Topic: Bladder Cancer

Updates in Radiotherapy for Bladder Cancer

by Daniel A. Hamstra, MD, PhD, FASTRO, FASCO | Dec 2024

Daniel A. Hamstra, MD, PhD, FASTRO, FASCO, explores advances in bladder cancer therapy, focusing on trimodality bladder preservation. In this 21-minute presentation, he compares the North American approach, which requires strict criteria for bladder preservation, including thorough TURBT and an absence of extensive CIS, to a more inclusive UK approach, which tolerates certain conditions such as CIS and hydronephrosis and utilizes non-platinum-based chemotherapy.

Hamstra shares a significant UK phase III trial that illustrates the effectiveness of adding chemotherapy to radiation, enhancing local control and survival, and reducing the need for cystectomy. A multi-institutional study comparing this approach with radical cystectomy indicates comparable metastasis-free and overall survival rates, suggesting trimodality therapy as a viable alternative to surgery.

Hamstra notes that neoadjuvant chemotherapy is emerging as beneficial in bladder preservation, with data supporting its utility across different cancers when combined with radiation. For node-positive bladder cancer, combined chemoradiotherapy (chemoRT) appears as effective as surgery in appropriately selected patients.

Newer immunotherapies and non-platinum regimens continue to expand options, while evidence supports chemoRT as an alternative to radical surgery, especially for patients prioritizing quality of life and organ preservation.

Updates in Advanced Urothelial Carcinoma

by Neda Hashemi, MD | 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.

The Bespoke Future of Cancer Care

by Leonard G. Gomella, MD, FACS | Nov 2024

Leonard G. Gomella, MD, explores the concept of “bespoke” cancer care, emphasizing its personalized, patient-centered approach. Originally a British term referring to custom-made items, “bespoke” now highlights the customization of cancer treatments through precision medicine, pharmacogenomics, AI technologies, and individualized care plans.

In this 10-minute presentation, Dr. Gomella stresses that innovations in cancer care reflect the growing trend of leveraging AI to enhance screening efficiency and reduce reliance on traditional biopsy methods. He discusses how precision medicine increasingly enables oncologists to tailor treatment plans by analyzing genetic mutations and matching patients to the most promising therapies or clinical trials. The need to balance technological advancements with affordability and patient access is a central concern.

Bespoke care offers better outcomes and underscores the importance of informed decision-making, empowering patients to actively participate in their treatment journey.

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

by Frances M. Alba, MD | 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.

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

by Jason A. Efstathiou, MD, DPhil | 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.

Updates on the Imaging for Urothelial Carcinoma

by Desencia E. Thomas, MD | Nov 2024

Desencia E. Thomas, MD, presents an update on imaging techniques for urothelial carcinoma (UC), emphasizing advancements in diagnosis and staging.

In this 18-minute presentation, Dr. Thomas highlights the diagnostic accuracy of CT urography. MR urography provides an alternative for patients unable to tolerate iodine-based contrast or when CT findings are inconclusive. PET imaging, including 18-F FDG PET, excels in detecting distant metastases, but tracers like 11-C acetate and choline help minimize false positives in the urinary tract due to reduced excretion.

Dr. Thomas discusses the role of MRI in bladder cancer staging, where VI-RADS scoring helps distinguish between muscle-invasive and non-invasive cancers. This system, using T2-weighted, diffusion-weighted, and contrast-enhanced sequences, enables precise preoperative staging. Dual-energy CT (DECT) is also emerging, allowing reduced radiation exposure while retaining diagnostic value.

Key challenges include limited imaging sensitivity for early-stage UC and difficulty assessing tumor invasion depth. Dr. Thomas emphasizes that contrast-enhanced ultrasound may assist patients with contraindications to CT or MRI, although it remains less sensitive for upper tract tumors. She stresses that imaging advancements hold promise for improving UC management and minimizing invasive procedures like TURBT.

Utilizing ctDNA in Bladder Cancer

by Leonard G. Gomella, MD, FACS | Nov 2024

Leonard G. Gomella, MD, FACS, explores the potential of circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA) as biomarkers in cancer detection, treatment monitoring, and prognosis.

In this 12-minute presentation, Dr. Gomella reviews recent studies, such as those conducted at the European Association of Urology (EAU), demonstrating ctDNA’s potential for early detection, risk assessment, treatment response evaluation, and post-treatment surveillance in bladder cancer. Trials such as InVigor010 highlight ctDNA’s prognostic utility, where analysis revealed that ctDNA positivity predicted a higher risk of relapse.

Gomella reports that innovations extend to ctDNA detection in urine, offering a non-invasive method to monitor disease burden. These developments and the integration of advanced sequencing technologies mark a new era in cancer management, facilitating earlier interventions and more effective treatment planning.

Current Management of T1 High Grade Bladder Cancer

by Frances M. Alba, MD | Oct 2024

Frances M. Alba, MD, discusses the management of T1 high-grade bladder cancer, focusing on cases that recur following BCG therapy.

In this 14-minute talk, Dr. Alba introduces the case of a 53-year-old male with T1 high-grade bladder cancer who underwent a complete six-week BCG course but experienced recurrence within ten weeks. Dr. Alba notes that BCG failure is not uncommon, with the term “BCG unresponsive” now used to describe persistent or recurrent disease within defined timeframes after adequate BCG treatment. In these patients, continued BCG is seldom effective.

Alba highlights the AUA guidelines for these patients, recommending cystectomy as the best chance to prevent disease progression. Despite its efficacy, only a quarter of urologists in the US recommend cystectomy for BCG-unresponsive cases, with many preferring intravesical chemotherapy. Gemcitabine-docetaxel combination therapy shows promise. Alba also shares additional options, such as nadofaragine, pembrolizumab, and novel therapies, including N-803.

The Making of the Ileal Orthotopic Bladder Substitute with an Afferent Tubular Segment: In Memory of Prof. Urs Studer

by Fiona C. Burkhard, MD | Oct 2024

Fiona C. Burkhard, MD, presented “The Making of the Ileal Orthotopic Bladder Substitute with an...

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

by Daniel P. Petrylak, MD | 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.

HoLEP

by Lori B. Lerner, MD | Sep 2024

Lori B. Lerner, MD, delves into the complexities of enucleation techniques for treating benign prostatic hyperplasia (BPH), emphasizing the importance of understanding prostate anatomy. In this 11-minute presentation, she highlights how individual anatomical variations influence surgical decisions and outcomes, particularly in laser enucleation.

Dr. Lerner outlines different approaches to enucleation, involving strategic incisions to address each patient’s specific anatomy. She discusses complex cases, such as patients with a significant portion of their prostate extending into the bladder, nodular prostates, or elevated bladder necks, which necessitate tailored approaches.

Dr. Lerner’s presentation underscores the necessity of careful preoperative imaging, using tools like MRI or CAT scans, to map the prostate’s structure and guide the surgical approach. She advocates against routine excessive testing, emphasizing responsible and targeted use of diagnostic tools to inform clinical decisions without unnecessary expenditure. Lerner also addresses potential complications such as postoperative stress urinary incontinence.

Bladder Cancer Journal Vol. 10, Issue 2

by Bladder Cancer Journal | Aug 2024

The Evolution of Nadofaragene Firadenovec: A Review and the Path Forward Abstract: BACKGROUND: The...

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