This is an extraordinary time in urology. After decades of relative stagnation, patients with urothelial carcinoma are receiving approved immuno-oncologic drugs that significantly extend survival and are safer and more tolerable than chemotherapy. The success of these treatments in metastatic bladder cancer has generated strong interest and promising early results for their use in localized disease.
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The Latest Research on Advanced Bladder Cancer
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From the Desk of the Editor
Bladder cancer is common and challenging to treat. A thorough assessment of the molecular biology and immunology background has pinpointed potential biomarkers, “drivers” and promising therapeutic targets. The advent of immune checkpoint inhibitors (ICI) has heralded a new era after approximately two decades of a “stagnant landscape”. As single agents in patients with advanced urothelial carcinoma, ICI can induce rapid and durable responses, with a very small proportion of patients achieving long term remission. However, most patients do not achieve response, while a proportion may have immune-related adverse events. Therefore, there is an urgent need for additional therapies that raise the bar, improve quality of life, and prolong the life of our patients.
Petros Grivas, MD, Ph.D. is an Associate Professor and the Clinical Director of the Genitourinary Cancers Program at the University of Washington, and an Associate Member of the Clinical Research Division at the Fred Hutchinson Cancer Research Center with expertise in genitourinary cancers such as bladder cancer, prostate cancer, and testis cancer.
Dr. Grivas is dedicated to efficient, personalized and outstanding patient care. He believes in an optimal patient-physician relationship and community outreach. Dr. Petros Grivas was recruited from the Cleveland Clinic where he was leading the bladder/urothelial cancer program and was seeing numerous patients with bladder/urothelial cancer, prostate cancer and testis cancer. Prior to Cleveland Clinic, Dr. Grivas was seeing patients with similar diseases at the University of Michigan, Ann Arbor. He played an important role in clinical trials that led to the FDA approval of new drugs for bladder/urothelial cancer, and he is considered a thought leader and international expert, giving lectures in several countries, educating other oncologists and trainees, leading clinical trials and publishing novel and important research.
Everyday Urology - Oncology Insights
Publications focusing on urologic cancer treatments through original manuscripts
Immuno-Oncology: The Urologist's Role
Immuno-oncology for Bladder Cancer
Initial Considerations
From BCG to interferon gene therapy, physicians have treated bladder cancer with immunotherapy for decades. Treatment particulars generally depend on whether bladder cancer is non-muscle invasive, muscle-invasive, or metastatic. About 75% of patients have non-muscle invasive bladder cancer (NMIBC),1 which is considered high-risk if it consists of non-invasive papillary carcinoma (TaHG),
From BCG to interferon gene therapy, physicians have treated bladder cancer with immunotherapy for decades. Treatment particulars generally depend on whether bladder cancer is non-muscle invasive, muscle-invasive, or metastatic. About 75% of patients have non-muscle invasive bladder cancer (NMIBC),1 which is considered high-risk if it consists of non-invasive papillary carcinoma (TaHG),
Library Resources
Evidence based monographs by experts to define and guide clinical practice
Expert Commentary
Evidence based monographs by experts to define and guide clinical practice
Gemcitabine-Eribulin in Cisplatin-Ineligible Patients with Metastatic Urothelial Carcinoma - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
The optimal treatment for cisplatin-ineligible patients with metastatic urothelial cancer is unknown.
Does Pathologic Response to Neoadjuvant Chemotherapy Predict Survival in Muscle-Invasive Bladder Cancer Patients? - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Patients who achieved a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) have a better prognosis compared to patients with pathologic residual disease (pRD).
The Efficacy of Immunotherapy and Carboplatin-Based Chemotherapy in Cisplatin-Ineligible Metastatic Urothelial Cancer Patients - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
The optimal treatment for patients with metastatic urothelial carcinoma (mUC) patients who are unfit to receive the standard cisplatin-based chemotherapy is uncertain.
APOBEC Mutagenesis is Associated with FGFR3 S249C Mutations in Bladder Cancer - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
FGFR3 mutations are common in urothelial carcinoma. The APOBEC mutational process is the dominant mutational mechanism in bladder cancer.
The Impact of Bacillus Calmette-Guérin Shortage on Non-Muscle-Invasive Bladder Cancer Patients - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
A shortage of the Bacillus Calmette-Guérin (BCG) Connaught strain occurred between 2013-2016.
Trends of Perioperative Chemotherapy for Muscle-Invasive Bladder Cancer - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Perioperative chemotherapy is frequently underutilized. Understanding the trends in the utilization of neoadjuvant or adjuvant cisplatin-based chemotherapy in muscle-invasive bladder cancer (MIBC) undergoing cystectomy is critical.
Efficacy and Safety of Neoadjuvant Pembrolizumab in Patients with Muscle-Invasive Bladder Cancer - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Neoadjuvant chemotherapy followed by radical cystectomy (RC) with lymph node dissection is the standard of care in patients with muscle-invasive urothelial bladder carcinoma (MIBC).
Response to Platinum Reintroduction After Immune Checkpoint Inhibitors for Metastatic Urothelial Carcinoma - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Immune checkpoints inhibitors (ICIs) are approved as a second line of treatment for metastatic urothelial carcinoma (mUC) patients with progression on cisplatin-based chemotherapy.
Comparing the Outcomes of ddMVAC vs. GC before Cystectomy in Patients with Muscle Invasive Bladder Cancer - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Patients with muscle-invasive bladder cancer (MIBC) who are treated with neoadjuvant chemotherapy (NAC) before cystectomy have a survival advantage.
The Significance of Persistent Muscle Invasive After Neoadjuvant Chemotherapy - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Downstaging of muscle-invasive bladder cancer (MIBC) following neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) has been correlated with higher survival rates.
Avelumab, an Anti–Programmed Death-Ligand 1 Antibody, In Patients With Refractory Metastatic Urothelial Carcinoma: Results From a Multicenter, Phase Ib Study - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Platinum-resistant urothelial carcinoma is a lethal disease. After a long period of therapeutic stagnation, the last two years have witnessed an explosion in the development of new second-line therapies.
Neoadjuvant Chemotherapy Prior to Radical Cystectomy for Muscle-Invasive Bladder Cancer with Variant Histology - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Neoadjuvant chemotherapy is a standard of care for patients with urothelial muscle-invasive bladder cancer.
Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy in Patients with Locally Advanced Bladder Cancer - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Methotrexate-vinblastine-doxorubicin-cisplatin (MVAC) neoadjuvant chemotherapy is a standard of care for muscle-invasive urothelial bladder cancer.
Do Molecular Subtypes of Muscle-invasive Bladder Cancer Predict Response to Neoadjuvant Chemotherapy? - Expert Commentary
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Neoadjuvant chemotherapy is a standard of care for muscle-invasive bladder cancer (MIBC).
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