AUA, SUO Release New Clinical Practice Guideline on the Diagnosis and Treatment of Non–Muscle-Invasive Bladder Cancer
The American Urological Association (AUA), together with the Society for Urologic Oncology (SUO), has released a new clinical practice guideline on non–muscle-invasive bladder cancer. This new document outlines guidance on a variety of topics, including diagnosis and treatment, as well as a...
Atezolizumab in Previously Treated Advanced Urothelial Carcinoma
The recent study by Rosenberg et al in The Lancet—summarized in this issue of The ASCO Post—is a very important paper in the field of bladder cancer therapy.1 It is the first phase II trial in metastatic transitional cell carcinoma that demonstrates the single-agent activity of the...
Anti–PD-L1 Antibody Atezolizumab Active in Previously Treated Advanced Urothelial Carcinoma
In a phase II trial reported in The Lancet, Jonathan E. Rosenberg, MD, of Memorial Sloan Kettering Cancer Center, and colleagues found that the anti–PD-L1 (programmed cell death ligand 1) antibody atezolizumab produced durable responses in a marked proportion of patients with previously treated...
ASCO and European Association of Urology Agree on Bladder Cancer Guidelines
I like economies of scale, and thus it makes perfect sense that ASCO has set a formal process to allow potential endorsement of selected guidelines from other organizations, rather than redoing the whole process. Recently, we have seen the publication of a formal endorsement of the European...
ASCO Endorses European Association of Urology Guideline on Muscle-Invasive and Metastatic Bladder Cancers
As reported in the Journal of Clinical Oncology by Matthew I. Milowsky, MD, of the University of North Carolina Lineberger Comprehensive Cancer Center, and colleagues,1 ASCO has endorsed the European Association of Urology clinical practice guideline on muscle-invasive and metastatic bladder...
FDA Approves Atezolizumab for Advanced Urothelial Carcinoma
The U.S. Food and Drug Administration (FDA) today granted accelerated approval to atezolizumab (Tecentriq) for the treatment of urothelial carcinoma, the most common type of bladder cancer. This is the first programmed cell death protein 1/programmed death ligand 1 (PD-1/PD-L1) inhibitor to be...
A Critical Analysis of Early Bladder Cancer Recurrence After Laparoscopic Radical Cystectomy
Although laparoscopic radical cystectomy and robotic-assisted radical cystectomy continue to grow in popularity and are successful in the treatment of bladder cancer, they are still considered experimental approaches. Using data collected by the Section of Uro-Technology of the European Association ...
Phase II Trial Shows Benefit of Adding Ramucirumab to Docetaxel in Previously Treated Advanced Urothelial Carcinoma
Adding the anti–vascular endothelial growth factor receptor 2 (VEGFR-2) antibody ramucirumab to docetaxel improved progression-free survival among previously treated patients with locally advanced or metastatic urothelial carcinoma, reported Petrylak et al in the Journal of Clinical Oncology. ...
Study Finds Adaptive Image-Guided Radiation Therapy for Bladder Preservation Clinically Feasible in Urinary Bladder Cancer
A prospective study examining a trimodality treatment approach in localized bladder cancer cases using adaptive image-guided, intensity-modulated radiation therapy found that the bladder preservation rate at 3 years was 83%. These findings were published by Murthy et al in the International Journal ...
ASCO Endorses European Association of Urology Guideline on Muscle-Invasive and Metastatic Bladder Cancer
As reported in the Journal of Clinical Oncology by Matthew I. Milowsky, MD, of the University of North Carolina Lineberger Comprehensive Cancer Center, and colleagues, ASCO has endorsed the European Association of Urology clinical practice guideline on muscle-invasive and metastatic bladder cancer. ...
MRI-Guided Adaptive Reoptimization in Radiotherapy Shows Promise in Urinary Bladder Cancer Treatment
A new radiotherapy technique could help doctors to focus treatment more precisely on tumors in the bladder and reduce damage to surrounding healthy tissue. Researchers showed that pretreatment imaging using magnetic resonance imaging (MRI) was effective at guiding radiotherapy toward tumors in the...
Atezolizumab Active in Previously Treated Locally Advanced or Metastatic Urothelial Carcinoma
The anti–PD-L1 (programmed cell death ligand 1) antibody atezolizumab produced durable responses in a marked proportion of patients with previously treated locally advanced or metastatic urothelial carcinoma, according to a phase II trial reported in The Lancet by Rosenberg et al. The...
Adjuvant Chemoradiotherapy in Locally Advanced Bladder Cancer: Hint of Benefit That Needs Confirmation
Adjuvant sequential chemotherapy plus radiation therapy and adjuvant radiation therapy alone significantly improved local tumor control compared with adjuvant chemotherapy alone in locally advanced bladder cancer but the improvement in disease-free survival (3-year disease-free survival of 68% vs...
Peter E. Clark, MD, on a Guideline Update in the Management of Bladder Cancer
Peter E. Clark, MD, of the Vanderbilt-Ingram Cancer Center discusses the highlights of the 2015 NCCN Guidelines for bladder cancer in both non–muscle invasive and muscle-invasive disease.
Derek Raghavan, MD, PhD: Roundup of Clinical Trial Results on Genitourinary Cancers
Derek Raghavan, MD, PhD, of the Levine Cancer Institute, gives his insights into key genitourinary cancer clinical trials presented at the 2015 ASCO Annual Meeting and his thoughts on where the research is headed.
Jonathan E. Rosenberg, MD, on Results of the IMvigor 210 Study on Atezolizumab in Locally Advanced or Metastatic Urothelial Cancer
Jonathan E. Rosenberg, MD, of Memorial Sloan Kettering Cancer Center, discusses this pivotal study of an investigational immunotherapy that has shown increased and durable responses, with a relatively benign toxicity profile (Abstract 21LBA).
Srikala S. Sridhar, MD: Bladder Cancer Update
Srikala S. Sridhar, MD, of the Princess Margaret Cancer Centre, summarizes important papers presented on bladder and urothelial cancers, including perspectives on immunotherapies and radiotherapies.
Neoadjuvant Chemotherapy with CMV Improves Outcome for Invasive Bladder Cancer
Long-term results from a phase III trial show that neoadjuvant chemotherapy with CMV (cisplatin, methotrexate, and vinblastine) improves the outcome for patients with muscle-invasive urothelial cancer of the bladder treated by cystectomy and/or radiotherapy. “Three cycles of CMV before cystectomy...
Updated Drug Label Approved for Pioglitazone after Safety Review
The FDA recently approved updated drug labels for pioglitazone (Actos) and other pioglitazone-containing medicines (in combination with metformin, Actoplus Met and Actoplus Met XR; and with glimepiride, Duetact) to include safety information that the use of pioglitazone for more than 1 year may be...
Neutrophil/Lymphocyte Ratio Can Upstage Patients with Bladder Cancer
A sizable proportion of bladder cancer patients who would benefit from neoadjuvant chemotherapy are not receiving it, researchers from the University of Wisconsin School of Medicine and Public Health, Madison, concluded. Their conclusion was based on their assessment of the neutrophil/lymphocyte...
Highlights of Bladder Cancer Research Include Novel Agents and New Approach to Identifying Biomarkers
It is an exciting time for researchers involved in developing new therapies for bladder cancer. More agents are in clinical development, drugs with novel mechanisms and novel trial designs are being implemented, and functional collaboration is occurring in the field, according to Noah Hahn, MD,...
Important News Briefs: New Data Reported in Prostate, Bladder, and Kidney Cancers
The recent 2012 Genitourinary Cancers Symposium featured a wealth of presentations on prostate, bladder, kidney, and other genitourinary cancers. Brief summaries of some of the oral and poster sessions are presented. Exercise and Recurrence Vigorous exercise has been shown to reduce cancer...
GU Symposium 2016: Updated Results of IMvigor 210 Show Durable Response Rates With Atezolizumab in Advanced Bladder Cancer
In the pivotal phase II IMvigor 210 study, the investigational cancer immunotherapy atezolizumab (MPDL3280A) showed encouraging response rates in patients with locally advanced or metastatic urothelial carcinoma, Roche announced. These data were presented by Hoffman-Censits et al at the 2016...
Study Shows Concurrent Chemoradiation Therapy to be a Viable Strategy for Muscle-invasive Bladder Cancer
Combined-modality therapy provides a bladder-sparing alternative to radical cystectomy with comparable outcomes in patients with muscle-invasive bladder cancer, according to a pooled analysis of six Radiation Therapy Oncology Group (RTOG) trials.1 The study included 468 patients and showed that...
Expert Point of View: Chemoradiation with Fluorouracil and Mitomycin Reduces Recurrence of Muscle-invasive Bladder Cancer
In an editorial accompanying the recently reported UK phase III Bladder Cancer 2001 (BC2001) trial, Shipley and Zietman, from Massachusetts General Hospital and Harvard Medical School, point out that this trial shows that “the addition of a very tolerable regimen of chemotherapy to radiotherapy...
Chemoradiation with Fluorouracil and Mitomycin Reduces Recurrence of Muscle-invasive Bladder Cancer
Radiotherapy is an alternative to surgery in muscle-invasive bladder cancer, particularly in less-fit patients. However, it is associated with high rates of incomplete response or recurrence, with salvage surgery often being required. Although synchronous chemoradiotherapy has improved local...
Clinical-Pathologic Stage Discrepancy High in Patients with Bladder Cancer Undergoing Surgery
About 48% of all patients with bladder cancer undergoing radical cystectomy have a discrepancy between their clinical stage and pathologic stage, according to the largest study to date to examine this issue. Upstaging after surgery is associated with reduced survival, while downstaging after...
Having Bladder Cancer Has Taught Me Important Life Lessons
I think one of the most frightening—and embarrassing—things that can happen to an adult is losing control of your bladder and wetting the bed. When that happened to me in the spring of 2012 while I was on a camping trip with my wife Kimberly and our two teenage daughters, I knew something was very...
Fine-Tuning Bladder-Preservation Trimodality Therapy for Patients With Muscle-Invasive Bladder Cancer
Organ preservation is a hallmark of progress in the world of cancer management. For patients with muscle-invasive bladder cancer, the bladder-sparing approach is a well-established alternative to radical cystectomy. Patients undergo cystoscopic evaluation between the induction and consolidation...
Bladder Cancer Patient With Rare Genetic Mutations Shows Exceptional Response to Everolimus/Pazopanib Combination
A patient with advanced bladder cancer experienced a complete response for 14 months to the drug combination everolimus (Afinitor) and pazopanib (Votrient) in a phase I trial, and genomic profiling of his tumor revealed two alterations that may have caused this exceptional response, according to a...
FGFR Inhibitors of Interest in Bladder and Lung Cancer
Fibroblast growth factor receptor (FGFR) inhibitors are an emerging area of interest in cancer therapeutics. Studies presented at the 2014 American Association for Cancer Research (AACR) Annual Meeting in San Diego provided early encouraging data for two investigational pan-FGFR inhibitors for the...
NCCN Scientific Posters Include New Findings in Bladder Cancer, Survivorship Care, and Antiemetic Therapy
The 19th Annual Conference of the National Comprehensive Cancer Network (NCCN), recently held in Hollywood, Florida, featured a number of scientific posters by member organizations and meeting sponsors. The ASCO Post captured some of the most interesting findings for our readers, including these...
Investigational Immunotherapy Demonstrates Response in Patients With PD-L1–Positive Metastatic Bladder Cancer
The investigational immunotherapy agent MPDL3280A (also known as anti-PDL1) produced an overall response rate of 43% in a phase I study of patients previously treated for metastatic urothelial bladder cancer whose tumors were characterized as programmed death ligand 1 (PD-L1)-positive. Results of...
Ongoing Clinical Trials Actively Recruiting Patients With Bladder Cancer
The information in this Clinical Trials Resource Guide includes actively recruiting clinical studies for patients with bladder cancer. The list includes randomized and nonrandomized phase 0 to III studies as well as observational clinical trials evaluating new therapies, surgical techniques, and...
Complications No Different Between Open and Robot-Assisted Radical Cystectomy When Open Urinary Diversion Performed
We read the letter to the editor in the July 24, 2014, issue of The New England Journal of Medicine entitled, “A Randomized Trial of Robot-Assisted Laparoscopic Radical Cystectomy,” with great interest.1 Provocative Results In the letter, reviewed in this issue of The ASCO Post, Bochner and...
No Difference in Complication Rates or Hospital Stay With Robot-Assisted vs Open-Surgery Cystectomy in Bladder Cancer
Retrospective analyses indicate that robot-assisted laparoscopic surgery for radical cystectomy in patients with bladder cancer is associated with reduced risk of complications and shorter hospital stay compared with open surgery. In a small single-institution randomized trial reported in a letter...
EGFR a Potential Target in Muscle-Invasive Bladder Cancer With Basal-Like Phenotype
As reported by Rebouissou and colleagues in Science Translational Medicine, a subset of muscle-invasive bladder cancers that present with a basal-like phenotype is associated with poorer survival, EGFR pathway activation, and sensitivity to EGFR inhibition. Assessment of data from 383 tumors...
Molecular Classification Predicts Postcystectomy Recurrence in High-Risk Bladder Cancer
Radical cystectomy is the standard therapeutic option for patients with muscle-invasive bladder cancer. However, 5-year overall survival for high-risk patients with pT3, pT4, pN-negative, and pN-positive M0 bladder cancer after radical cystectomy is only about 50% and ranges from 32% in patients...
Novel Genomic Signature Predicts Postcystectomy Recurrence in High-Risk Bladder Cancer
As reported in the Journal of the National Cancer Institute, Anirban P. Mitra, MD, PhD, of the University of Southern California, and colleagues identified a novel genome-based signature that improves prediction of postcystectomy recurrence in patients with high-risk bladder cancer.1 Use of the...
Treating Bladder Cancer in 2015
Treatment of advanced bladder cancer continues to prove challenging, and therapies that offer long-term survival remain elusive. The ASCO Post recently spoke with Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, President of the Levine Cancer Center, Charlotte, North Carolina, about the current state...
Adjuvant Chemotherapy Favored in Locally Advanced Bladder Cancer Not Treated With Neoadjuvant Therapy
A large observational study presented at the 2015 Genitourinary Cancers Symposium in Orlando, Florida, found that adjuvant chemotherapy extended the likelihood of survival in locally advanced bladder cancer compared with observation alone.1 Using three different approaches to propensity scores...
Antiangiogenesis Plus Chemotherapy Pursued in Advanced Bladder Cancer
Two separate phase II studies lend support to the concept of antiangiogenesis in advanced bladder cancer. The combination of an antiangiogenic agent and chemotherapy may fulfill an unmet need in this disease, the studies suggest. Both studies were presented at the 2015 Genitourinary Cancers...
Adjuvant Chemotherapy and Overall Survival in Muscle-Invasive Bladder Cancer: Still Climbing the Mountain
Muscle-invasive bladder cancer can be a lethal disease despite curative intent local therapy, with 5-year survival that can be as low as 30% based on the extent of T status and/or lymph node involvement. The use of neoadjuvant chemotherapy with MVAC (methotrexate, vinblastine, doxorubicin, and...
No Overall Survival Difference for Immediate vs Deferred Chemotherapy After Radical Cystectomy in Muscle-Invasive Bladder Cancer
In the European Organisation for Research and Treatment of Cancer (EORTC) 30994 trial, a phase III intergroup study reported in The Lancet Oncology,1 Cora N. Sternberg, MD, FACP, Chief of Medical Oncology at San Camillo and Forlanini Hospitals, Rome, and colleagues found no overall survival...
Immunotherapy Marches On, Making Headway in Advanced Urothelial Bladder Cancer
Two immunotherapy agents show promise in preliminary studies of advanced urothelial bladder cancer: the anti–PD-1 (programmed cell death protein 1) antibody pembrolizumab (Keytruda) and the anti–PD-L1 (programmed cell death ligand 1) antibody atezolizumab. Separate phase I studies of each drug...
Clinical Trials Actively Recruiting Patients With Genitourinary Cancers
The information contained in this Clinical Trials Resource Guide includes actively recruiting clinical studies for patients with genitourinary cancers—prostate, bladder, uterine, and testicular. The trials are investigating genetic biomarkers of cancer; proton beam therapy; allogeneic bone marrow...
PD-1/PD-L1 Inhibitors Show Promise in Additional Tumor Types
While inhibitors of programmed cell death protein 1 (PD-1) or its ligand (PD-L1) are becoming established in melanoma, non–small cell lung cancer, and renal cell carcinoma, their efficacy is also being evaluated in numerous other tumor types, with promising results, according to studies presented...
Study Finds Investigational Personalized Peptide Vaccination Increased Survival in Patients With Advanced Bladder Cancer
Although urothelial cancer of the bladder is sensitive to platinum-based chemotherapy, the vast majority of patients treated with these therapies will develop progressive disease within 8 months of treatment, and the median survival is reported to be between 13 and 15 months, according to a new...
ECC 2015: Atezolizumab in Locally Advanced or Metastatic Urothelial Carcinoma: Results of the IMvigor 210 Study
At the 2015 European Cancer Congress in Vienna, Austria, early results were announced (Abstract 21LBA) from a pivotal phase II study, IMvigor 210, of the investigational cancer immunotherapy atezolizumab (anti–PD-L1; MPDL3280A) in people with locally advanced or metastatic urothelial...
Study Identifies Genetic Mutations That Predict Response to Chemotherapy in Bladder Cancer
Although cisplatin-based neoadjuvant chemotherapy before cystectomy is the standard of care for muscle-invasive bladder cancer, only between 25% and 50% of patients achieve a pathologic response. A study investigating biomarkers that can predict response to chemotherapy in patients with...
