Seth P. Lerner, MD

Seth P. Lerner, MD

Baylor College of Medicine

Houston, Texas

Seth P. Lerner, MD, is a Professor of Urology and holds the Beth and Dave Swalm Chair in Urologic Oncology in the Scott Department of Urology at Baylor College of Medicine. He is also Director of Urologic Oncology and the Multidisciplinary Bladder Cancer Program and Faculty Group Practice Medical Director for the Urology Clinic at Baylor. He earned his medical degree from 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 under Peter Jones and Don Skinner before returning to join the full-time Baylor faculty in 1992. His clinical practice, education, and research activities are devoted to urologic oncology, particularly lower and upper tract urothelial cancer. Dr. Lerner is an author on over 190 peer-reviewed articles, and co-editor of the comprehensive Textbook of Bladder Cancer. He is the founding Co-Editor-in-Chief of the Bladder Cancer journal. He established and directs the multi-disciplinary Bladder Cancer Research Program at Baylor, and his research interests include the use of selective estrogen receptor modulators for the treatment of bladder cancer, gene therapy, integrated genomic analysis of bladder and upper urinary tract cancers, and outcomes of radical cystectomy and pelvic lymphadenectomy. He has 25 years of experience as a clinical investigator for both NCI and industry-funded clinical trials. He is the PI of the ongoing SWOG NCI Phase III trial comparing extended vs. standard pelvic lymphadenectomy at the time of radical cystectomy. He is Chair of the Local Bladder Cancer Committee of SWOG, founding and former Co-Chair of the NCI Bladder Cancer Task Force and current Co-Chair of the NCI CTEP Genitourinary Steering Committee, and he has co-chaired the Analysis Working Group of The Cancer Genome Atlas Project for muscle-invasive bladder cancer for the past decade. He is very active in the Bladder Cancer Advocacy Network (BCAN) as a member of the Board of Directors, and is Past Chair of the Bladder Cancer Think Tank and 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.”

Disclosures:

Articles by Seth P. Lerner, MD

Advances in Treating Upper Tract Urothelial Cancer

Seth P. Lerner, MD, Professor of Urology and holder of the Beth and Dave Swalm Chair in Urologic Oncology in the Scott Department of Urology at Baylor College of Medicine, discusses developments in upper tract urothelial carcinoma (UTUC) treatment. He delivers a rationale for adjuvant therapy based on a lack of clinical staging accuracy, a lack of high-level evidence to support perioperative systemic therapy, the perceived benefit in cases of high-risk bladder cancer, and the ability of pathologic staging to identify patients most likely to benefit. He then reviews the POUT trial of adjuvant chemotherapy, noting that it found a statistically significant benefit in disease-free survival and metastasis-free survival. Dr. Lerner continues by summarizing guideline statements. The EAU statement recommends perioperative chemo to patients with muscle invasive UTUC. ICUD states that it is unknown if adjuvant chemotherapy or waiting for the development of clinically evident disease is better. The French ccAFU recommends adjuvant chemotherapy after radical nephroureterectomy in pT2-T4 N0-3 M0 disease. Dr. Lerner then discusses neoadjuvant therapy, which studies suggest is beneficial to patients with optimized renal function. A Hopkins study specifically displayed a pathologic complete response of 9.4%, while the EA8141 trial found a total pathologic complete response of 13.8%. Dr. Lerner continues with a review of management options for low-grade UTUC, a rare disease with limited treatment options. He posits that a kidney-sparing treatment option is needed for patients, as there is a high chance of recurrence and kidney damage with the treatments currently available. Dr. Lerner theorizes that if durability of complete response following ablation with UGN-101 is demonstrated, this could provide a potential new kidney-sparing treatment for patients with low-grade UTUC. Dr. Lerner concludes with a discussion of the OLYMPUS study on UGN-101, which found a complete response in 59% of patients.

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Updates in Upper Tract Urothelial Carcinoma

Seth P. Lerner, MD, Professor of Urology, Director of Urologic Oncology and the Multidisciplinary Bladder Cancer Program, and Faculty Group Practice Medical Director for the Urology Clinic at Baylor College of Medicine discusses the impact of several upper tract urothelial carcinoma studies on the treatment of the disease. The POUT phase III trial used adjuvant therapy for high-risk patients who didn’t receive neoadjuvant therapy and through increased survival rates supported the establishment of the new adjuvant therapy standard of care. ECOG, a phase II trial of neoadjuvant systemic chemotherapy followed by extirpative surgery in high-risk upper tract urothelial carcinoma found about a 10% pathological complete response rate from treatment. QED, an ongoing adjuvant trial, tested infigratinib, an oral FGFR1-3 selective kinase inhibitor, so far finding increased survival rates in patients. Dr. Lerner concludes with the Olympus Study, a phase III prospective study on patients with low-grade disease in the renal pelvis using mitomycin gel for treatment and found a 58% complete response rate and led to the treatment’s approval by the FDA.

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A Review of The OLYMPUS Trial: Nephron Sparing for UTUC

Seth P. Lerner, MD, Professor of Urology at Baylor College of Medicine, reviews the results of the Optimized DeLivery of Mitomycin for Primary UTUC Study (OLYMPUS) trial, of which he was the principal investigator. In this study, a thermal, reversible gel was used as a kidney-sparing treatment of low-grade upper tract urothelial cancer (UTUC). He discusses the difficulty of managing UTUC, the function of UGN-101, and the dramatic results in patient outcomes from this trial.

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Neoadjuvant/Adjuvant Chemotherapy: Are We Ready to Accept NAC as the Gold Standard?

Seth P. Lerner, MD, provides the rationale for integrating perioperative chemotherapy and radical cystectomy, describes the evidence supporting neoadjuvant chemotherapy (NAC), and reviews the limited evidence supporting adjuvant therapy for patients with bladder cancer. He then discusses the future of predictive biomarkers and precision medicine in the management of this disease.

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