Topic: Bladder Cancer

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.

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.

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...

Therapy for High Risk NMIBC

by Colin P. N. Dinney, MD | Aug 2024

Colin P.N. Dinney, MD, defines the criteria that categorize patients as high-risk, such as tumor grade, size, and recurrence history. He underscores the importance of early and accurate diagnosis using advanced imaging techniques and molecular markers, which play a crucial role in guiding treatment decisions.

He focuses on Bacillus Calmette-Guérin (BCG) therapy, the gold standard for high-risk NMIBC. Dr. Dinney reviews BCG’s mechanisms of action, administration protocols, and factors influencing its efficacy. He also addresses the challenges posed by BCG shortages and the emergence of BCG-unresponsive disease, highlighting the need for alternative therapeutic strategies.

Further, Dr. Dinney discusses the potential of immune checkpoint inhibitors, targeted therapies, and gene therapy in the context of high-risk NMIBC. He presents data from recent clinical trials that demonstrate the promising results of these innovative approaches in achieving durable responses and reducing recurrence rates.

Imaging and Biomarkers in Patient Selection for Focal Ablation

by Ezekiel Becher, MD | Aug 2024

Ezequiel Becher, MD, discusses the critical role of imaging and biomarkers in selecting patients for focal ablation in prostate cancer treatment.

He highlights the advancements in imaging technologies that have revolutionized prostate cancer diagnostics, particularly multiparametric MRI (mpMRI). In addition to imaging, Dr. Becher underscores the significance of biomarkers in patient selection. While prostate-specific antigen (PSA) levels are traditionally used, they are complemented by more specific biomarkers such as PCA3, TMPRSS2-ERG, and genomic tests that provide a deeper understanding of tumor biology and aggressiveness.

Dr. Becher also addresses the challenges and limitations of current imaging and biomarker techniques. He advocates for continuous refinement of these technologies and the development of standardized protocols to enhance diagnostic accuracy. Looking forward, he points to the potential of artificial intelligence and machine learning in improving diagnostic precision and patient selection processes.

Clinical Trials in MIBC and NMIBC

by Daniel P. Petrylak, MD | Aug 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.

Updates on the Latest Classifications of Urothelial Cancers

by Francisco G. La Rosa, MD | Aug 2024

Francisco G. La Rosa, MD, provides an overview of the historical evolution and recent updates in cancer classification.

In this 11-minute presentation, he highlights the early stages of pathology in the 1800s. Key advancements emerged with the establishment of histopathology in the early 1900s, marking significant strides in cancer characterization.

La Rosa reviews refinements in classifications, such as the 1952 Armed Forces Institute of Pathology system, the WHO’s 1973 classification, the WHO and International Society of Urological Pathology 1998 collaboration, and, finally, the 2022 WHO update. This final update represents a major advancement by incorporating molecular insights and enhancing cancer classifications’ prognostic and therapeutic implications. This edition also discards ambiguous terms like “urothelial dysplasia” and “papillary proliferation of undetermined malignant potential” to reduce diagnostic variability.

Additionally, the updated classification system includes detailed subtypes based on molecular markers, supporting a more nuanced understanding of tumor behavior. The Cancer Genome Atlas is pivotal in this molecular stratification, identifying specific cancer subtypes and associated prognostic markers.

Join the GRU Community

- Why Join? -

Topic: Bladder Cancer

Join the GRU Community

You have Successfully Subscribed!