Roger Li, MD, addresses the open questions surrounding adjuvant therapy after cystectomy, the urologist's role in recognizing treatment-related toxicities, and why multidisciplinary referral is the change most likely to deliver the full benefit of perioperative therapy.
Roger Li, MD, explains why patients with MIBC fall away between TURBT and a medical oncology visit, how strong urologist–oncologist relationships speed the start of neoadjuvant therapy, and how newer non-cisplatin regimens are changing referral patterns and surgical timing.
Roger Li, MD, reviews how the NIAGARA, KEYNOTE-905, KEYNOTE-B15, and VOLGA trials are moving perioperative care for muscle-invasive bladder cancer beyond cisplatin-based chemotherapy and why the data should change which patients urologists refer for neoadjuvant therapy.
New FDA-approved perioperative options reshape bladder cancer care; learn how teams coordinate referrals, biomarkers, and bladder-sparing follow-up.
New perioperative bladder cancer options reshape referrals and biomarker-driven planning, helping more patients get safer, personalized care.
Experts debate bladder MRI limits after TUR/chemo and how ctDNA/utDNA may refine staging and bladder-sparing decisions in muscle-invasive disease.
Experts debate bladder MRI limits after TUR/chemo and weigh ctDNA/utDNA promise, yet accuracy gaps keep bladder-sparing decisions cautious.
ctDNA and urine DNA reshape bladder cancer care, guiding surgery timing and adjuvant therapy—yet key questions await clearer trials.
EV+pembrolizumab drives deep nodal responses in bladder cancer, shifting decisions on cystectomy and retroperitoneal node dissection.
See how cystectomy after immunotherapy looks surprisingly routine, with insights on pelvic node dissection and post-op treatment decisions.
Watch surgeons review cystectomy after immunotherapy—tissue planes stay familiar, lymph node dissection matters, and adjuvant choices remain unclear.
EV-pembro and immunotherapy may shorten time to cystectomy, with fewer chemo-era blood issues but new immune toxicities to manage.
New bladder cancer trials test perioperative immunotherapy combos, weighing added enfortumab vedotin vs adjuvant de-escalation to boost durable cures.
EV/pembrolizumab in EV-304 delivers strong pathologic response, event-free and overall survival gains versus standard chemo, reshaping neoadjuvant bladder cancer choices.
This episode, titled “Comparing Perioperative Strategies in Cisplatin-Eligible MIBC,” features panelists discussing how the KEYNOTE-B15/EV-304 trial is reshaping perioperative treatment considerations for patients with muscle-invasive bladder cancer (MIBC). The expert faculty review the study design evaluating perioperative enfortumab vedotin plus pembrolizumab (EVP) compared with standard neoadjuvant gemcitabine-cisplatin (Gem-CIS), and discuss how these findings may influence treatment selection in cisplatin-eligible patients.
In “Perioperative Therapy Expansion in Cisplatin-Ineligible MIBC,” our panel explores how the treatment paradigm for muscle-invasive bladder cancer (MIBC) is rapidly evolving with the emergence of effective perioperative therapies for cisplatin-ineligible patients. The expert faculty discuss how traditional approaches that relied heavily on determining cisplatin eligibility are changing in light of recent clinical trial data supporting enfortumab vedotin plus pembrolizumab (EVP) in patients who historically would have proceeded directly to surgery.
In this episode, “The Emerging Perioperative Era in MIBC with the NIAGARA Trial,” the expert faculty explore how the NIAGARA trial is reshaping the treatment landscape for muscle-invasive bladder cancer (MIBC). The panel reviews the clinical data supporting perioperative durvalumab plus gemcitabine-cisplatin (GC) in cisplatin-eligible patients, including findings related to pathologic complete response, event-free survival, overall survival, and safety, and discusses how these outcomes are influencing treatment strategies in clinical practice.
Welcome back to another Urology Times Peer Exchange series. In this episode titled, “The Evolving Treatment Landscape in MIBC,” the expert faculty discuss how the treatment landscape for muscle-invasive bladder cancer (MIBC) is evolving with the emergence of perioperative treatment strategies that integrate systemic therapy before and after surgery.
Roger Li, MD, discusses the development and validation of a CHAI-based biomarker to identify patients with LG NMIBC who are at higher risk of progression.
In this final episode, panelists conclude with reflections on the significant progress made in treating NMIBC over the past decade, particularly in the last 5 years. Looking ahead to 2024, experts in urology express excitement about investigational treatments (ie, cretostimogene grenadenorepvec and UGN 102), the potential for personalized medicine, emphasizing the need to understand molecular characteristics of the disease for better treatment customization. The session also highlights the importance of balancing quality of life with effective treatment strategies, and the prospect of utilizing emerging therapies early in the disease process.
This video segment explores various investigational strategies, including the use of agents like UGN 102, and recent clinical trials for intermediate-risk NMIBC. The conversation highlights the importance of balancing side effects with efficacy and the shift towards non-surgical management in treating intermediate-risk NMIBC and in the BCG-naive population.
This video episode discusses various new therapies and strategies for treating patients with high-risk BCG-unresponsive NMIBC. It includes a review of nadofaragene firadenovec-vncg, its FDA approval, dosing schedule, and patient response rates. The conversation also explores the practical aspects of treatment, such as the balance between efficacy and treatment frequency, and the potential sequencing of therapies in clinical practice.
This video segment provides insights into various innovative trials and agents being explored for high-risk BCG-unresponsive NMIBC. The discussion covers a range of approaches including oncolytic immunotherapy, gene therapy, systemic IO agents, antibody-drug conjugates, and cytokine therapies. It emphasizes the need for personalized dosing regimens based on individual immune responses and highlights the significance of longer-term efficacy evaluations beyond initial three-month response rates.
This episode provides an in-depth discussion on Cretostimogene Grenadenorepvec (CG), an investigational agent for high-risk BCG-unresponsive NMIBC, including the mechanism of action, its efficacy and safety data from clinical trial trials like CORE01 and BOND-003 (NCT04452591), and the rationale behind combining CG with anti-PD-1/PD-L1 antibodies. Experts also provide their insights on future directions in clinical development and application of CG in various NMIBC treatment scenarios, such as a monotherapy and in combination with IO, including its potential use in intermediate-risk disease.
This episode explores the potential of emerging therapies in providing effective treatment alternatives for challenging NMIBC cases. Current clinical trials and investigational treatments for high-risk, BCG-unresponsive NMIBC are highlighted, including the use of N-803, an IL-15 superagonist, in combination with BCG, and discusses TAR-200, an intravesical drug delivery system, which releases gemcitabine directly into the bladder over time.
Sam S. Chang MD, MBA leads a discussion of various treatment approaches for a hypothetical case of a 74-year-old female patient with T1 bladder cancer and associated CIS, exploring the necessity of repeat resections. The conversation emphasizes the importance of personalized treatment plans, considering BCG therapy, clinical trials involving immunotherapy, and the possibility of cystectomy, while also addressing the complexities and risks associated with high-grade bladder cancer in elderly patients.
This episode focuses on the complex management of recurrent low-grade bladder tumors and highlights the limitations and challenges of current treatments, including intravesical chemotherapy and BCG, and underscores the need for better therapies and clinical trials in this area.
The various treatment approaches for NMIBC in the context of a BCG shortage, with a focus on initial cases, are shared. Urologists discuss their strategies for treating a hypothetical patient with a 3 cm bladder tumor, weighing options like perioperative chemotherapy, the importance of thorough resection, and adapting treatment protocols based on tumor characteristics and the ongoing BCG shortage.
The impact of the BCG shortage on the treatment of bladder cancer, exploring various strategies adopted by urologists to optimize patient care. The conversation highlights the importance of risk stratification in deciding treatment protocols, considering factors like tumor size, location, multifocality, and histology, as well as patient age and overall health.
Experts discuss grading, staging, and risk stratification of Non-Muscle Invasive Bladder Cancer (NMIBC). Panelists highlight differentiation between the risks of recurrence and progression, emphasizing the importance of categorizing patients into low, intermediate, and high-risk groups based on various factors, including tumor size, grade, and history of recurrence. The importance of continuous prospective observation of patients with NMIBC is emphasized.
December 19th 2023
