Topic: Bladder Cancer

Role of Circulating Tumor DNA and Adjuvant Therapy in Urothelial Carcinoma

Role of Circulating Tumor DNA and Adjuvant Therapy in Urothelial Carcinoma

by | Jun 2023

Tyler F. Stewart, MD, discusses the groundbreaking role of circulating tumor DNA (ctDNA) in adjuvant therapy for urothelial carcinoma, highlighting its potential to revolutionize cancer treatment. ctDNA, a fragmented DNA shed by cells into the bloodstream, holds immense promise in identifying minimal residual disease and predicting patient outcomes.

Dr. Stewart emphasizes the significance of ctDNA as a biomarker and its successful application in various cancer types, including colorectal and bladder cancer. He presents studies showcasing the prognostic value of ctDNA monitoring throughout the treatment course, revealing its ability to accurately predict disease recurrence. The assay DNA methodologies, such as digital PCR and targeted capture NGS, offer remarkable sensitivity and customization to individual patients.

Dr. Stewart explores the potential of ctDNA as a predictive marker for perioperative systemic therapy, which could aid in identifying patients who would benefit most from adjuvant therapy. He highlights the positive outcomes observed in ctDNA-positive patients receiving adjuvant atezolizumab, leading to improved disease-free survival and overall survival rates.

Ongoing clinical trials, such as TOMBOLA and ImVigor011, further explore the integration of ctDNA as an essential biomarker in the management of muscle invasive bladder cancer. The extensive research on ultrasensitive ctDNA assays, novel ctDNA assays, and the use of urinary biomarkers for disease monitoring adds to the growing body of evidence supporting the clinical utility of ctDNA in cancer care.

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Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Pro

Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Pro

by | Jun 2023

T. Mike Hsieh, MD, MBA, presents the pros of using PDE5 inhibitors and early penile rehabilitation to treat erectile dysfunction post-radical prostatectomy. In this presentation, Dr. Hsieh discusses, the role of tissue hypoxia in recovery failure, the changing ratios of collagen versus smooth muscle in the organ pre- and post-operation, and why Restoration of QoL, not Spontaneous Erection Recovery, should be the measure of success.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery–Con.”

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NMIBC Trials for BCG Naive Patients: What is Exciting

NMIBC Trials for BCG Naive Patients: What is Exciting

by | May 2023

Joshua J. Meeks, MD, PhD, Associate Professor of Urology, Biochemistry and Molecular Genetics at the Northwestern University Feinberg School of Medicine in Chicago, IL, provides insights into the latest advancements in bladder cancer research. He highlights the potential of large-scale clinical trials and the role of immunotherapy in shaping future treatment strategies. The North American trial, with a thousand patients, offers numerous opportunities to explore new treatment modalities. Additionally, the Bridge study led by Max Kate examines the efficacy of gemcitabine docetaxel compared to the standard BCG treatment. Despite initial skepticism, the trial presents promising results that may offer an alternative for patients who cannot access BCG. Dr. Meeks emphasizes the importance of identifying the patient population that would benefit most from checkpoint immunotherapy and coordinating care effectively.

He discusses ongoing trials that investigate the synergy between immunotherapy and BCG, the possibility of using less BCG, and the introduction of a Sub-Q delivery system. The Sunrise trials, TAR 200, and the Danish study DaBlaCa all hold potential in improving treatment outcomes for bladder cancer patients. Dr. Meeks concludes by highlighting the transformative impact of the Terra system, a device that delivers gemcitabine consistently and may revolutionize bladder cancer treatment. Overall, this comprehensive summary underscores the significant advancements and future prospects in bladder cancer research.

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Neoadjuvant or Adjuvant Therapy?

Neoadjuvant or Adjuvant Therapy?

by | May 2023

Parminder Singh, MD, Assistant Professor of Hematology and Oncology at Mayo Clinic in Phoenix, Arizona, discusses the future of care for muscle-invasive bladder cancer (MIBC) in this 14-minute talk. Two large trials–one SWOG trial from 2003 evaluating methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) prior to cystectomy, and an international trial reporting on cisplatin, methotrexate, and vinblastine (CMV) prior to cystectomy or radiation–both famously showed improved survival in MIBC patients. Because of this data, neoadjuvant chemotherapy (NAC) became the gold standard for care. Since then, research in this area has focused on fine-tuning drug options and patient selection under the NAC framework, such as evaluating MVAC versus gemcitabine and cisplatin (GC), options for cisplatin-ineligible patients, and how pathological responses to NAC affect survival. However, Singh suggests this space of MIBC management is ready to move into a new chapter due to antibody-drug conjugates. The current data about these emerging drugs is promising. There is evidence that patients who priorly did not respond to chemotherapy had improvements in overall survival with enfortumab vedotin (EV). Currently, there is a mock trial comparing EV, pembrolizumab, and GC in cisplatin ineligible patients at the Mayo Clinic. Singh is optimistic EV and pembrolizumab may be able to replace cisplatin for those who are ineligible in the future.

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