Topic: Muscle Invasive Bladder Cancer

Bladder Cancer Journal Vol. 6, Issue 4

Upregulated FGFR3 signaling in NMIBC and MIBC, the diagnosis and management of checkpoint inhibitor side effects in bladder cancer patients, the etiology of treatment delays in patients receiving neoadjuvant chemotherapy for MIBC, and 25-year trends in stage-specific incidence rates for bladder cancer.

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Immunotherapy For Muscle Invasive Bladder Cancer

A. Edward Yen, MD, Assistant Professor of Medicine in the Hematology and Oncology Section at Baylor College of Medicine in Houston, Texas, discusses the findings of recent immunotherapy trials for muscle invasive bladder cancer (MIBC). He explains that cisplatin-based neoadjuvant chemotherapy combinations are the current standard of care for MIBC and can provide a significant overall survival benefit, but 40 to 50% of patients are not eligible for cisplatin to begin with, and only 20% of those eligible patients actually receive cisplatin, which suggests that there are major therapeutic gaps that immunotherapies could potentially fill. Dr. Yen goes into depth on the findings of the phase II PURE-01 study of pembrolizumab, the phase II ABACUS study of atezolizumab, and the phase I NABUCCO study of nivolumab/ipilimumab, observing that all three therapies produced good responses and appeared to be correlated to different biomarkers from one another. He concludes by predicting that neoadjuvant immunotherapy will become standard of care for cisplatin-ineligible patients, but he also stresses that future studies should include higher-risk patients and should focus on predictive biomarkers.

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Updates in Muscle Invasive Bladder Cancer

Sia Daneshmand, MD, Associate Professor of Urology and Director of Clinical Research at the University of Southern California, describes the current landscape of muscle invasive bladder cancer treatment, highlighting developments in radical cystectomy and chemotherapy. He observes that while radical cystectomy has long been the gold standard, efforts are being made to preserve reproductive organs in female patients who have low-stage disease. Dr. Daneshmand also notes the significant number of neoadjuvant chemotherapy phase II trials currently underway. While studies examining adjuvant chemotherapy have shown promise, the limitations of these trials necessitate further research. Similarly, research comparing super-extended lymph node dissection (LND) with extended LND have yielded insignificant p-values, but absolute numbers demonstrate a positive upward survival trend over 5 years. Dr. Daneshmand concludes that additional clinical trials will reveal the optimal combination and sequencing of treatment options.

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Robotic Cystectomy and ICUD for Muscle Invasive Bladder Cancer

Sanjay G. Patel, MD, Assistant Professor of Urology at the University of Oklahoma College of Medicine, evaluates oncologic evidence comparing open radical cystectomy to robotic cystectomy. This includes addressing morbidity rates detailed in a recent meta-analysis, and questioning whether open diversion could affect these results. Additionally, Dr. Patel analyzes the learning curve associated with performing a robotic cystectomy. Finally, he explains the cost differences between the two techniques, as well as why a more costly operation and/or hospital stay may still be more indirectly cost-effective down the road.

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Case-Based Panel Discussion: Muscle-Invasive Bladder Cancer

A. Edward Yen, MD; Jennifer M. Taylor, MD, MPH; Guilherme Godoy, MD, MPH; and Seth P. Lerner, MD, examine four unique case examples to elaborate on various treatment approaches for muscle-invasive bladder cancer (MIBC) based on individual patient needs. The panel discussion reviews current data on neoadjuvant chemotherapy, trimodal therapy, and checkpoint inhibitors in this setting.

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