Daniel P. Petrylak, MD, discusses the efficacy of checkpoint inhibitors in previously cisplatin treated metastatic urothelial carcinoma patients and the need for better biomarkers for checkpoint proteins. He also identifies future directions for treating the disease, including ipilimumab/nivolumab and epacadostat/ pembrolizumab combinations, and PD-L1 immunohistochemical staining.
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Peter Black, MD, FRCSC, fills in for Ashish Kamat, MD, at the 2nd annual IBCU, discussing why and how clinicians should adapt bladder cancer treatment based on variant histologies. Dr. Black identifies sub-types of bladder cancer and the way gene expression and squamous differentiation play a role in risk-stratifying the disease. He explains the proper management of each sub-type, including MD Anderson treatment algorithms for NMIBC and MIBC.
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Seth P. Lerner, MD, argues for adopting neoadjuvant chemotherapy as the standard of care for metastatic bladder cancer patients. Dr. Lerner believes the urological community needs to define a better range of risk-stratification and more accurate diagnostic methods in order to do this. He discusses current developments in prognostic biomarkers and expression subtypes that he believes will make these necessary improvements possible.
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Leonard G. Gomella, MD, FACS, reviews the basic scientific concepts of immunotherapy for bladder cancer, from why BCG is the “gold standard” of treatment and describing the mechanics of augmenting the immune system to eliminate tumor cells, to categorizing therapies into vaccine based, cytokines, monoclonal antibodies, checkpoint inhibitors, and CAR-T cells. He also explains why, generally, immunotherapy is particularly effective in the bladder cancer setting, as opposed to other cancers.
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Dan Theodorescu, MD, PhD, describes clinically relevant scientific concepts underlying bladder cancer biology and the technologies, including biomarkers, Polymerase Chain Reaction (PRC), and Western blots, that have enabled the formation of our knowledge today. He then explains how these concepts have and will be used in the clinical management of bladder cancer.
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Daniel P. Petrylak, MD, discusses recent advances and clinical trials for targeted checkpoint inhibition therapy in the setting of metastatic urothelial carcinoma.
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Peter Black, MD, FRCSC, provides an overview of the current Enhanced Recovery After Surgery (ERAS) protocol in the setting of radical cystectomy, recommendations from the ERAS Society, and how the practice increases bladder cancer patients’ quality of life. He also touches upon the possibility of adding alvimopan to ERAS protocol in the near future.
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Jehonathan H. Pinthus, MD, PhD, FRCSC, explains factors that influence a bladder cancer patient’s risk of thromboembolic complications and prevention methods. His discussion includes the optimal timing of venous thromboembolism (VTE) prophylaxis after radical cystectomy, how cisplatin-based neoadjuvant chemotherapy effects thromboembolic events, and his opinion on current guidelines.
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Sam Chang, MD, MBA, who has served as chair of the American Urological Association (AUA) guidelines panel for non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC), provides an overview of updated non-metastatic MIBC treatment guidelines, including a comprehensive treatment algorithm. He also discusses directions of future research for the disease.
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Seth Lerner, MD, defines what places a bladder cancer patient into the BCG unresponsive category and treatment options in these cases. He touches on valrubicin, summarizes data regarding off-trial options such as gemcitabine, docetaxel, and the gem/doce combination, and discusses clinical trials for CG0070, Ad-IFN, and atezolizumab.
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Michael S. Cookson, MD, describes the components of a quality transurethral resection of bladder tumor (TURBT), enhanced detection technologies such as blue light cystoscopy and narrow band imaging (NBI), and the induction of these new technologies into the American Urological Association (AUA) and Society of Urologic Oncology (SUO) bladder cancer guidelines and common practice.
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Peter Black, MD, FRCSC, discusses the benefits and limitations of the currently FDA approved urinary biomarkers for bladder cancer. He defines criteria for the ideal biomarker, which would reduce the need for other diagnostic tests, have a high sensitivity and specificity rate, and be cost-effective for patients, as well as the possibility of using biomarkers in place of cystoscopy.
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