Neoadjuvant Therapy for MIBC in the Genomic Era

Colin P.N. Dinney, MD, presented “Neoadjuvant Therapy for MIBC in the Genomic Era” during the 42nd Annual Ralph E. Hopkins Urology Seminar on February 1, 2023, in Jackson Hole, Wyoming.

How to cite: Dinney, Colin P.N. “Neoadjuvant Therapy for MIBC in the Genomic Era.” February 1, 2023. Accessed Nov 2024. https://grandroundsinurology.com/neoadjuvant-therapy-for-mibc-in-the-genomic-era/

Neoadjuvant Therapy for MIBC in the Genomic Era – Summary

Colin P.N. Dinney, MD, Chairman of the Department of Urology in the Division of Surgery and Co-chair of the Genitourinary Steering Committee for the Bladder Task Force at the University of Texas MD Anderson Cancer Center in Houston, Texas, discusses neoadjuvant therapy for muscle-invasive bladder cancer (MIBC) in the genomic era. Dr. Dinney shares level-one evidence demonstrating that neoadjuvant chemotherapy (NAC) improves survival for patients with MIBC. Despite this survival advantage, NAC is underutilized. He proposes that refining clinical staging to identify high-risk individuals (likely to progress despite radical cystectomy [RC] alone) and identifying likely responders to platinum-based chemotherapy and immunotherapy would improve the impact of NAC. Dr. Dinney presents a risk-based approach to select candidates for either NAC or RC alone. He outlines breakthroughs in bladder cancer genomics that radically transformed the view of tumor biology and generated new hypotheses for therapy, sharing research that used gene expression profiling to identify unique molecular subtypes with distinct biology and natural history. The limitations of using molecular subtypes to predict response to NAC, including that assignment to a specific subtype is used to predict therapy response rather than the patient’s individual gene expression profile. He explains the COXEN study and research on specific DNA damage repair (DDR) gene mutations predicting response to NAC. Dr. Dinney explains that identification of predictive biomarkers remains a work in progress. Moving forward, he explains the field is undergoing a paradigm shift in the management of MIBC, with practitioners moving away from a one-size-fits-all approach. Instead, practitioners will rely on tumor biology to guide the selection of patients for NAC, RC alone, or bladder preservation. He closes by emphasizing that doctors should discuss the pros and cons of NAC with patients with MIBC who are undergoing RC.

About The 42nd Annual Ralph E. Hopkins Urology Seminar:

The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, sexual function, emerging surgical techniques, and general urology. The 42nd iteration of the meeting took place from February 1st to 4th, 2023, in Jackson Hole, Wyoming.

For further educational activities from this conference, visit our collection page.