A review of urinary bladder microbiome in patients with bladder cancer and its implications in bladder pathogenesis.

PURPOSE: The recent discovery of the urinary microbiome has led to an emerging field of investigation about the potential role of microorganisms in the pathogenesis of urinary bladder cancer. Few preliminary data have been reported so far implicating urobiome as causative and prognostic factor of bladder tumorigenesis. In the present study, a review of the current evidence is presented about microbiome composition among patients with bladder cancer and healthy individuals as well as possible implications of microbiome on urothelial carcinoma of the bladder. METHODS: A literature review was conducted using PubMed/MEDLINE, Scopus, and the Cochrane library until December 2023. Search algorithm was constructed using the following terms and their associated Mesh terms and Boolean operators: "urinary microbiome" and "urinary microbiota". Studies written in English language, identifying, and comparing urinary microbiome among bladder cancer patients and healthy control group were included in the review. RESULTS: A total of 2,356 reports were identified. From this total 16 articles complied with the inclusion criteria were selected for analysis. These articles represent a total of about 486 bladder cancer patients. CONCLUSION: Recent studies revealed the colonization of the urinary tract and the bladder by micro-organisms using both enhanced culture- and molecular-based techniques for microbial characterization. However, several limitations exist in the literature decreasing the reliability of the current reports. As a result, urinary microbiome consist an ambitious era in bladder cancer research with an increasing number of evidence about its potential pathogenetic, prognostic and therapeutic role.

Novel treatments in bcg failure. Where do we stand today? / Nuevos tratamientos en el fracaso de bcg. ¿Dónde estamos hoy?

Objetives: Most patients at first diagnosis of bladder cancer (BC) present with nonmuscleinvasive disease (NMIBC). BCG intravesical therapyafter transurethral resection of the bladder tumor is thegold standard in intermediate and high risk NMIBC patients. However, it is estimated that approximately 50%of these patients will present with BCG failure whichincreases their risk for progression to muscle invasive disease. Currently, the best option for these patients is radical cystectomy. Thus, it is of great interest to pursue new,therapeutic options for BCG failure patients to avoid thenecessity of radical cystectomy. We hereby review novel treatment modalities for BCG failure patients.Methods: This is a narrative review. Keywords for thesearch were BCG failure, BCG unresponsive, BCG refractory, BCG relapsing and BCG intolerance. Evidencewas identified through a search for publications with a ’BCG unresponsive’’ tag through 2020. Studies wereselected if they contained clinical data on BCG unresponsive therapeutics with near-term availability. Clinicaltrial landscape evaluation for emerging therapies wasperformed by searching ClinicalTrials.gov for recruiting/open interventional trials in 2020.Results: Novel treatment modalities for BCG failureinclude intravesical chemotherapy, BCG re-challengeor combination of BCG with IFN-α2β, valrubicin, radiotherapy, electromotive drug administration, vicinium,chemohyperthermia, photodynamic therapy, gene therapy, vaccine therapy and immunotherapy. For patients inwhom BCG has once failed a repeat course of BCG orBCG plus interferon appears to be a reasonable practice. Likewise, single agent gemcitabine may be considered a treatment modality. However, after 2 or moreBCG failures, especially in patients with earlier relapsesor cancer persistence, single agent intravesical chemotherapy with valrubicin, gemcitabine or docetaxel...(AU)

Objetivos: La mayoría de pacientes alprimer diagnóstico de cáncer de vejiga se presentancomo canceres no musculo-invasivos. El tratamiento conBCG intravesical después de resección transuretral devejiga es el tratamiento de elección en los pacientes deriesgo intermedio y alto. Aunque, se estima que aproximadamente el 50% de estos pacientes presentaran unfallo a BCG, que incrementa su riesgo de progresióna enfermedad musculo-invasiva. Actualmente, la mejoropción para estos pacientes es la cistectomía radical.Por tanto, es de alto interés la investigación de nuevostratamientos para pacientes con fallo a BCG para evitarla cistectomía radical. Hemos revisado las nuevas modalidades de tratamiento en pacientes con fallo a BCG.Métodos: Es una revisión narrativa. Las palabrasclave para la búsqueda fueron BCG failure, BCG unresponsive, BCG refractory, BCG relapsing y BCG intolerance. La evidencia se identifico a través de unabúsqueda para las publicaciones con BCG unresponsive hasta 2020. Los estudios fueron seleccionadossi contenían datos clínicos con tratamiento para BCGunresponsive. La evaluación de ensayos clínicos paraterapias emergentes se realizó a través de clinicaltrials.gov para ensayos abierto o en recrutamiento, intervencionales en 2020.Resultados: Las nuevas modalidades de tratamientopara el fallo de la BCG incluyen quimioterapia intravesical, reemplace de BCG o combinación de BCGcon INF-α2β, valrubicina, radioterapia, administraciónelectromotiva del tratamiento (EMDA), vicinium, quimiohipertermia, terapia fotodinámica, terapia genética,terapia por vacunas e immunoterapia. Para pacientesen que la BCG ha fallado una vez, el reemplace deBCG o BCG junto interferón parece ser una opciónrazonable. De la misma forma, gemcitabina sola puedeser utilizada como modalidad de tratamiento. Aunque,después de 2 o mas fallos a BCG, especialmente enpacientes con fallos precoces o persistencia de cáncer...(AU)