Trimodal therapy for invasive bladder cancer: is it really equal to radical cystectomy?

PURPOSE OF REVIEW: Trimodal therapy (TMT) is considered the most effective bladder-sparing approach for muscle-invasive urothelial carcinoma of the bladder (MIBC) and an alternative to radical cystectomy. The purpose of this article was to review and summarize the current knowledge on the equivalence of TMT and radical cystectomy based on the recent literature. RECENT FINDINGS: TMT consists of a maximal transuretral resection of the bladder, followed by a concurrent radiotherapy and chemotherapy, limiting salvage radical cystectomy to nonresponder tumors or muscle-invasive recurrence. In large population studies, less than 6% of the patients with nonmetastatic MIBC receive a chemoradiation therapy and this rate is stable. A growing body of evidence exists that TMT provides good oncologic outcomes with low morbidity when compared with radical cystectomy. TMT requires, however, a close follow-up because of the high risk of local recurrence and salvage radical cystectomy in up to 30% of the patients. Salvage radical cystectomy can be performed with adequate results but does not offer the same opportunity of reconstruction and functional outcomes than primary radical cystectomy. SUMMARY: Although radical cystectomy is still the treatment of reference for most of the patients with localized MIBC, TMT represents a reasonable alternative in highly selected patients. Any firm conclusion on the equivalence or superiority of one treatment to the other is still limited by the lack of randomized controlled trials and the heterogeneity of the available literature. Future studies and multidisciplinary approach are mandatory to optimize the patient selection and regimen of TMT.

Characterization of cation exchanger stationary phases applied for the separations of therapeutic monoclonal antibodies.

Cation exchange chromatography (CEX) is a well established strategy for the characterization of monoclonal antibodies (mAbs). The optimization of mobile phase conditions is well described in the literature, but there is a lack of information about CEX stationary phases for the analysis of therapeutic proteins. The aim of this study was to compare five state-of-the-art CEX stationary phases based on the retention, selectivity and resolving power achieved in pH- and salt-gradient modes, with various therapeutic mAbs and their variants. The Sepax Antibodix WCX-NP3, Thermo MAbPac SCX-10 RS, YMC BioPro SP-F, Waters Protein-Pak Hi Res SP and Agilent Bio mAb NP1.7 SS were considered in this study. In terms of retention, the YMC Bio Pro SP-F material was the less retentive one, while the Agilent Bio mAb NP1.7 SS provides the highest retention. Regarding the selectivity achieved between the main mAbs isoforms and their variants, the Thermo MabPac SCX column generally gave the highest selectivity. Finally, it was hard to rank columns in term of kinetic performance since their performance is strongly solute (mAb) and elution mode (pH or salt gradient) dependent. However, the highest resolution--in most cases--was observed on the strong cation exchanger YMC Bio Pro SP-F material.