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This is Part 3 of Immunotherapy Approaches in Muscle-Invasive Bladder Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this roundtable. In this video, Drs. Matthew Galsky, Srikala Sridhar, and Abhishek Tripathi discuss perioperative treatment strategies for a patient with muscle-invasive bladder cancer and borderline renal function. The patient is a 74-year-old man with a history of hypertension who is seen in the ER for lower abdominal discomfort. A CT scan reveals a bladder mass, and labs are notable for a creatinine clearance of 43 mL/min. He undergoes cystoscopy and transurethral resection of the bladder tumor (TURBT). Pathology reveals high-grade urothelial cancer with invasion of the lamina propria but no muscularis propria present in the sample. In the conversation that follows, the faculty discuss the importance of repeat TURBT in patients with high-grade urothelial cancer and no muscularis propria in the pathology specimen, the clinical implications of the NIAGARA study, whether bladder-sparing trimodality approaches could be an option, and more.
This is Part 2 of Immunotherapy Approaches in Muscle-Invasive Bladder Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this roundtable. In this video, Drs. Matthew Galsky, Srikala Sridhar, and Abhishek Tripathi discuss adjuvant treatment options for a patient with cisplatin-ineligible, pathologic node-positive muscle-invasive bladder cancer. The patient is an 82-year-old woman with a history of non–muscle-invasive bladder cancer who was subsequently treated with intravesical docetaxel plus gemcitabine for high-grade cT1 recurrence. On staging cystoscopy plus transurethral resection of the bladder tumor, she is found to have muscle-invasive bladder cancer. A CT scan reveals bladder wall thickening, and lab work is notable for creatinine clearance of 35 mL/min. She proceeds with radical cystectomy, and pathology reveals pT3N0 urothelial cancer of the bladder, and she has detectable ctDNA. In the conversation that follows, the faculty discuss how to counsel older or frail patients who are not eligible for upfront neoadjuvant chemotherapy, the role of adjuvant immunotherapy, and the impact on ctDNA on outcomes.
This is Part 1 of Immunotherapy Approaches in Muscle-Invasive Bladder Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this roundtable. In this video, Drs. Matthew Galsky, Srikala Sridhar, and Abhishek Tripathi discuss neoadjuvant treatment options for a patient with muscle-invasive bladder cancer and squamous differentiation. The patient is a 65-year-old man with a history of hypertension and type 2 diabetes mellitus who presents with gross hematuria. A CT scan reveals a bladder mass, a single borderline enlarged pelvic lymph node, and mild right-sided hydronephrosis. Lab work is notable for a creatinine clearance of 65 mL/min and urinalysis showing red blood cells. Cystoscopy reveals a bladder tumor, and he undergoes cystoscopy and transurethral resection of the bladder tumor. Pathology reveals muscle-invasive urothelial cancer of the bladder with ~55% squamous differentiation. In the conversation that follows, the faculty discuss the relevance of histology in determining his treatment course, whether immune checkpoint blockade should be considered, the role of local therapy, and more.
A whole-genome sequencing–based, error-corrected method for detecting cancer from blood samples could be more sensitive and accurate in monitoring disease status posttreatment among patients with cancer compared with prior methods, according to a recent study published by Cheng et al in Nature...
In a French phase II trial (iNDUCT-GETUG V08) reported in the Journal of Clinical Oncology, Houédé et al found evidence of activity of neoadjuvant durvalumab plus chemotherapy in patients with high-risk, upper tract urothelial carcinoma. Study Details In this multicenter open-label trial, 45...
On March 28, the U.S. Food and Drug Administration (FDA) approved the PD-L1 inhibitor durvalumab (Imfinzi) with gemcitabine and cisplatin as neoadjuvant treatment, followed by single-agent durvalumab as adjuvant treatment following radical cystectomy, for adults with muscle-invasive bladder ...
In a systematic review and meta-analysis reported in JAMA Network Open, Yajima et al found that both pembrolizumab plus enfortumab vedotin-ejfv and enfortumab vedotin alone were active in the first-line setting and later lines of therapy, respectively, in metastatic urothelial carcinoma. Study...
Two doses of a simple tuberculosis (TB) vaccination after surgery helps the immune system fight cancer cells and may improve patient outcomes among those with non–muscle-invasive bladder cancer, according to a pilot study of 40 patients. Initial results from the RUTIVAC-1 Trial were presented by...
As reported in the journal Urologic Oncology: Seminars and Original Investigations by Fallara et al, an analysis of individual patient data from the IMvigor210 and IMvigor211 trials revealed that concomitant second-line treatment of locally advanced or metastatic urothelial carcinoma with...
In previously untreated patients with locally advanced or metastatic urothelial carcinoma, use of the antibody-drug conjugate enfortumab vedotin-ejfv in combination with the PD-1 inhibitor pembrolizumab continues to demonstrate a significant survival benefit over chemotherapy, according to updated...
In a multicohort phase Ib study (COSMIC-021) reported in the Journal of Clinical Oncology, Sumanta K. Pal, MD, FASCO, and colleagues identified the activity of cabozantinib plus atezolizumab in a cohort of patients with locally advanced or metastatic urothelial carcinoma according to first-line...
Studies show that although radical cystectomy has long been recognized as the standard-of-care for localized muscle-invasive bladder cancer (MIBC), the surgery carries significant morbidity and the risk of subsequent loss of quality of life for patients. Preclinical studies have suggested that a...
Multiparametric magnetic resonance imaging (MRI) and biopsy may speed up the time to correct treatment among patients with a muscle-invasive urothelial carcinoma, according to a recent study published by Bryan et al in the Journal of Clinical Oncology. Background Usual tests for muscle-invasive...
In a phase II trial (RETAIN 1) reported in the Journal of Clinical Oncology, Geynisman et al found that risk-adapted active surveillance following neoadjuvant chemotherapy was associated with a high rate of metastasis-free survival in patients with muscle-invasive bladder cancer. Study Details In ...
A novel immunotherapy may offer a new option for patients with bladder cancer who no longer respond to bacillus Calmette-Guérin (BCG), according to a study presented on December 5 at the 2024 Society of Urologic Oncology Annual Meeting in Dallas. The therapy, cretostimogene grenadenorepvec, is an...
The soaring number of cancer survivors since the National Cancer Act of 1971 was enacted into law provides a snapshot of the profound progress made against cancer over the past half-century: 3 million survivors in the 1970s,1 compared to more than 18 million today, and that number is expected to...
Targeting certain bacterial strains linked to cancer with treatments or vaccines may help to reduce the risk of colorectal cancer, urothelial carcinoma, and prostate cancer, according to a novel study published by Mäklin et al in The Lancet Microbiome. Background The bacterium Escherichia coli is...
My twin brother and I were adopted at 18 months old, so I don’t know the medical history of our biological parents and family. But for certain, cancer has played an integral—and heartbreaking—role in my life. Both of my adoptive parents were diagnosed with genitourinary cancers at relatively early ...
Recent advances in urothelial carcinoma treatments may offer a path to curative care for more patients, including those with high-risk localized, muscle-invasive disease, according to an editorial published by Milowsky in The New England Journal of Medicine. The findings indicated that...
In addition to our in-depth analysis of important clinical trials presented at the European Society for Medical Oncology (ESMO) Congress 2024, there is always room for more coverage from The ASCO Post, including these brief summaries of other presentations of interest. They focus on a potential...
Researchers have found that combining the immunotherapy drug pembrolizumab with standard chemotherapy may improve treatment outcomes in patients with small cell bladder cancer and small cell/neuroendocrine prostate cancer, according to a recent study published by Gu et al in Cell Reports Medicine....
The addition of the PD-L1 inhibitor durvalumab to standard neoadjuvant gemcitabine/cisplatin chemotherapy has demonstrated statistically significant and clinically meaningful improvements in survival compared with neoadjuvant chemotherapy in cisplatin-eligible patients with muscle-invasive bladder...
As reported in the Journal of Clinical Oncology by Galsky et al, extended follow-up of the phase III CheckMate 274 trial supported the efficacy of adjuvant nivolumab in patients with muscle-invasive urothelial carcinoma at high risk of recurrence after radical resection. Study Details In the...
In a phase I clinical trial (SURF301) investigating the fibroblast growth factor receptor 3 (FGFR3) oral inhibitor TYRA-300 in patients with advanced bladder cancer, the drug showed early antitumor activity and produced lower rates of significant adverse events compared with pan-FGFR inhibitors....
Researchers may have uncovered how urothelial carcinoma originates and progresses, according to a novel study published by Nguyen et al in Nature. The findings provided insights into the biology of urothelial carcinoma and may point to new therapeutic strategies for this difficult-to-treat cancer...
In the phase Ib FORT-2 trial reported in JAMA Oncology, Sweis et al found that the combination of the pan-FGFR inhibitor rogaratinib and atezolizumab was active in cisplatin-ineligible patients with locally advanced or metastatic urothelial cancer overexpressing FGFR mRNA. Study Details The study...
On October 18, Gilead Sciences announced its plans to voluntarily withdraw the U.S. accelerated approval for sacituzumab govitecan-hziy (Trodelvy) for the treatment of adult patients with locally advanced or metastatic urothelial cancer who have previously received a platinum-containing...
As reported in The New England Journal of Medicine by Lerner et al, the phase III SWOG S1011 trial showed no disease-free survival benefit for extended vs standard lymphadenectomy in patients with muscle-invasive bladder cancer undergoing radical cystectomy. Study Details In the trial, 592 patients ...
Treatment with the immunotherapy agent pembrolizumab may nearly double the length that patients with high-risk, muscle-invasive urothelial carcinoma are cancer free following surgical removal of the bladder, according to a recent study published by Apolo et al in The New England Journal of...
Based on the first results of the single-center phase II NURE-Combo trial, which were reported in the Journal of Clinical Oncology (JCO) by Mercinelli et al, the combination of neoadjuvant nivolumab plus nab-paclitaxel followed by postsurgical adjuvant nivolumab appeared to be safe and active in...
Positive results from the phase III NIAGARA trial showed perioperative treatment with the PD-L1 blocker durvalumab in combination with neoadjuvant chemotherapy demonstrated a statistically significant and clinically meaningful improvement in the primary endpoint of event-free survival and the key...
The results of numerous large international studies reported at the European Society for Medical Oncology (ESMO) Congress 2024 showed that immunotherapy improves long-term overall survival in patients with a variety of cancer types, including advanced melanoma,1,2 triple-negative breast cancer,3...
As reported in Journal of Clinical Oncology by Dahl et al, a phase II trial (NRG Oncology/RTOG 0926) has shown good outcomes with bladder-preserving trimodality the�rapy for recurrent high-grade T1 bladder cancer among patients in whom bacillus Calmette-Guérin therapy failed. Study Details In the...
In cohort 2 of the phase II TROPHY-U-01 study, reported in the Journal of Clinical Oncology, Petrylak et al found that sacituzumab govitecan-hziy was active in cisplatin-ineligible patients with locally advanced or metastatic urothelial cancer progressing after immune checkpoint inhibitor (ICI)...
Nivolumab (Opdivo) was approved for use in combination with cisplatin and gemcitabine for first-line treatment of patients with unresectable or metastatic urothelial carcinoma.1 Supporting Efficacy Data Approval was based on the open-label CheckMate 901 trial (ClinicalTrials.gov identifier...
The combination of nivolumab plus gemcitabine/cisplatin chemotherapy achieved high response rates and durable responses and improved overall survival and progression-free survival compared with gemcitabine/cisplatin chemotherapy alone in patients with urothelial carcinoma and clinical evidence of...
The presence of a mutation in any one of three genes known to be involved in DNA damage repair may be associated with complete pathologic response to cisplatin-based neoadjuvant chemotherapy, as measured by pathologic downstaging at the time of cystectomy in patients with muscle-invasive urothelial ...
Agricultural pesticides may carry a similar risk as smoking for some types of cancers, according to a recent study published by Gerken et al in Frontiers in Cancer Control and Society. Background In modern agriculture practices, pesticides are essential to ensure high enough crop yields and food...
As reported in the Journal of Clinical Oncology by Andrea B. Apolo, MD, and colleagues, findings in expansion cohorts of a phase I study showed the activity of cabozantinib/nivolumab alone or with the addition of ipilimumab in patients with advanced/metastatic genitourinary (GU) tumors. Study...
On April 22, 2024, the interleukin-15 receptor agonist nogapendekin alfa inbakicept-pmln was approved for use with bacillus Calmette-Guérin (BCG) for adults with BCG-unresponsive non–muscle-invasive bladder cancer with carcinoma in situ with or without papillary tumors.1 Supporting Efficacy Data...
Jonathan E. Rosenberg, MD, of Memorial Sloan Kettering Cancer Center, and Thomas Powles, MD, PhD, of Barts Cancer Institute and the University of London, discuss phase III findings from two studies: the first, investigating enfortumab vedotin-ejfv and pembrolizumab vs platinum-based chemotherapy in previously untreated patients with locally advanced or metastatic urothelial cancer; and the second, looking at nivolumab plus gemcitabine and cisplatin vs gemcitabine and cisplatin alone in patients with lymph node–only metastatic disease enrolled in the CheckMate 901 trial (Abstracts 4581 and 4565).
Thomas Powles, MD, PhD, of Barts Cancer Institute and the University of London, and Jonathan E. Rosenberg, MD, of Memorial Sloan Kettering Cancer Center, discuss clinical outcomes of sacituzumab govitecan-hziy after prior exposure to enfortumab vedotin-ejfv in patients with metastatic urothelial carcinoma, as well as the safety and efficacy of fam-trastuzumab deruxtecan-nxki in patients with HER2-expressing bladder tumors (Abstracts 4502 and 4509).
As reported in The Lancet Oncology by Andrea Necchi, MD, and colleagues, findings in cohort B of the phase II KEYNOTE-057 study indicated that pembrolizumab was active in patients with bacillus Calmette-Guérin (BCG)-unresponsive, high-risk non–muscle invasive bladder cancer. As noted by the...
In a German-Austrian phase II study (TITAN-TCC) reported in JAMA Oncology, Grimm et al described outcomes with the use of nivolumab plus ipilimumab as an immunotherapeutic boost in metastatic urothelial carcinoma. Study Details In the multicenter trial, 169 patients were enrolled into two cohorts...
The National Comprehensive Cancer Network® published its first set of Clinical Practice Guidelines in Oncology (NCCN Guidelines®) in 1996, covering eight tumor types. Currently, guidelines are available for more than 60 tumor types, subtypes, and related topics. The NCCN’s 29th Annual Conference...
As reported in The New England Journal of Medicine by Thomas Powles, MD, Barts Cancer Institute Biomedical Research Centre, Queen Mary University of London, and colleagues, the phase III EV-302 trial has shown that the combination of the antibody–drug conjugate enfortumab vedotin-ejfv, which is...
In a study reported in the Journal of Clinical Oncology, Klümper et al established a fluorescence in situ hybridization (FISH) assay to measure NECTIN4 copy number variations and found that NECTIN4 amplification was associated with high activity of the anti-NECTIN4 antibody-drug conjugate...
The American Urological Association (AUA), in partnership with ASCO and the Society of Urologic Oncology (SUO), has issued a 2024 clinical practice guideline amendment for the diagnosis and treatment of nonmetastatic muscle-invasive bladder cancer. The updated guidelines were published by...
On April 22, the U.S. Food and Drug Administration (FDA) approved nogapendekin alfa inbakicept-pmln (Anktiva) with bacillus Calmette-Guérin (BCG) for adults with BCG-unresponsive non–muscle invasive bladder cancer with carcinoma in situ with or without papillary tumors. QUILT-3.032 Trial Efficacy...
Researchers have found that a novel urine biomarker test may effectively halve the number of cystoscopies necessary in high-risk patients with bladder cancer, according to recent findings presented by Dreyer et al at the European Association of Urology (EAU) Congress 2024. The research also...