Bladder Cancer

A computerized artificial intelligence (AI)-based decision support system (CDSS-T) enhanced the performance of clinicians when assessing patients’ response to chemotherapy prior to radical cystectomy.

“This study really shows the power of the area deprivation index in predicting postoperative and oncologic outcomes for bladder cancer patients undergoing radical cystectomy,” said Byron H. Lee, MD, PhD, Cleveland Clinic urologist and senior author of the study.

The approval was based on data from the phase 3 EV-301 trial, in which enfortumab vedotin reduced the risk of death by 30% versus chemotherapy in patients with heavily pretreated locally advanced or metastatic urothelial carcinoma.

Early findings from the phase 2 CORE1 trial showed that the combination of the novel oncolytic immunotherapy CG0070 and the immune checkpoint inhibitor pembrolizumab was safe and active in patients with BGG-unresponsive NMIBC.

Patients achieving RC-pentafecta had less blood loss, shorter hospital stays, and lower perioperative mortality.

The approval was based on results from the randomized, double-blind phase 3 CheckMate-274 trial.

The phase 1/2 study is exploring the anti–CTLA-4 immunotherapy zalifrelimab (UGN-301) in patients with recurrent non–muscle-invasive bladder cancer.

In discussing treatment determinations, Petrylak noted that for patients with low PD-L1 expression had decreased survival benefits compared with patients treated with chemotherapy in the monotherapy arms of the phase 3 KEYNOTE-361 (NCT02853305) and phase 3 IMVIGOR-130 (NCT02807636) trials.

“There are many trials that clinicians should be aware of,” says Daniel P. Petrylak, MD.

At the 2022 NY GU Cancers Symposium, Jean Hoffman-Censits, MD, discussed the latest developments in the neoadjuvant and adjuvant setting for patients with bladder cancer.

“One of the reasons I so enjoy this conference is the multidisciplinary nature,” says Peter A. Humphrey, MD, PhD.

In this installment of Urology Times' 50th Anniversary Innovation Celebration, Sam S. Chang, MD, MBA, discusses the critical role that BCG has played in managing bladder cancer, and how the BCG shortage continues to evolve.

The BLASST-1 study presented at the 2022 ASCO Genitourinary Cancers Symposium assessed the safety and efficacy of neoadjuvant nivolumab in combination with gemcitabine/cisplatin in patients with muscle-invasive bladder cancer .

"It is clearly the standard and it's the treatment of choice. When you have that, and it's very good, it's evidenced by the fact that none of the agents are compared against BCG because it sets such a high standard of effectiveness," says Sam S. Chang, MD, MBA.

Min Dong, PhD, discusses the main points of the presentation he gave at the 2022 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, along with the potential impact of onabotulinumtoxinA (Botox) therapies on future urologic treatment.

“The fascinating thing is that we have so many new treatments that are now available to us,” says Leonard G. Gomella, MD, FACS.

“I think the audience would be encouraged to know that in the future, it seems like immunotherapy would become the standard of care,” says Shilpa Gupta, MD.

In this interview, senior author and scientific principal investigator Seth P. Lerner, MD, discusses the results of the OLYMPUS trial and what they mean for the management of this disease

"The future is bright for immunotherapy in bladder cancer," writes Michael S. Cookson, MD, MMHC.

“The complete response rates were 49%, which is quite impressive compared to historical controls,” says Shilpa Gupta, MD.

“Multidisciplinary discussion is best,” says Shawn Dason, MD, FRCSC.

In this interview, Kenneth M. Kernen, MD, describes his practice’s Jelmyto program and offers advice for urologists interested in implementing it in their practice.

The application for enfortumab vedotin is based on data from the phase 3 EV-301 trial.

The recommendation for EU approval was based on results from the CheckMate -274 trial.

The addition of lenvatinib to pembrolizumab did not improve overall survival in patients with advanced urothelial carcinoma.

“I think research is a very important tool,” says Padraic O’Malley, MD, MSc, FRCSC.

Shawn Dason, MD, discusses the findings and takeaways of the study, "How often does cisplatin ineligibility prevent patients from receiving adjuvant therapy following radical nephroureterectomy for upper tract urothelial carcinoma?"

“While Jelmyto is approved for both retrograde and antegrade instillation, the instructions for administration address retrograde instillation, and this is the first time that data on antegrade instillation has been documented in a clinical setting for this chemoablative therapy,” said Katie Murray, DO.

“We definitely don't have a clear standard,” says Shawn Dason, MD, FRCSC.

“These findings are an internal validation that the disparities we're seeing are real,” says Padraic O’Malley, MD, MSc, FRCSC.