Topic: Advanced Disease

Clinical Trials in MIBC and NMIBC

Clinical Trials in MIBC and NMIBC

by | Dec 2024

Daniel P. Petrylak, MD, discusses advancements in treating urothelial carcinoma, emphasizing innovative therapies for BCG-refractory, recurrent, and metastatic disease.

In this 10-minute talk, Petrylak highlights Dr. Neil Shore’s INSTIL trial, a significant phase 3 study evaluating the adenovirus interferon agent nadofaragene firadenovec. Dr. Petrylak also discusses how immune checkpoint inhibitors, such as pembrolizumab, are moving into early-stage treatment and combined with BCG for non-cystectomy patients.

The discussion transitions to innovative drug delivery systems, such as a “pretzel” device designed for intravesical drug release.
Dr. Petrylak shares new trials in treating metastatic carcinoma that focus on minimizing side effects linked to conventional drugs like enfortumab vedotin by introducing smaller, less immunogenic agents. These trials, including a DEVAL phase 1 dose-escalation study, underscore the importance of these targeted innovations in battling this challenging cancer.

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Updates in Advanced Urothelial Carcinoma

Updates in Advanced Urothelial Carcinoma

by | Nov 2024

Neda Hashemi, MD, presents emerging systemic therapies for advanced bladder cancer, focusing on the transformative shifts since 2023. She highlights the pivotal role of recent ESMO findings in reshaping treatment paradigms, underscoring the shift from conventional platinum-based chemotherapy to more advanced immunotherapy-based approaches.

In this 18-minute presentation, Hashmi elaborates on the importance of the EV-302 trial, noting that these advances mark a turning point in treating metastatic bladder cancer. The CheckMate 901 study, though overshadowed by EV-302, also reveals promising results. Response rates for these patients suggest potential breakthroughs in disease management.

Hashemi acknowledges the complexity of managing treatment-related toxicities and emphasizes the importance of developing strategies to manage side effects effectively. Hashmi also touches on accessibility challenges outside the US, stressing the need for personalized approaches based on regional availability.

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Recurrent T1HG Bladder cancer after BCG: More Intravesical Therapy or Radical Cystectomy

Recurrent T1HG Bladder cancer after BCG: More Intravesical Therapy or Radical Cystectomy

by | Nov 2024

Frances M. Alba, MD, Associate Professor of Urology at the University of New Mexico, discusses the management of T1 high-grade bladder cancer, focusing on cases that recur following BCG therapy. In this 14-minute talk, Dr. Alba notes that continued BCG is seldom effective in these patients. Alba highlights the AUA guidelines, recommending cystectomy as the best chance to prevent disease progression, but shares additional treatment paths when not an option.

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Current State of the Art in Bladder-Preserving Trimodality Therapy for Muscle-Invasive Bladder Cancer

Current State of the Art in Bladder-Preserving Trimodality Therapy for Muscle-Invasive Bladder Cancer

by | Nov 2024

Jason A. Efstathiou, MD, DPhil, FASTRO, FACRO, emphasizes the growing interest in bladder preservation therapies as an alternative to radical cystectomy for muscle-invasive bladder cancer (MIBC). While cystectomy remains an effective treatment, it is not performed in about half of eligible patients. Trimodality therapy (TMT), combining maximal transurethral resection (TUR), chemotherapy, and radiation, offers a promising bladder-sparing approach.

In this 11-minute presentation, Dr. Efstathiou compares outcomes between TMT and cystectomy, showing no significant difference in metastasis-free or cancer-specific survival. A shift toward biomarker-driven management is also highlighted, with specific markers, such as MRE11 and immune signatures, indicating better responses to chemoradiation. Immunotherapy is increasingly integrated into treatment regimens, with promising trials like SWOG 1806 exploring the addition of immune checkpoint inhibitors to chemoradiation.

TMT, now recognized by major guidelines, offers patients a viable option with preserved bladder function, improved quality of life, and less life interference. The presentation stresses the need for improved staging, expanded access to bladder-sparing options, and informed decision-making to optimize outcomes for MIBC patients.

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Innovations in Bladder Cancer: Strategies for Improving Outcomes Across the Disease Continuum

Innovations in Bladder Cancer: Strategies for Improving Outcomes Across the Disease Continuum

by | Sep 2024

Daniel P. Petrylak, MD, discusses recent advancements in bladder cancer management, highlighting the evolving treatment landscape and the integration of novel therapies. In this 10-minute talk, Petrylak notes a paradigm shift in treating metastatic bladder cancer, moving beyond traditional platinum-based chemotherapies such as gemcitabine and cisplatin, toward immune checkpoint inhibitors.

Petrylak shares trials exploring new therapeutic strategies, such as integrating agents into neoadjuvant and adjuvant settings. For patients ineligible for platinum-based chemotherapy, new protocols involving EV and pembrolizumab provide promising alternatives.

The presentation emphasizes future research’s importance in optimizing treatment sequencing, improving bladder preservation, and minimizing toxicity. With survival rates for metastatic bladder cancer doubling in recent years, ongoing trials are expected to further refine therapeutic strategies and define the next era of bladder cancer care.

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