Case Based Decision-Making for Treatment of MIBC

Posted by Seth P. Lerner, MD, FACS | Nov 2018

Seth P. Lerner, MD presented “Case Based Decision-Making for Treatment of MIBC” during the 23rd Annual Innovations in Urologic Practice on September 14, 2018 in Santa Fe, New Mexico.

How to cite: Lerner, Seth P. “Case Based Decision-Making for Treatment of MIBC” September 14, 2018. Accessed [date today]. https://grandroundsinurology.com/case-based-decision-making-for-treatment-of-mibc/

Case Based Decision-Making for Treatment of MIBC – Summary:

Seth P. Lerner, MD, provides a brief overview of variant histologies in muscle invasive bladder cancer (MIBC). He then reviews individualized management options and optimal decision-making for treating the disease using three unique cases.

Abstract:

Variant histologies appear in 6%-25% of transurethral resection (TUR) samples from patients with MIBC. American Urological Association (AUA) guidelines state that an experienced genitourinary pathologist should review the pathology of a patient with suspected variant histology or if muscle invasion is equivocal. European Association of Urology (EAU) guidelines corroborate this in a similar statement. According to World Health Organization classifications, of urothelial carcinoma (UC) variants, squamous differentiation, neuroendocrine, and micropapillary variants are the most common. However, the National Cancer Data Base reports that non-urothelial variants are relatively uncommon. Markedly, in a multivariable Cox proportional hazards model, urothelial variant histology proved to confer a worse prognosis than non-variant disease.

This presentation follows three unique cases as an illustration of appropriate decision-making in management of MIBC. The first case discussed in this presentation involves a patient with a T1 high-grade UC, as well as a micropapillary variant. The second case follows a patient who presented with a high concentration of squamous cell differentiation. Finally, the third case follows a patient with T3 UC with a neuroendocrine phenotype and small cell features. By reviewing the challenges and decisions made during these cases, this presentation identifies optimal application of neoadjuvant chemotherapy, preoperative radiation therapy, cystectomy, and other management options for individualized situations.

About Innovations in Urologic Practice

Innovations in Urologic Practice (IUP) is an annual CME-accredited conference devoted to updating urologists on the rapidly changing healthcare environment. Topics focus on innovative diagnostic and treatment strategies, controversies, new and currently developing technologies, and challenges in today’s urologic practice. Dr. Lerner presented this lecture during the 23rd IUP in 2018. Please visit this page in order to learn more about future IUP meetings.

ABOUT THE AUTHOR

Seth P. Lerner, MD, FACS

Seth P. Lerner, MD, FACS, is Professor of Urology and Vice-Chair for Faculty Affairs in the Scott Department of Urology at the Baylor College of Medicine in Houston, Texas. He holds the Beth and Dave Swalm Chair in Urologic Oncology. Dr. Lerner is the Director of Urologic Oncology and the Multidisciplinary Bladder Cancer Program, also at Baylor.

Dr. Lerner earned his medical degree from the Baylor College of Medicine, completed a surgical internship at Virginia Mason Hospital in Seattle, and returned to Baylor for his residency training. He completed a two-year fellowship at the University of Southern California in Urologic Oncology and Reconstructive Surgery and joined the full-time Baylor faculty in 1992.

About The Author

Seth P. Lerner, MD, FACS

Seth P. Lerner, MD, FACS, is Professor of Urology and Vice-Chair for Faculty Affairs in the Scott Department of Urology at the Baylor College of Medicine in Houston, Texas. He holds the Beth and Dave Swalm Chair in Urologic Oncology. Dr. Lerner is the Director of Urologic Oncology and the Multidisciplinary Bladder Cancer Program, also at Baylor. Dr. Lerner earned his medical degree from the Baylor College of Medicine, completed a surgical internship at Virginia Mason Hospital in Seattle, and returned to Baylor for his residency training. He completed a two-year fellowship at the University of Southern California in Urologic Oncology and Reconstructive Surgery and joined the full-time Baylor faculty in 1992. Dr. Lerner’s clinical practice, education, and research activities are devoted to urologic oncology, particularly to lower and upper tract urothelial cancer. Dr. Lerner is the author of 228 peer-reviewed articles, co-editor of a comprehensive Textbook on Bladder Cancer, and founding co-editor-in-chief of the Bladder Cancer journal. His research interests include the use of selective estrogen receptor modulators for treatment of bladder cancer, gene therapy, integrated proteogenomic analysis of bladder and upper urinary tract cancers, and outcomes of radical cystectomy and pelvic lymphadenectomy. Dr. Lerner has 30 years of experience as a clinical investigator for both National Cancer Institute (NCI) and industry-funded clinical trials. He is Principal Investigator of the ongoing SWOG NCI Phase III trial comparing extended vs. standard pelvic lymphadenectomy at time of radical cystectomy. He is active in the leadership of several national bladder cancer research enterprises, serving as chair of the Local Bladder Cancer committee of SWOG, founding and former co-chair of the NCI Bladder Cancer Task Force, and former co-chair of theNCI National Clinical Trials Network (NCTN) Genitourinary Steering Committee. He co-chaired the Analysis Working Group of The Cancer Genome Atlas Project for muscle invasive bladder cancer and was recently appointed to a 4-year term to the NCI Clinical Trials and Translational Research Advisory Committee. Dr. Lerner is very active in the Bladder Cancer Advocacy Network (BCAN) as a member of the Board of Directors, is past chair of the Bladder Cancer Think Tank, and is co-chair of the management committee of the Bladder Cancer Research Network. Dr. Lerner is an active member of the prestigious American Association of Genitourinary Surgeons and is listed routinely among “America’s Top Doctors” and “Best Doctors in America.”

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