Vanderbilt University Medical Center | Strategic Alliance Partners

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.

"There's just a tremendous opportunity for telehealth and being able to increase delivery to patients in these areas or at least reduce their amount of travel time to get to see a urologist based on where they live," says Kara L. Watts, MD.

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.

Amy Luckenbaugh, MD, is an assistant professor of Urology at Vanderbilt University Medical Center.

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.

Experts in urology discuss the importance of evaluation to accurately identify the stage and grade of NMIBC, which plays a crucial role in determining the risk category focusing on the distinction between low and high-grade tumors and the significance for each patient with NMIBC​​.

“When it comes to this, I think having a great team around you is really so important,” says Bree Duncan, RN, BSN.

“I think being younger and going through something so scary, I think it's been really important to her to have someone with her throughout the whole process,” says Bree Duncan, RN, BSN.

“We found that these genetic proxies of thiazide diuretics were associated with a 15% lower risk of kidney stones,” says Jefferson Triozzi, MD.

"There are a lot of questions and issues regarding [topics] like body image and sexual function, and things like that, that also, being a woman in this role, I feel like they feel comfortable asking me those questions," says Bree Duncan, RN, BSN.

"My goal is to always meet them there in clinic, and then just start that relationship, in a sense of, I'm there for whatever they need," says Bree Duncan, RN, BSN.

The phase 2a open-label dose ascending study to assess the safety, tolerability, and efficacy of VMB-100 in female patients with moderate SUI is expected to begin in the first half of 2024.

"We as a specialty have to do a better job of educating our colleagues and referring docs," says Roger R. Dmochowski, MD, MMHC, FACS

W. Kimryn Rathmell, MD, PhD, an internationally recognized expert in kidney cancer, is Chair of the Department of Medicine and Physician-in-Chief at Vanderbilt University Medical Center.

“How we set up patients for success comes not just in our individual clinical encounters, but also how we approach patient care as an organization,” says Niels V. Johnsen, MD, MPH.

"The background for this paper stems from the increasingly identified need to do a better job of management of urinary tract infection, not only from a recognition standpoint, but also from a diagnostic and treatment standpoint," says Roger R. Dmochowski, MD, MMHC, FACS.

“I think the key to remember for a lot of what we're doing is that kidney stone disease is complicated. It's a really heterogenous patient population,” says Nicholas L. Kavoussi, MD.

"The ABU continues to reevaluate all policies related to diplomates. As medical practice continues to evolve in United States, and these changes affect the practitioners of medicine, likely further changes will be necessary in board certification procedures," writes Roger Dmochowski, MD, MA (Conflict Management and Resolution), MMHC, FACS.

A multidisciplinary team at the Vanderbilt Institute for Surgery and Engineering is collaborating on a 3D navigational system to help limit kidney stone fragments that remain after surgery.

The study assessed 120 women with overactive bladder for associations between anxiety and somatic symptoms, quality of life, quantitative sensory testing measures, and psychological stress symptoms.

Active surveillance is the preferred treatment option for men with low-risk prostate cancer and an option for some men with favorable intermediate-risk prostate cancer.