The role of adjuvant therapy in nonmetastatic muscle invasive bladder cancer, and an overview of promising novel therapies in the treatment pipeline.
Leonard G. Gomella, MD: Sam, make a couple of comments about nonmetastatic muscle invasive muscle cancer. As urologists, the go-to is radical cystectomy. We’ll do selective bladder preservation with radiation and chemotherapy traditionally, but what is the urologist view on the immuno-oncology [I/O] agents in bladder preservation?
Sam S. Chang, MD, MBA: As with almost every disease process that we treat—prostate cancer, renal carcinoma, bladder cancer—we need to go beyond just resection and removal. It took us a long time to get on the neoadjuvant chemotherapy train, and we’ve improved with that. But with trials that have shown a benefit to adjuvant therapy, the nivolumab following cystectomy in patients with or without chemotherapy beforehand, clearly, we’ve involved our oncology colleagues in not only a neoadjuvant but also an adjuvant setting. Importantly, there are trials that are open, looking at I/O therapies either by themselves or in combination with chemotherapy, that perhaps would give us benefit in addition to therapy afterward.
There are also combinations of such things as enfortumab [vedotin] and pembrolizumab that are being looking at neoadjuvantly. Then cystectomy and therapy afterward. Unquestionably, radical cystectomy as the single modality and curative—for certain patients that’s still the truth, but the majority of patients will benefit from this combined therapy. This will give me a chance to give a shout out to you, Lenny, because the folks at Thomas Jefferson [University] have laid out an algorithm and a process in terms of setting up a multidisciplinary clinic, which you guys have done for prostate cancer and bladder cancer. It’s served as a model for a lot of academic institutions.
Leonard G. Gomella, MD: Sam, thank you. That makes my day, so thanks for that comment. That comes from a center of excellence for GU [genitourinary] oncology, so thanks.
Transcript edited for clarity.