The Influence of Dietary Isothiocyanates on the Effectiveness of Mitomycin C and Bacillus Calmette-Guérin in Treating Nonmuscle-Invasive Bladder Cancer

No AccessJournal of UrologyTranslational Research Article7 Jun 2024The Influence of Dietary Isothiocyanates on the Effectiveness of Mitomycin C and Bacillus Calmette-Guérin in Treating Nonmuscle-Invasive Bladder CancerThis article is commented on by the following:Editorial CommentEditorial Comment Marilyn L. Kwan, Zinian Wang, Reina Haque, Valerie S. Lee, Janise M. Roh, Isaac J. Ergas, Kimberly L. Cannavale, Rachel Pratt, Maciej Goniewicz, Ronald K. Loo, David S. Aaronson, Charles P. Quesenberry, Yuesheng Zhang, Christine B. Ambrosone, Lawrence H. Kushi, and Li Tang Marilyn L. KwanMarilyn L. Kwan Corresponding Author: Marilyn L. Kwan, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 ([email protected]). , Zinian WangZinian Wang Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York , Reina HaqueReina Haque Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California , Valerie S. LeeValerie S. Lee Division of Research, Kaiser Permanente Northern California, Oakland, California , Janise M. RohJanise M. Roh Division of Research, Kaiser Permanente Northern California, Oakland, California , Isaac J. ErgasIsaac J. Ergas Division of Research, Kaiser Permanente Northern California, Oakland, California , Kimberly L. CannavaleKimberly L. Cannavale Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California , Rachel PrattRachel Pratt Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York , Maciej GoniewiczMaciej Goniewicz Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York , Ronald K. LooRonald K. Loo Department of Urology, Kaiser Permanente Downey Medical Center, Downey, California , David S. AaronsonDavid S. Aaronson Department of Urology, Kaiser Permanente South San Francisco Medical Center, Oakland, California , Charles P. QuesenberryCharles P. Quesenberry Division of Research, Kaiser Permanente Northern California, Oakland, California , Yuesheng ZhangYuesheng Zhang Department of Pharmacology and Toxicology, Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, Virginia , Christine B. AmbrosoneChristine B. Ambrosone Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York , Lawrence H. KushiLawrence H. Kushi Division of Research, Kaiser Permanente Northern California, Oakland, California , and Li TangLi Tang Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York View All Author Informationhttps://doi.org/10.1097/JU.0000000000004070AboutFull TextPDF Cite Export CitationSelect Citation formatNLMIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Nonmuscle-invasive bladder cancer (NMIBC) has high recurrence rates and is often treated with mitomycin C (MMC) and bacillus Calmette-Guérin (BCG). Their efficacy relies on phase 2 enzyme metabolism and immune response activation, respectively. Dietary isothiocyanates, phytochemicals in cruciferous vegetables, are phase 2 enzyme inducers and immunomodulators, and may impact treatment outcomes. We investigated the modifying effects of cruciferous vegetable and isothiocyanate intake on recurrence risk following MMC or BCG treatment. Materials and Methods: Self-reported cruciferous vegetable intake, estimated isothiocyanate intake, and urinary isothiocyanate metabolites were collected from 1158 patients with incident NMIBC in the prospective Be-Well Study. Hazard ratios (HRs) and 95% CIs were calculated from Cox proportional hazards regression models for risk of first recurrences, and random effects Cox shared frailty models for multiple recurrences. Results: Over median follow-up of 23 months, 343 (30%) recurrences occurred. Receipt of MMC and BCG was associated with decreased risks of first recurrence (MMC: HR = 0.58; 95% CI: 0.46-0.73; BCG: HR = 0.66; 95% CI: 0.49-0.88) and multiple recurrences (MMC: HR = 0.55; 95% CI: 0.44-0.68; BCG: HR = 0.72; 95% CI: 0.55-0.95). Patients receiving BCG and having high intake (>2.4 servings/mo), but not low intake, of raw cruciferous vegetables had reduced risk of recurrence (HR: 0.56; 95% CI: 0.36-0.86; P for interaction = .02) and multiple recurrences (HR: 0.51; 95% CI: 0.34-0.77; P for interaction < .001). The inverse association between MMC receipt and recurrence risk was not modified. Conclusions: For NMIBC patients who receive induction BCG, increasing consumption of raw cruciferous vegetables could be a promising strategy to attenuate recurrence risk. REFERENCES 1. . Cancer statistics, 2022. CA Cancer J Clin. 2022; 72(1):7-33. doi: 10.3322/caac.21708 Crossref, Medline, Google Scholar 2. . Bladder cancer: a review. 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Urol Ann. 2020; 12(1):25-30. doi: 10.4103/ua.Ua_143_18 Crossref, Medline, Google Scholar Funding/Support: This study was supported by National Cancer Institute grants R01CA172855 (Drs Kwan, Tang, and Kushi), R01CA257480 (Drs Tang and Kwan), U01CA280991 (Drs Kwan and Tang), and P30CA016056 (Roswell Park Comprehensive Cancer Center). Conflict of Interest Disclosures: Drs Kwan, Wang, and Pratt reported a financial relationship with UroGen Pharma. No other disclosures were reported. Ethics Statement: This study received Institutional Review Board approval (Kaiser Permanente Northern California Region IRB No. 00001045). Author Contributions: Conception and design: Kwan, Wang, Haque, Ergas, Loo, Zhang, Tang. Data analysis and interpretation: Kwan, Haque, Lee, Goniewicz, Aaronson, Quesenberry, Zhang, Ambrosone, Kushi, Tang. Data acquisition: Kwan, Haque, Roh, Ergas, Cannavale, Pratt, Tang. Drafting the manuscript: Kwan, Goniewicz, Tang. Critical revision of the manuscript for scientific and factual content: Kwan, Wang, Haque, Lee, Roh, Ergas, Cannavale, Pratt, Loo, Aaronson, Quesenberry, Zhang, Ambrosone, Kushi, Tang. Statistical analysis: Kwan, Wang, Lee, Quesenberry. Supervision: Kwan, Wang, Haque, Roh, Pratt, Loo, Aaronson, Tang. Data Availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byButler I and Laviana A Editorial CommentJournal of Urology, Ibilibor C Editorial CommentJournal of Urology, Related articlesJournal of Urology12 Jun 2024Editorial CommentJournal of Urology20 Jun 2024Editorial Comment Supplementary Materials Peer Review Report Open Peer Review Report Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordsnon-muscle invasive bladder cancercruciferous vegetableisothiocyanatebacillus Calmette-GuérinrecurrenceACKNOWLEDGMENTSWe thank the participants and staff of the Be-Well Study for their valuable contributions.Metrics Author Information Marilyn L. Kwan Corresponding Author: Marilyn L. Kwan, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 ([email protected]). More articles by this author Zinian Wang Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Reina Haque Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California More articles by this author Valerie S. Lee Division of Research, Kaiser Permanente Northern California, Oakland, California More articles by this author Janise M. Roh Division of Research, Kaiser Permanente Northern California, Oakland, California More articles by this author Isaac J. Ergas Division of Research, Kaiser Permanente Northern California, Oakland, California More articles by this author Kimberly L. Cannavale Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California More articles by this author Rachel Pratt Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Maciej Goniewicz Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Ronald K. Loo Department of Urology, Kaiser Permanente Downey Medical Center, Downey, California More articles by this author David S. Aaronson Department of Urology, Kaiser Permanente South San Francisco Medical Center, Oakland, California More articles by this author Charles P. Quesenberry Division of Research, Kaiser Permanente Northern California, Oakland, California More articles by this author Yuesheng Zhang Department of Pharmacology and Toxicology, Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, Virginia More articles by this author Christine B. Ambrosone Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Lawrence H. Kushi Division of Research, Kaiser Permanente Northern California, Oakland, California More articles by this author Li Tang Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Expand All Funding/Support: This study was supported by National Cancer Institute grants R01CA172855 (Drs Kwan, Tang, and Kushi), R01CA257480 (Drs Tang and Kwan), U01CA280991 (Drs Kwan and Tang), and P30CA016056 (Roswell Park Comprehensive Cancer Center). Conflict of Interest Disclosures: Drs Kwan, Wang, and Pratt reported a financial relationship with UroGen Pharma. No other disclosures were reported. Ethics Statement: This study received Institutional Review Board approval (Kaiser Permanente Northern California Region IRB No. 00001045). Author Contributions: Conception and design: Kwan, Wang, Haque, Ergas, Loo, Zhang, Tang. Data analysis and interpretation: Kwan, Haque, Lee, Goniewicz, Aaronson, Quesenberry, Zhang, Ambrosone, Kushi, Tang. Data acquisition: Kwan, Haque, Roh, Ergas, Cannavale, Pratt, Tang. Drafting the manuscript: Kwan, Goniewicz, Tang. Critical revision of the manuscript for scientific and factual content: Kwan, Wang, Haque, Lee, Roh, Ergas, Cannavale, Pratt, Loo, Aaronson, Quesenberry, Zhang, Ambrosone, Kushi, Tang. Statistical analysis: Kwan, Wang, Lee, Quesenberry. Supervision: Kwan, Wang, Haque, Roh, Pratt, Loo, Aaronson, Tang. Data Availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Advertisement PDF downloadLoading ...