Publications by authors named "Wade Sexton"
Objectives: To reassess the role of primary retroperitoneal lymph node dissection (RPLND) in patients with marker-negative non-seminomatous germ cell tumour (NSGCT) clinical stage (CS) 2a, to explore results in patients with CS 2b and to evaluate surgical methods, recurrence, and adjuvant chemotherapy indications.
Materials And Methods: Data from 17 institutions were collected, comprising 305 men who underwent primary RPLND for CS 2 NSGCT. Regression analyses were conducted to predict histology in the RPLND specimen and disease-free survival (DFS).
There is a critical unmet need for safe and efficacious neoadjuvant treatment for cisplatin-ineligible patients with muscle-invasive bladder cancer. Here we launched a phase 1b study using the combination of intravesical cretostimogene grenadenorepvec (oncolytic serotype 5 adenovirus encoding granulocyte-macrophage colony-stimulating factor) with systemic nivolumab in cisplatin-ineligible patients with cT2-4aN0-1M0 muscle-invasive bladder cancer. The primary objective was to measure safety, and the secondary objective was to assess the anti-tumor efficacy as measured by pathologic complete response along with 1-year recurrence-free survival.
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- Neuroendocrine carcinoma of the bladder (NEC-bladder) is a rare and aggressive cancer, and the study focused on patients treated between 2001-2021 to assess treatment outcomes.
- The research found that most patients received neoadjuvant chemotherapy (NAC), and higher rates of pathologic complete response (pCR) and downstaging were associated with improved progression-free and overall survival (PFS and OS).
- Key findings indicated that achieving ypN0 status (negative nodes post-treatment) correlated with better long-term survival, while the presence of nodal involvement (pN+) was linked to poorer outcomes.
Article Synopsis
- There is limited data on how often testicular germ cell tumors (TGCT) occur alongside venous tumor thrombus (VTT), and the study aims to provide insights on this rare condition and its management.
- Researchers analyzed records from the IBM Marketscan database, identifying a small prevalence of TGCT with VTT and gathered expert insights from surgeons on the patient management practices at multiple centers.
- Findings showed that approximately 0.3% to 3.1% of TGCT cases involved VTT, with surgical options being the primary treatment, emphasizing the complexity of managing this combination and the need for a multidisciplinary approach.
Article Synopsis
- The summary discusses two studies evaluating the safety and efficacy of N-803 (Anktiva) combined with the standard treatment BCG for patients with non-muscle invasive bladder cancer (NMIBC).
- The Phase 1b study used increasing doses of N-803 in BCG-naive participants, while the Phase 2/3 study included participants with BCG-unresponsive disease and a cohort treated solely with N-803.
- Key findings showed that the combination treatment was effective, eliminating NMIBC in all nine BCG-naive participants and leading to long-lasting results, with a significant percentage of participants avoiding bladder surgery and experiencing minimal adverse effects.
Article Synopsis
- The review focuses on the emerging role of urinary tumor DNA (utDNA) in diagnosing, monitoring, and treating bladder cancer, emphasizing its potential for personalized care.
- Recent studies suggest that utDNA is a highly effective biomarker, particularly in the early stages of bladder cancer, offering better sensitivity and more detailed genetic insights compared to traditional methods like urine cytology.
- The promise of utDNA lies in its ability for non-invasive and real-time assessment of tumor biology, indicating that future clinical trials could transform how bladder cancer is managed and treated.
Article Synopsis
- * Recent updates to the NCCN Guidelines for Bladder Cancer reflect changes from the fifth edition of the WHO Classification of Tumours, ensuring alignment with new standards.
- * The guidelines also introduce new treatment options for NMIBC that doesn't respond to bacillus Calmette-Guérin (BCG) therapy and provide updated recommendations for systemic therapy targeting advanced or metastatic bladder cancer.
A specific splicing isoform of RNASET2 is associated with worse oncologic outcomes in clear cell renal cell carcinoma (ccRCC). However, the interplay between wild-type RNASET2 and its splice variant and how this might contribute to the pathogenesis of ccRCC remains poorly understood. We sought to better understand the relationship of RNASET2 in the pathogenesis of ccRCC and the interplay with a pathogenic splicing isoform (RNASET2-SV) and the tumor immune microenvironment.
View Article and Find Full Text PDFBackground: Recent progresses in the use of immune checkpoint inhibitor (ICI) have challenged the therapeutic standards in patients with muscle-invasive urothelial bladder carcinoma (MIBC).
Objective: To compare neoadjuvant pembrolizumab followed by radical cystectomy (RC) versus neoadjuvant chemotherapy (NAC) and RC or upfront RC, according to cisplatin eligibility.
Design, Setting, And Participants: We conducted two separate analyses for cisplatin-eligible and cisplatin-ineligible cT2-4N0M0 MIBC patients.
Background: Despite abundant evidence supporting the use of perioperative chemotherapy from clinical trials, no study to date has comprehensively evaluated its use in the treatment of muscle-invasive bladder cancer (MIBC) in the real-world setting. Little is known regarding the impact of pretreatment disease stage and real-world factors such as patient comorbidities preventing timely completion of therapy on its effectiveness. This study aims to assess the usage of perioperative chemotherapy and examines its impact on pathologic downstaging rates and recurrence free survival in patients undergoing radical cystectomy.
View Article and Find Full Text PDFBackground: Optimal patient selection for neoadjuvant chemotherapy prior to surgical extirpation is limited by the inaccuracy of contemporary clinical staging methods in high-risk upper tract urothelial carcinoma (UTUC).
Objective: To investigate whether the detection of plasma circulating tumor DNA (ctDNA) can predict muscle-invasive (MI) and non-organ-confined (NOC) UTUC.
Design, Setting, And Participants: Plasma cell-free DNA was prospectively collected from chemotherapy-naïve, high-risk UTUC patients undergoing surgical extirpation and sequenced using a 152-gene panel and low-pass whole-genome sequencing.
Objective: To evaluate factors associated with perioperative outcomes in a multi-institutional cohort of patients treated with cytoreductive nephrectomy (CN).
Methods: Data were analyzed for metastatic renal cell carcinoma patients treated with CN at 6 tertiary academic centers from 2005 to 2019. Outcomes included: Clavien-Dindo complications, mortality, length of hospitalization, 30-day readmission rate, and time to systemic therapy.
Purpose: No consensus exists on the management of men with nonseminoma and viable nonteratomatous germ cell tumor in the postchemotherapy retroperitoneal lymph node dissection (pcRPLND) specimen after first-line chemotherapy. We analyzed surveillance versus different adjuvant chemotherapy regimens and the influence of time to pcRPLND on oncologic outcomes.
Methods: Data on 117 men treated with cisplatin-based first-line chemotherapy between 1990 and 2018 were collected from 13 institutions.
Objective: UGN-101 has been approved for the chemoablation of low-grade upper tract urothelial cancer (UTUC) involving the renal pelvis and calyces. Herein is the first reported cohort of patients with ureteral tumors treated with UGN-101.
Patients And Methods: We performed a retrospective review of patients treated with UGN-101 for UTUC at 15 high-volume academic and community centers focusing on outcomes of patients treated for ureteral disease.
Purpose: Immune checkpoint blockade holds promise for treating bacillus Calmette-Guerin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC). In this phase II study, we investigated the safety and efficacy of durvalumab, a human IgG1 monoclonal antibody, against BCG-unresponsive carcinoma in situ (CIS).
Patients And Methods: Patients with BCG-unresponsive CIS-containing NMIBC received durvalumab IV at 1,500 mg every 4 weeks for up to 12 months.
Background: Careful patient selection is critical when considering cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) but few studies have investigated the prognostic value of radiologic features that measure tumor burden.
Objective: To develop a prognostic model to improve CN selection with integration of common radiologic features with known prognostic factors associated with mortality in the first year following surgery.
Design, Settings, And Participants: Data were analyzed for consecutive patients with mRCC treated with upfront CN at five institutions from 2006 to 2017.
Background: UGN-101 can be used for chemoablation of low-grade upper tract urothelial carcinoma (UTUC). The gel can be administered via a retrograde route through a ureteral catheter or an antegrade route via a nephrostomy tube.
Objective: To report outcomes of UGN-101 by route of administration.
Purpose: Assess the real-world ablative effect of mitomycin reverse thermal gel for low-grade upper tract urothelial carcinoma (UTUC) in patients who undergo biopsy only or partial ablation and evaluate utility of complete ablation prior to UGN-101.
Material And Methods: We retrospectively reviewed low-grade UTUC patients treated with UGN-101 from 15 high-volume centers. Patients were categorized based on initial endoscopic ablation (biopsy only, partial ablation, or complete ablation) and by size of remaining tumor (complete ablation, <1cm, 1-3cm, or >3cm) prior to UGN-101.