Amirali Salmasi, MD

Amirali Salmasi, MD

University of California, San Diego

La Jolla, California

Amirali Salmasi, MD, is a urologist with expertise in the management of genitourinary cancers in men and women, including bladder, prostate, kidney, ureteral, testicular, adrenal, and penile cancers. He provides a personalized, multidisciplinary approach to deliver the best possible treatment options (active surveillance, focal therapy, surgery, radiation, systemic treatments, or clinical trials) for his patients. Dr. Salmasi performs advanced minimally invasive and complex open surgeries, such as robotic-assisted laparoscopic cystectomy, nerve-sparing prostatectomy, retro-peritoneal lymph node dissection, adrenalectomy, and partial nephrectomy. He is also interested in translational research and clinical trials in urologic oncology, and his hope is to bridge the gap between the bench and clinical research. He has published over 50 articles in peer-reviewed journals. Dr. Salmasi completed a urologic oncology fellowship at the University of California, Los Angeles, and a urology residency at Rutgers Robert Wood Johnson Medical School. As a first step towards a career in academic medicine and research, he also did a postdoctoral fellowship at Johns Hopkins School of Medicine. He earned his medical degree from Tehran University of Medical Sciences and holds a master's degree in clinical research (MSCR) from UCLA Clinical and Translational Science Institute. He is a member of the American Urological Association, the Society for Urologic Oncology and the American Society of Clinical Oncology.


Talks by Amirali Salmasi, MD

Biomarkers for Bladder Cancer

Amirali Salmasi, MD, delivers a comprehensive presentation on the significance of biomarkers in detecting and monitoring bladder cancer. He reviews the various types and classifications of biomarkers, and their role in identifying the presence or confirmation of diseases and medical conditions, including bladder cancer.

Dr. Salmasi focuses on the concept of response biomarkers, shedding light on how changes in biomarker levels can indicate the efficacy of exposure or treatment. He delves into the specific mechanisms and capabilities of URO17 and ADXBLADDER tests, both of which exhibit promising sensitivity and specificity in detecting bladder cancer.

Concluding the presentation, Dr. Salmasi emphasizes the need for large-scale validation studies to confirm the role of these biomarkers. He mentions the potential role of circulating free DNA, the emerging significance of microRNA, extracellular vesicles, exosomes, and artificial intelligence in revolutionizing the field of biomarker research.

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Clinical Trials for BCG-Naive and BCG-Unresponsive NMIBC

Amirali Salmasi, MD, delves into a comprehensive discussion on risk stratification and treatment options for BCG-naive and BCG-unresponsive bladder cancer. In his enlightening presentation, Dr. Salmasi provides a thorough examination of the diverse risk groups, elucidating the distinctions between low risk, intermediate risk, and high risk based on tumor grade and size. Moreover, he delves into the crucial aspects of adequate BCG treatment and outlines the criteria for BCG unresponsiveness, enhancing our understanding of these critical factors.

Furthermore, Dr. Salmasi takes us on an exploratory journey through the realm of treatment approaches for bladder cancer. He shares insights on the exciting possibilities offered by sequential chemo, hyperthermia, immunotherapy, and targeted therapy, elaborating on their respective mechanisms and potential benefits. To bolster his insights, Dr. Salmasi highlights key studies and trials conducted, underscoring the promising outcomes that have been observed.

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Point-Counterpoint: Neoadjuvant Chemotherapy Prior to Cystectomy (Pro)

Taking the pro side in a point-counterpoint debate, Amirali Salmasi, MD, Assistant Professor of Urology at the University of California, San Diego, argues that neoadjuvant chemotherapy (NAC) should be offered to any “fit” patient with invasive bladder cancer before radical cystectomy (RC). After noting that survival outcomes for invasive bladder cancer after cystectomy are not great in general, Dr. Salmasi considers decades of trial data on the addition of NAC to RC. He looks at the SWOG-8710 trial, two Nordic trials, the BA06 30894 trial, a trial of ddMVAC, and more, all of which indicate that NAC improves outcomes significantly. Dr. Salmasi also notes that these trials did find that NAC increased perioperative risks. He then considers the potential role of adjuvant chemotherapy, observing that the limited data available suggest that NAC is superior to adjuvant treatment. Dr. Salmasi concludes with a brief discussion of how urologists and oncologists should optimize the use of NAC by researching therapy combinations, duration, patient selection, and biomarkers.

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Updating the Definitions, Endpoints, and Clinical Trial Designs for Bladder Cancer

Amirali Salmasi, MD, Assistant Professor of Urology at the University of California, San Diego, reviews risk stratification guidelines for non-muscle invasive bladder cancer (NMIBC) from the American Urological Association (AUA) and European Association of Urology (EAU); pointing out that the AUA classifies solitary high-grade (HG) Ta lesions ≤3cm classified as intermediate risk (IR-Ta) while the EAU recommends all HG tumors be classified as high-risk. Dr. Salmasi then presents data suggesting that, indeed, all HG Ta lesions should be considered high risk, supporting the EAU risk stratification model. He then reviews recommendations from the International Bladder Cancer Group, including definitions, end points, and clinical trial designs for NMIBC for both BCG-naive and BCG-unresponsive patients. For BCG-naive patients, Dr. Salmasi defines the clinically significant outcome of an absolute difference of 10 percent in the percentage of patients with recurrence at two years. For BCG-unresponsive patients with carcinoma in situ (CIS), a clinically meaningful magnitude of effect is an initial complete response rate of 50 percent at six months and a durable response rate of 30 percent at 12 months and 25 percent at 18 months; for those with papillary disease, it is a recurrence-free rate of 30 percent at 12 months and 25 percent at 18 months. Dr. Salmasi then shares information refining neoadjuvant therapy clinical trial design for muscle-invasive bladder cancer (MIBC) before cystectomy, citing level-one evidence that says neoadjuvant chemotherapy (NAC) should be offered to any “fit” patient before radical cystectomy (RC). He discusses eligibility and staging before discussing treatment options, posing questions about appropriate control arms for neoadjuvant trials as well as what number of neoadjuvant therapy cycles might be ideal, acknowledging that the best combination of treatment options remains uncertain. Dr. Salmasi discusses primary endpoints for neoadjuvant trials before shifting to a discussion on the future of trial design. He outlines some potential improvements to trial design, including sample size re-estimation; adaptive enrichment; seamless design; multi-arm, multistage (MAMS) trials; and biomarker-based adaptive study. Dr. Salmasi then outlines the benefits and limitations of MAMS trials and describes the characteristics of umbrella trials and basket trials. He discusses the BISCAY flowchart and the trial’s limitations and discusses the future of biomarker-based trial design in bladder cancer, citing two successful, meaningful biomarker-adaptive trials (PROOF 302 and IMvigor 011). Dr. Salmasi concludes by outlining future directions in the field, including ongoing trials for treatments for BCG-unresponsive NMIBC as well as neoadjuvant therapy for MIBC, where he asserts that work must be done to find the biomarkers of response, the need for improvements in molecular subtyping and treatment selection, and the need to identify optimal treatment. Finally, he asserts that improved patient outcomes would stem from an improved patient selection for radical cystectomy versus chemoradiation; there is also a need to continue to design adaptive trials to personalize treatment for those with metastatic urothelial cancer.

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Emerging Treatments for BCG Unresponsive Non-muscle Invasive Bladder Cancer

Amirali Salmasi, MD, Assistant Professor of Urology at the University of California, San Diego, discusses available and emerging treatments for bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC). He begins by giving a brief history of intravesical BCG and explaining how BCG works, before moving on to discuss treatments for BCG-unresponsive NMIBC. Dr. Salmasi observes that valrubicin was the best available treatment for a long time, but suggests that some of the many emerging treatments may prove superior. He then summarizes recent and ongoing research into various potential therapies for BCG-unresponsive NMIBC, including: sequential gemcitabine and docetaxel; intravesical cabazitaxel, gemcitabine, and cisplatin; chemohyperthermia treatment; CG0070, an oncolytic adenovirus; superagonist N-803; intravesical nadofaragene firadenovec gene therapy; and pembrolizumab. Dr. Salmasi concludes that, for the moment, the gold standard treatment for a patient with BCG-unresponsive bladder cancer remains radical cystectomy, but he argues that if someone is not eligible for or turns down cystectomy, pembrolizumab is now the go-to rather than valrubicin, although this may change depending on the results of some of these ongoing trials.

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