Topic: Bladder Cancer

New Targets for Advanced Bladder Cancer

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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Should Variant Histology Change Management of Bladder Cancer?

Dr. Peter Black, MD, fills in for Dr. 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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Neoadjuvant/ Adjuvant Chemotherapy—Are We Ready to Accept Neoadjuvant as the Gold Standard?

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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Basic Concepts in Bladder Cancer Immunotherapy

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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Perioperative Pathways: What We Know Works

Peter Black, MD, 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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Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guidelines

Sam Chang, MD, 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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Enhanced Techniques of Non-Muscle Invasive Bladder Cancer Detection

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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Urine Markers for Bladder Cancer

Dr. Peter Black, MD, discusses the benefits and limitations of the currently FDA approved and commercially available urinary biomarkers for bladder cancer, including UroVysion FISH, ImmunoCyt, AssureMDx, and CxBladder. He defines the yet-to-be-developed “ideal” marker, which would reduce the need for other diagnostic tests, have a high sensitivity and specificity rate, and be cost-effective for patients. Also, he discusses when it is possible to use markers in place of cystoscopy.

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Robotic Cystectomy Versus Open Cystectomy: What Do We Know?

Dr. Sam Chang, MD, delineates the benefits and shortcomings of both robotic and open cystectomy, specifically in terms of morbidity, compilation, and recurrence rates for patients, and the learning curve associated with each method for clinicians. He also discusses how the financial cost of robotic surgery factors into this comparison.

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