Find Full Text PDFSmall cell/neuroendocrine bladder cancers (SCBCs) are rare and highly aggressive tumors that are associated with poor clinical outcomes. We discovered that lineage-specific transcription factors (ASCL1, NEUROD1, and POU2F3) defined three SCBC molecular subtypes that resemble well-characterized subtypes in small cell lung cancer. The subtypes expressed various levels of neuroendocrine (NE) markers and distinct downstream transcriptional targets.
View Article and Find Full Text PDFBackground: Squamous cell carcinoma of the bladder (SqCC) is a rare disease with limited management data. Thus, we sought to characterize the clinicopathologic and survival outcomes amongst patients with SqCC and explore the association of squamous differentiation within urothelial carcinoma (UC w/Squam), as compared to muscle invasive pure UC.
Methods: We conducted a single-center retrospective cohort study of patients, stratified by histology, who underwent cystectomy for MIBC.
Aims: Small cell bladder carcinoma (SCBC) is a rare, divergent form of urothelial carcinoma (UC). We aimed to determine whether pure (n = 16) and mixed (SCBC and UC; n = 30) tumours differed in pathology, gene expression characteristics, genetic alterations, and clinical outcomes.
Methods And Results: Forty (87%) patients received first-line chemotherapy.
Article Synopsis
- A phase 1 trial was conducted to assess the safety and early effectiveness of durvalumab (D) alone and in combination with BCG or EBRT for treating patients with non-muscle-invasive bladder cancer (NMIBC) who did not respond to standard BCG therapy.
- Patients received D every 3 weeks for eight cycles, with some also receiving BCG or EBRT, and outcomes were measured using cystoscopy, urine cytology, and bladder biopsies at 3 and 6 months.
- Results showed that 64% of patients achieved a complete response at 3 months, with notable responses in combination therapy groups, suggesting that D combined with BCG or EBRT is safe and warrants further investigation.
We present a case of a large intra-abdominal mass found to be localized pure seminoma within a retained gonad of a 53-year-old phenotypic female with 46,XY differences in sex development (DSD) and androgen insensitivity syndrome (AIS). Our management included extirpation of the mass with contralateral gonadectomy. Historically, patients with AIS would undergo gonadectomy to mitigate the lifetime risk of testicular germ cell tumor development; however, growing evidence suggests safety in retention and surveillance of these gonads into adulthood.
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