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RESUMEN Los tumores neuroendocrinos primarios (NET) del mediastino son muy raros. Presentamos el caso de un tumor carcinoide atipico primario de timo. Un hombre de 52 anos que fue a un examen medico porque se quejaba de tos no productiva sin hemoptisis. Se solicito una radiografia de torax donde se evidencio un mediastino notablemente ensanchado, con una tomografia de torax que mostro una masa tumoral de 90 x 50 mm en el mediastino anterosuperior que comprime el arco aortico y la arteria pulmonar sin un plano de clivaje adecuado. Debido a que el tumor era infiltrativo, se proporciono escision quirurgica completa, quimioterapia y radioterapia al mediastino. El objetivo principal de nuestro estudio fue evaluar los hallazgos de CT y MRI con relacion a la literatura mundial. ABSTRACT Primary neuroendocrine tumors (NET) of the mediastinum are very rare. We present the case of a primary atypical carcinoid tumor of the thymus. A 52-year-old man who went to a medical examination because he complained of a non-productive cough without hemoptysis. A chest radiograph was requested where a markedly widened mediastinum was evidenced, with a thoracic tomography showing a tumor mass of 90 x 50 mm in the anterosuperior mediastinum that compresses the aortic arch and pulmonary artery without an adequate cleavage plane. Because the tumor was infiltrative, complete surgical excision, chemotherapy and radiotherapy were provided to the mediastinum. The main objective of our study was to evaluate the findings of CT and MRI in relation to universal literature.

Disclosure TP has received research funding from Merck Serono, Merck, Sharp & Dohme (MSD), Roche, Bristol Myers Squibb (BMS), AstraZeneca, Astellas, Novartis, Johnson and Johnson, Seattle Genetics, Pfizer, Exelixis and Eisai and honoraria from Merck Serono, MSD, Roche, BMS, AstraZeneca, Astellas, Novartis, Johnson and Johnson, Seattle Genetics, Pfizer, Exelixis and Eisai; JB has received honoraria for participation in advisory boards from Pfizer, AstraZeneca, Merck and BMS, invited speaker fees from Merck, Genentech and MSD, royalties from UpToDate, institutional research funding as principal investigator (PI) for MSD and Pfizer, research funding from Takeda and non-remunerated activities as steering committee member of the IMvigor 011 study; EC has received honoraria from Jansen for invited speaker and non-remunerated activities in an advisory role for the EAU guidelines; MDS has received honoraria for participation in advisory boards and as an invited speaker for 4D, AAA, Amgen, Astellas, AstraZeneca, Basilea, Bayer, Bioclin, BMS, EISAI, Ferring, Immunomedics, Ipsen, Janssen, MSD, Merck Serono, Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sandoz, Sanofi, SeaGen and Amgen and institutional research as PI and steering committee member for Basilea, AstraZeneca, MSD, Merck, EISAI, Astellas, SeaGen, Exelixis, Ipsen, Roche, Immunomedics, Janssen and Calithera; RH has received honoraria for participation in advisory boards for Roche, Nektar, BMS, MSD and Astellas, expert testimony for National Institute of Clinical Excellence and partnership in the Cancer Centre London, institutional royalties received from Janssen, research grants from MSD and Roche, local PI for Roche, MSD, Basilea and Cancer Research UK; patient funding from Astellas and steering committee member with Cancer Research UK; YL has received honoraria for lectures, presentations, speaker’s bureau, manuscript writing or educational events from BMS, Pfizer, Merck KGaA, MSD, AstraZeneca, Roche, Jansen, Astellas, Seattle Genetics and Immunomedics and support for attending meetings and/or travel grants from BMS, Roche, AstraZeneca, MSD and Pfizer; AN has received institutional research grants from Merck, AstraZeneca, Ipsen and BMS and has undertaken personal research as a steering committee member for Roche, Janssen, Bayer, Astellas, AstraZeneca, Merck and Clovis Oncology; BPV has received honoraria for advisory boards for Pfizer, Astellas Pharma, BMS, Ipsen, EUSA Pharma, Sanofi-Aventis and Merck and has been an invited speaker for Janssen, Pfizer, BMS, Roche, Bayer, EUSA Pharma, MSD and Merck; AR has received honoraria for advisory boards for Pfizer, Merck GA, BMS, Ipsen, MSD and AstraZeneca and has been an invited speaker for Pfizer, Merck GA, BMS, Ipsen and MSD and has received institutional grants from Pfizer, Merck GA and Ipsen; SFS has received honoraria for participation in advisory boards for Astellas, Janssen, MSD, AstraZeneca, Bayer, BMS, Cepheid, Ferring Pharmaceuticals, Ipsen, Lilly, Olympus, Pfizer, Pierre Fabre, Richard Wolf, Roche, Sanochemia, Sanofi, Takeda and UroGen; BS has received honoraria from Ellipses, Ipsen, Merck, Pfizer and Roche and has received travel and research funding from BMS, Genentech, MSD, Pfizer and Roche; MSvdH has received honoraria (paid to institute) for participation in advisory boards for BMS, Roche, Seagen, AstraZeneca, Janssen, Pfizer and MSD, stock ownership with Gilead; and institutional research funding from BMS, Roche, AstraZeneca and 4SC; SG has received personal honoraria for participation in advisory boards for Sanofi, Orion, Roche, Amgen, MSD and Aranda; other honoraria from RSI Televisione Svizzera Italiana); has been an invited speaker for ESMO, SAKK, SAMO, Orikata and CACA-GU, speaker’s bureau for Janssen Cilag; travel grant from ProteoMEdiX, institutional honoraria for advisory boards for Bayer, Janssen Cilag, Roche and AAA International including Independent Data Monitoring Committee; steering committee for Amgen, Menarini Silicon Biosystems, Astellas Pharma, Tolero Pharmaceuticals, MSD, Pfizer, Telixpharma, BMS and Orion and has received a patent, royalties and other intellectual property from Method for Biomarker WO2009138392.

Adjuvant Nivolumab for Invasive Urothelial Carcinoma In a prospective, randomized trial involving patients with urothelial carcinoma who had undergone radical surgery, adjuvant nivolumab was compared with placebo. The median disease-free survival was 20.8 months with nivolumab and 10.8 months with placebo. Treatment-related adverse events of grade 3 or higher were noted in 17.9% of patients in the nivolumab group. Background The role of adjuvant treatment in high-risk muscle-invasive urothelial carcinoma after radical surgery is not clear. Methods In a phase 3, multicenter, double-blind, randomized, controlled trial, we assigned patients with muscle-invasive urothelial carcinoma who had undergone radical surgery to receive, in a 1:1 ratio, either nivolumab (240 mg intravenously) or placebo every 2 weeks for up to 1 year. Neoadjuvant cisplatin-based chemotherapy before trial entry was allowed. The primary end points were disease-free survival among all the patients (intention-to-treat population) and among patients with a tumor programmed death ligand 1 (PD-L1) expression level of 1% or more. Survival free from recurrence outside the urothelial tract was a secondary end point. Results A total of 353 patients were assigned to receive nivolumab and 356 to receive placebo. The median disease-free survival in the intention-to-treat population was 20.8 months (95% confidence interval [CI], 16.5 to 27.6) with nivolumab and 10.8 months (95% CI, 8.3 to 13.9) with placebo. The percentage of patients who were alive and disease-free at 6 months was 74.9% with nivolumab and 60.3% with placebo (hazard ratio for disease recurrence or death, 0.70; 98.22% CI, 0.55 to 0.90; P

Background: Survival outcomes are poor for patients with metastatic urothelial carcinoma who receive standard, first-line, platinum-based chemotherapy. We assessed the overall survival of patients who received durvalumab (a PD-L1 inhibitor), with or without tremelimumab (a CTLA-4 inhibitor), as a first-line treatment for metastatic urothelial carcinoma. Methods: DANUBE is an open-label, randomised, controlled, phase 3 trial in patients with untreated, unresectable, locally advanced or metastatic urothelial carcinoma, conducted at 224 academic research centres, hospitals, and oncology clinics in 23 countries. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0 or 1. We randomly assigned patients (1:1:1) to receive durvalumab monotherapy (1500 mg) administered intravenously every 4 weeks; durvalumab (1500 mg) plus tremelimumab (75 mg) administered intravenously every 4 weeks for up to four doses, followed by durvalumab maintenance (1500 mg) every 4 weeks; or standard-of-care chemotherapy (gemcitabine plus cisplatin or gemcitabine plus carboplatin, depending on cisplatin eligibility) administered intravenously for up to six cycles. Randomisation was done through an interactive voice–web response system, with stratification by cisplatin eligibility, PD-L1 status, and presence or absence of liver metastases, lung metastases, or both. The coprimary endpoints were overall survival compared between the durvalumab monotherapy versus chemotherapy groups in the population of patients with high PD-L1 expression (the high PD-L1 population) and between the durvalumab plus tremelimumab versus chemotherapy groups in the intention-to-treat population (all randomly assigned patients). The study has completed enrolment and the final analysis of overall survival is reported. The trial is registered with ClinicalTrials.gov, NCT02516241, and the EU Clinical Trials Register, EudraCT number 2015-001633-24. Findings: Between Nov 24, 2015, and March 21, 2017, we randomly assigned 1032 patients to receive durvalumab (n=346), durvalumab plus tremelimumab (n=342), or chemotherapy (n=344). At data cutoff (Jan 27, 2020), median follow-up for survival was 41·2 months (IQR 37·9–43·2) for all patients. In the high PD-L1 population, median overall survival was 14·4 months (95% CI 10·4–17·3) in the durvalumab monotherapy group (n=209) versus 12·1 months (10·4–15·0) in the chemotherapy group (n=207; hazard ratio 0·89, 95% CI 0·71–1·11; p=0·30). In the intention-to-treat population, median overall survival was 15·1 months (13·1–18·0) in the durvalumab plus tremelimumab group versus 12·1 months (10·9–14·0) in the chemotherapy group (0·85, 95% CI 0·72–1·02; p=0·075). In the safety population, grade 3 or 4 treatment-related adverse events occurred in 47 (14%) of 345 patients in the durvalumab group, 93 (27%) of 340 patients in the durvalumab plus tremelimumab group, and in 188 (60%) of 313 patients in the chemotherapy group. The most common grade 3 or 4 treatment-related adverse event was increased lipase in the durvalumab group (seven [2%] of 345 patients) and in the durvalumab plus tremelimumab group (16 [5%] of 340 patients), and neutropenia in the chemotherapy group (66 [21%] of 313 patients). Serious treatment-related adverse events occurred in 30 (9%) of 345 patients in the durvalumab group, 78 (23%) of 340 patients in the durvalumab plus tremelimumab group, and 50 (16%) of 313 patients in the chemotherapy group. Deaths due to study drug toxicity were reported in two (1%) patients in the durvalumab group (acute hepatic failure and hepatitis), two (1%) patients in the durvalumab plus tremelimumab group (septic shock and pneumonitis), and one (

Bladder cancer is the fourth most common cancer in men and the ninth most common in women in the Western world. The management of bladder carcinoma requires a multidisciplinary approach. Optimal treatment depends on several factors, including histology, stage, patient status, and possible comorbidities. Here we review recent findings on the treatment of muscle-invasive bladder carcinoma, advanced urothelial carcinoma, upper tract urothelial carcinoma, non-urothelial carcinoma, and urologic complications arising from the disease or treatment. In addition, we present the recommendations of the Spanish Oncology Genitourinary Group for the treatment of these diseases, based on a focused analysis of clinical management and the potential of current research, including recent findings on the potential benefit of immunotherapy. In recent years, whole-genome approaches have provided new predictive biomarkers and promising molecular targets that could lead to precision medicine in bladder cancer. Moreover, the involvement of other specialists in addition to urologists will ensure not only appropriate therapeutic decisions but also adequate follow-up for response evaluation and management of complications. It is crucial, however, to apply recent molecular findings and implement clinical guidelines as soon as possible in order to maximize therapeutic gains and improve patient prognosis.