A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions?

OBJECTIVE: It is recognized that multidisciplinary teams may improve management decisions for patients with malignancies. We prospectively studied the effect of such a multidisciplinary approach on the diagnosis and treatment decisions of patients newly presenting with urologic malignancies. METHODS: Two hundred sixty-nine consecutive new patients presenting to our institution with an outside diagnosis of a urologic malignancy for diagnostic or treatment considerations (2007-2008). All cases were reviewed and discussed at a tumor board with all members of the different subspecialties present. Reevaluation of the outside diagnostic and treatment plan was undertaken. Based on this team review and approach, patients were classified based on changes in diagnosis and/or treatment. RESULTS: Cohort was comprised of patients with the diagnosis of cancer of the prostate (34%), bladder (23%), kidney (35%), testicle (5%), and other (1%). Only 35% of patients had no changes in diagnosis or treatment, 38% had a change in diagnosis or treatment, 10% required further analysis (i.e., "other"), and 17% were N/A. Changes in diagnosis were most common in bladder (23%) and renal (17%) cancers. Changes in treatment were most common in bladder cancer (44%), followed by kidney (36%), testicular (29%), then prostate (22%) cancers. A stage effect on diagnostic and treatment considerations was also noted, especially for bladder cancer. CONCLUSIONS: A multidisciplinary team approach affects the diagnostic and management decisions in a significant number patients with a newly diagnosed urologic malignancy, and thereby seems to have a clinical impact for many of our patients with urologic cancers.

A phase II trial of neoadjuvant erlotinib in patients with muscle-invasive bladder cancer undergoing radical cystectomy: clinical and pathological results.

OBJECTIVE: To evaluate the clinicopathological efficacy of neoadjuvant erlotinib (an epidermal growth factor receptor, EGFR, inhibitor) for invasive bladder cancer in patients undergoing radical cystectomy (RC) as despite definitive surgical therapy, only half of patients undergoing RC will have long-term disease-free survival, and effective adjunctive therapies, especially using agents with lower toxicity, would be a significant advance in the treatment of invasive bladder cancer. PATIENTS AND METHODS: The primary endpoint of this phase II trial is to determine the effect of neoadjuvant erlotinib (150 mg once daily for 4 weeks) before RC on the pathological complete response rate (pT0 rate) in RC specimens. In addition, the safety of therapy with erlotinib was also evaluated. Patients selected for study included those with histologically confirmed muscle-invasive bladder cancer who had undergone initial transurethral resection. RESULTS: In all, 20 patients with clinical stage T2 disease had neoadjuvant erlotinib therapy followed by RC. On surgical pathology, five patients (25%) were pT0; in addition, seven (35%) were clinically down-staged (< or = pT1) and 15 (75%) had organ-confined disease at surgical pathology. At a mean follow-up of 24.8 months, 10 patients remain alive and with no evidence of disease, four with organ-confined disease had progression and nine died, including six from disease and three from other causes. Erlotinib was tolerated in all patients, with drug rash being the most common side-effect, in 15 patients (75%). Interestingly, all pT0 and pTis/T1 patients had a rash. CONCLUSIONS: The EGFR inhibitor erlotinib, when administered in the neoadjuvant setting, can have beneficial effects in terms of surgical pathology and short-term clinical outcomes in patients undergoing RC for invasive bladder cancer. Analyses are underway to examine the molecular correlates of the apparent clinical effect of neoadjuvant therapy in these patients.