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Written by Zachary Klaassen, MD, MSc Associate Professor of Urology Urologic Oncologist Medical College of Georgia, Georgia Cancer Center Augusta, GA and Rashid Sayyid, MD, MSc Urologic Oncology Fellow University of Toronto Toronto, Ontario, Canada
March 13, 2024

Introduction

Metastatic urothelial carcinoma is associated with a poor prognosis, with an estimated 17,000 deaths annually in the United States from this disease.1 Platinum-based chemotherapy had long been considered the standard of care first line treatment for platinum-eligible patients with metastatic urothelial carcinoma.
Written by Zachary Klaassen, MD, MSc Associate Professor of Urology Urologic Oncologist Medical College of Georgia, Georgia Cancer Center Augusta, GA and Rashid Sayyid, MD, MSc Urologic Oncology Fellow University of Toronto Toronto, Ontario, Canada
September 14, 2023
For patients with metastatic urothelial carcinoma, first line therapy for cisplatin eligible patients remains platinum-based chemotherapy1 (followed by maintenance avelumab2), whereas those that are cisplatin ineligible may receive gemcitabine + carboplatin3 (followed by maintenance avelumab2)
Written by Zachary Klaassen, MD, MSc Associate Professor of Urology Urologic Oncologist Medical College of Georgia, Georgia Cancer Center Augusta, GA and Rashid Sayyid, MD, MSc Urologic Oncology Fellow University of Toronto Toronto, Ontario, Canada
August 29, 2023
Metastatic urothelial carcinoma is associated with a poor prognosis, with a median overall survival of less than two years. To date, combination platinum-based chemotherapy remains the standard of care first line treatment for these patients who are suitable for chemotherapy.
Written by Rashid K. Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
March 21, 2023
Neoadjuvant cisplatin-based chemotherapy combinations have demonstrated five-year overall survival benefits of around 5%5 and pathologic complete responses rates of 36 to 42% with contemporary chemotherapy regimens.6
Written by Rashid K. Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
March 21, 2023
Early treatment intensification with neoadjuvant cisplatin-based chemotherapy has long been advocated as means to improve survival outcomes in patients with clinically localized, muscle invasive disease undergoing definitive local therapy.
Written by Rashid K. Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
March 20, 2023
While neoadjuvant cisplatin-based chemotherapy combinations have demonstrated five-year overall survival benefits of at least 5%,5 a significant proportion of patients remain “cisplatin ineligible”, defined by at least one of the following criteria.
Written by Rashid K. Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
March 20, 2023
While the majority of patients are diagnosed with non-muscle invasive disease (i.e. carcinoma in situ, Ta, and T1), approximately 25 to 33% of patients are initially diagnosed with muscle invasive bladder cancer and a meaningful proportion of patients initially diagnosed with non-muscle invasive disease will subsequently progress to MIBC.1
Written by Janet Baack Kukreja, MD, MPH and Ashish Kamat, MD, MBBS
April 16, 2019
Bladder cancer was one of the top five leading causes of cancer death in 2015.1 Most of these cases are of urothelial histologic origin. For about 35% of patients, bladder cancer is either muscle-invasive or metastatic at disease presentation.
April 16, 2019
BALVERSA is a kinase inhibitor indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma that has 

  • susceptible FGFR3 or FGFR2 genetic alterations and
  • progressed during or following at least one line of prior platinum-containing chemotherapy including within 12 months of neoadjuvant 
Physician-Scientist Commentaries
Peer-reviewed Abstract Supplemental Commentaries
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
Neoadjuvant chemotherapy followed by radical cystectomy (RC) is a standard of care for patients with muscle-invasive bladder cancer (MIBC). Adjuvant treatment is recommended for patients with a high-risk of relapse. Biomarkers like circulating tumor DNA (ctDNA) could potentially predict relapse and guide adjuvant therapy.
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
The standard treatment for muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC) with neoadjuvant chemotherapy (NAC). Although NAC is associated with a 5-10% increase in overall survival (OS) compared to RC alone, it is underutilized. The European Association of Urology recommends RC
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
The standard treatment for metastatic urothelial carcinoma (mUC) is platinum-based chemotherapy followed by immunotherapy. Recently, two antibody-drug conjugates (ADCs), enfortumab vedotin (EV) and sacituzumab govitecan (SG) have been approved for mUC.
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
The presence of circulating tumor DNA (ctDNA) in patients with muscle-invasive bladder cancer (MIBC) is indicative of relapse and worsening prognosis. Due to the practical barriers to sequencing tumor samples for ctDNA measurement, medical researchers have focused efforts on developing alternative assays.
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
Patients with advanced urothelial carcinoma (aUC) treated with immune checkpoint inhibitors have exhibited low objective response rates (ORR) of 20-30%. ORR can reach around 40% among patients with FGFR2/3 alterations who receive FGFR inhibitors. Two antibody-drug conjugates (ADCs), sacituzumab govitecan (SG) and enfortumab vedotin (EV) were recently approved for refractory aUC.
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
Platinum-based chemotherapy is the standard of care for first-line treatment in patients with advanced urothelial carcinoma. Switch maintenance therapy with a drug with a different mode of action and better tolerability can enhance the clinical benefit of first-line chemotherapy. This was confirmed in the phase 3 JAVELIN Bladder 100 trial, in which improved survival was observed in patients with advanced urothelial carcinoma
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
Patients with advanced urothelial carcinoma still have low 5-year survival rates. Most patients experience disease progression after treatment with chemotherapy or PD-1 inhibitors. Enfortumab vedotin is an antibody-drug conjugate that targets Nectin-4, a protein highly expressed in UC. A recent study by Rosenberg et al. reports long-term outcomes from EV-301, an open-label phase III trial for EV versus chemotherapy in previously treated patients with advanced UC.
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
The standard of care for muscle-invasive bladder cancer (MIBC) is cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy. Studies have documented the clinical benefit of dose-dense methotrexate-vinblastine-adriamycin-cisplatin (ddMVAC) or gemcitabine plus cisplatin (GC). The COXEN approach was developed to use gene expression 
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
The standard of care first-line treatment for advanced urothelial carcinoma is platinum-based chemotherapy, followed by avelumab (anti-PD-L1), for maintenance treatment in patients without progression. The JAVELIN trial confirmed that maintenance avelumab was associated with significantly prolonged overall survival and progression-free survival. 
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
Radical surgery and neoadjuvant or adjuvant chemotherapy are potentially curative for patients with muscle-invasive bladder cancer and upper tract urothelial carcinoma. Roupret et al. conducted the retrospective MINOTAUR study to analyze real-world data on the epidemiology, management, and survival of patients with muscle-invasive urothelial carcinomas
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
While immune checkpoint inhibitors (ICI) have revolutionized treatment for bladder cancer patients, studies have shown that not all patients achieve a response. To identify potential genetic predictors of ICI treatment response, Sarfaty et al. investigated the link between specific subtypes based on genomic alterations in ICI-treated patients with advanced urothelial carcinoma and survival outcomes.
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
The choice of first-line treatment is particularly crucial for patients with advanced or metastatic urothelial carcinoma (AMUC), as only 15-20% of patients receive second-line treatment due to poor survival. Mori et al. recently re-evaluated the efficacy of carboplatin as a first-line treatment in patients with AMUC by conducting a meta-analysis.
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
Up to a third of patients with muscle-invasive bladder cancer present with clinically lymph node-positive disease, associated with poor prognosis. Eligible patients can be treated with cisplatin-based induction chemotherapy followed by radical cystectomy if they exhibit a clinical response.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
The introduction of immune checkpoint inhibitors (ICIs) has improved the outcomes for a subset of metastatic urothelial carcinoma (mUCC) patients. There is a need for a predictive tool to identify
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Nivolumab is an FDA-approved immune checkpoint for treating platinum-resistant metastatic or surgically unresectable urothelial carcinoma (mUC). The development of predictive biomarkers
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
A significant number of patients with locally advanced and metastatic urothelial cancer (aUC) are not eligible for cisplatin-based chemotherapy.
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.
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).
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.
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.
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. 
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.
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).
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.
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.
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.  
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.
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.
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.
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).
Conference Coverage
Conference Highlights Written by Physician-Scientist
Presented by Jens Bedke, MD
The 2024 ASCO annual meeting was host to a presentation by Dr. Jens Bedke who presented their poster titled: Enfortumab vedotin (EV) with pembrolizumab (P) versus chemotherapy in previously untreated locally advanced or metastatic urothelial carcinoma (la/mUC): Analysis of cisplatin (cis)-eligible population from EV-302/KEYNOTE-A39.
Presented by Michiel Simon Van Der Heijden, MD, PhD
 The 2024 ASCO annual meeting was host to a presentation by Dr. Michiel Simon Van Der Heijden presenting a secondary analysis of the cisplatin (cis)-ineligible population from EV-302/KEYNOTE-A39 comparing Enfortumab vedotin (EV) with pembrolizumab (P) versus chemotherapy in previously untreated locally advanced or metastatic urothelial carcinoma (la/mUC).
Presented by Peter H. O'Donnell, MD
The 2024 ASCO annual meeting was host to a presentation by Dr. Peter H. O'Donnell, who presented the study EV-103: Neoadjuvant treatment with enfortumab vedotin monotherapy in cisplatin-ineligible patients with muscle invasive bladder cancer (MIBC)—2-year event-free survival and safety data for Cohort H.
Presented by Bassel Nazha, MD, MPH
The 2024 ASCO Annual Meeting was host to a kidney and bladder cancers trials-in-progress poster session. Dr. Bassel Nazha presented an ongoing phase II study evaluating the combination of enfortumab vedotin plus pembrolizumab for the treatment of locally advanced or metastatic bladder cancer of variant histology.
Presented by Hayato Yamamoto MD
The 2024 AUA annual meeting was host to a presentation by Dr. Hayato Yamamoto who presented the results of a retrospective multicenter study exploring the association between cutaneous reactions related to treatment with Enfortumab Vedotin and its relationship with serum albumin levels in patients with advanced urothelial carcinoma.
Presented by Rikiya Taoka, MD, PhD
The 2024 AUA annual meeting was host to a presentation by Dr. Rikiya Taoka, who presented the results of a Prospective Multicenter Cohort Study assessing peripheral neuropathy and nerve electrophysiological changes in patients with advanced urothelial carcinoma treated with Enfortumab Vedotin.
Presented by Thomas Büettner, MD
The 2024 EAU annual meeting hosted a presentation by Dr. Thomas Büttner discussing membranous NECTIN-4 expression in metastasis compared to the primary tumor and the outcome of enfortumab vedotin response.
Presented by Michiel Simon van der Heijden, MD, PhD
Dr. Michiel van der Heijden presented subgroup analyses from EV-302, a phase 3 global trial of enfortumab vedotin in combination with pembrolizumab versus chemotherapy in previously untreated locally advanced metastatic urothelial carcinoma.
Presented by Cindy Y. Jiang, MD
The 2024 ASCO GU cancers symposium was host to a presentation by Dr. Cindy Jiang who presented an analysis of the UNITE database evaluating the sequencing of erdafitinib and enfortumab vedotin in patients with fibroblast growth factor receptor (FGFR2/3) altered advanced urothelial cancer.
Presented by Jacqueline T. Brown, MD
The 2024 ASCO GU cancers symposium was host to a presentation by Dr. Jacqueline Brown who presented an interim analysis of a phase I/Ib study of enfortumab vedotin plus cabozantinib in patients with metastatic urothelial carcinoma.
Presented by Stefanie Zschaebitz, MD
 The 2024 ASCO GU cancers symposium was host to a presentation by Dr. Stefanie Zschaebitz who presented the results of a European real-world analysis of the safety and efficacy of enfortumab vedotin (EV) in patients with metastatic/locally advanced urothelial cancer.
Presented by Amanda Nizam, MD
The 2024 GU ASCO annual meeting featured a presentation by Dr. Amanda Nizam discussing outcomes in patients with advanced urothelial carcinoma treated with enfortumab vedotin after switch maintenance avelumab in the UNITE study.
Presented by Umang Swami, MD, MS
The 2024 ASCO GU cancers symposium was host to a presentation by Dr. Umang Swami who presented the stage 1 results of a phase 2 trial evaluating enfortumab vedotin as monotherapy in patients with metastatic castration-resistant prostate cancer (mCRPC).
Presented by Thomas Powles, MD, MBBS, MRCP
Dr. Thomas Powles presented the late-breaking abstract results of EV-302/KEYNOTE-A39, an open label, randomized phase III study of enfortumab vedotin plus pembrolizumab versus chemotherapy in patients with previously untreated locally advanced and/or metastatic urothelial carcinoma.
Presented by Nicolas Sayegh, MD
Dr. Nicholas Sayegh presented the results of a real-world effectiveness study of single agent enfortumab vedotin (EV) in patients with locally advanced or metastatic urothelial carcinoma based on the line of therapy and impact of prior platinum-based chemotherapy and PD-1/PD-L1 inhibitors.
Presented by Elizabeth R. Plimack, MD, MS
The 2023 ESMO Annual Congress held in Madrid, Spain between October 20th and 24th, 2023 was host to a bladder preservation strategies oral session. Dr. Elizabeth Plimack discussed the role of systemic therapy in bladder preservation for patients with muscle-invasive bladder cancer (MIBC).
Presented by Arlene O. Siefker-Radtke, MD
The 2023 ESMO annual meeting included a session on urothelial carcinoma, featuring a presentation by Dr. Arlene Siefker-Radtke discussing results of the THOR study, a phase 3 trial of erdafitinib versus pembrolizumab in pretreated patients with advanced or metastatic urothelial cancer with select fibroblast growth factor receptor (FGFR) alterations. 
Presented by Thomas W. Flaig, MD
The 2023 American Society of Clinical Oncology (ASCO) annual meeting included a bladder cancer session, featuring a presentation by Dr. Thomas Flaig discussing updated results for Cohort H of the EV-103 trial assessing neoadjuvant treatment with enfortumab vedotin monotherapy in cisplatin-ineligible patients with muscle-invasive bladder cancer (MIBC).
Presented by Srikala Sridhar, MD, MSc, FRCSC
In this presentation, Dr. Srikala Sridhar gave a talk on the role of neoadjuvant immunotherapy (IO) for muscle-invasive bladder cancer (MIBC). As she notes off the bat, MIBC is a highly aggressive systemic disease with poor long-term outcomes. Neoadjuvant cisplatin-based chemotherapy (NAC) remains the standard of care
Presented by Christian Schulz-Quach, MD MSc MA FHEA MRCPsych
The 2023 EAU annual meeting included a session on the misconception of informed consent in locally advanced bladder cancer, featuring a presentation by Dr. Christian Schulz-Quach discussing psycho-oncological counselling in the context of locally advanced bladder cancer.
Presented by Iver Nordentoft, MSc, PhD,
In this study presented by Dr. Nordentoft, a whole-genome sequencing (WGS) approach to circulating tumor DNA (ctDNA) was applied for sensitive monitoring of Minimal Residual Disease (MRD).
Presented by Rana McKay, MD
(UroToday.com) The 2022 ESMO annual meeting featured a urothelial carcinoma session, including a discussant presentation by Dr. Rana McKay discussing biomarkers for advanced urothelial carcinoma. Dr. McKay discussed two abstracts including “Genomic biomarkers in peripheral blood from patients enrolled in the JAVELIN Bladder 100 trial of avelumab first-line maintenance in advanced urothelial carcinoma.
Presented by Jonathan E. Rosenberg, MD
Dr. Jonathan E. Rosenberg presented long-term outcomes of enfortumab vedotin (EV) in patients with previously treated advanced urothelial carcinoma (UC) in the EV-301 trial.
At the 2022 ASCO annual meeting, the poster discussion session that focused on Kidney and Bladder cancers included a presentation from Dr. Richard Cathomas discussing the role of peri-operative chemoimmunotherapy for patients undergoing radical cystectomy for muscle invasive urothelial carcinoma based on the SAKK 06/17 trial.
Presented by Joaquim Bellmunt, MD, PhD
At the 2022 American Society of Clinical Oncology Annual Meeting, Dr. Joaquim Bellmunt presented long-term outcomes from the JAVELIN Bladder 100 trial among patients receiving first-line avelumab maintenance therapy, with a specific focus on the use of subsequent second-line therapy.
Presented by Sumanta K. Pal, MD
In this presentation, Dr. Pal presented results from cohorts 3, 4 and 5 of COSMIC-021. In these cohorts, patients with locally advanced or metastatic transitional cell urothelial carcinoma who were ineligible for surgery were treated with cabozantinib and atezolizumab.
Presented by Sumanta K. Pal, MD
The 2022 ASCO annual meeting featured an oral abstract session on kidney and bladder cancer, including a presentation by Dr. Monty Pal discussing results of cohorts 3, 4, and 5 in the COSMIC-021 study assessing cabozantinib + atezolizumab in urothelial carcinoma. Cabozantinib, a multi-targeted receptor tyrosine kinase inhibitor (TKI), promotes an immune-permissive environment that may enhance response to immune checkpoint inhibitors.
Presented by Sandy Srinivas, MD
(UroToday.com) In an oral abstract presentation on the first day of the American Society for Clinical Oncology (ASCO) Genitourinary Cancer Symposium 2022Dr. Heath provided a discussion following presentations from Dr. Crabb and Dr. Rosenberg on the ATLANTIS and BAYOU trials, respectively.
Presented by Michiel Simon Van Der Heijden MD, PhD
On the second day of the American Society for Clinical Oncology (ASCO) Genitourinary Cancer Symposium 2022 focused on urothelial carcinoma during the Trials in Progress Poster Session B, Dr. Van Der Heijden presented the rationale and design of EV-302 assessing enfortumab vedotin (EV) with pembrolizumab compared to chemotherapy as first-line treatment in advanced urothelial carcinoma (aUC).
Presented by Jonathan E. Rosenberg, MD

In an oral abstract presentation on the second day of the American Society for Clinical Oncology (ASCO) Genitourinary Cancer Symposium 2022 Dr. Rosenberg presented results of BAYOU, examining durvalumab and olaparib as first-line therapy in platinum-ineligible patients with unresectable stage IV urothelial carcinoma.

 

Presented by Simon J. Crabb, PhD, MBBS
Dr. Crabb presented results of the rucaparib arm of the ATLANTIS trial among patients with metastatic urothelial carcinoma (mUC). The authors postulated that switch maintenance with the poly(ADP-ribose) polymerase (PARP) inhibitor rucaparib would improve outcomes for patients who had derived benefit from PBC.
Presented by Francesca Vignani, MD
Dr. Vignani presented results of the Meet-URO12 trial examining niraparib as maintenance therapy in advanced urothelial carcinoma. The authors hypothesized that maintenance treatment with niraparib would improve outcomes among patients who have objective response or stable disease to first line chemotherapy.
Presented by Matt D. Galsky MD, FASCO
Dr. Galsky presented an analysis of the CheckMate274 trial of adjuvant nivolumab in urothelial carcinoma. To better understand the relationship between PD-L1 expression and the efficacy of nivolumab in this space, the authors undertook an analysis of DFS based on PD-L1 expression in both tumor and immune cells using the combined positive score.
Presented by Matt D. Galsky, FASCO, MD
Dr. Galsky and colleagues presented results of the DS8201-A-U105 trial of trastuzumab deruxtecan (T-DXd) with nivolumab in patients with HER2-expressing urothelial carcinoma (UC). The authors performed a phase 1b, 2-part, open-label, multicenter study of T-DXd in combination with nivo in pts with HER2-expressing advanced/metastatic UC.
Presented by Petros Grivas MD, PhD
Dr. Grivas presented a poster examining the effect of PD-L1 expression, as determined by immunohistochemistry (IHC), on genomic alteration profiles in patients with urothelial bladder carcinoma (UBC).
Presented by Alejandro Berlin, MD MSc
In the Latin America ASTRO session of the American Society for Radiation Oncology (ASTRO) Annual Congress, Dr. Berlin presented on controversies in the management of patients with Muscle-invasive bladder cancer (MIBC).
Presented by Ronald de Wit, MD, Ph.D.
As a portion of the ESMO Annual Congress, an Educational Session focused on improving outcomes in bladder cancer was held. In this context, Dr. de Wit discussed new developments in muscle-invasive disease.Dr. de Wit began by highlighting the role of chemotherapy as it evolved through the 1980s and 1990s, utilizing a cisplatin backbone in various combinations.
Presented by Cora Sternberg, MD, FACP
In this rapid review for the American Urologic Association (AUA) plenary session, Dr. Cora Sternberg summarized the current status of first and second-line therapy for advanced and metastatic urothelial cancer – while also touching on changes that are upcoming.
Presented by Thomas Powles, MD, MBBS, MRCP
In this presentation during the thematic session at the 2021 European Association of Urology (EAU) annual meeting, focusing on immunotherapy in urothelial cancer, Dr. Thomas Powles reviews predictive markers for response in urothelial cancer. 
Presented by Nick Beije, MD, Ph.D and Morgan Roupret, MD, Ph.D
Dr. Nick Beije of Rotterdam, presented the final results of the CirGuidance Study, which focused on the use of the circulating tumor cells (CTCs) to drive neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC). This was followed by a discussion and summary from Dr. Morgan Roupret.
Presented by  Shilpa Gupta, MD
Previous studies have suggested that gemcitabine-cisplatin + drug X is not better than gemcitabine-cisplatin alone in phase 3 trials to date. This includes the EORTC 30987 trial assessing gemcitabine-cisplatin + paclitaxel versus gemcitabine-cisplatin and the recently published CALGB 90601 trial assessing gemcitabine-cisplatin + bevacizumab versus gemcitabine-cisplatin + placebo.
Presented by Bishoy M. Faltas, MD
The bladder cancer poster discussion session at American Society of Clinical Oncology (ASCO) 2021 featured a discussant presentation by Dr. Bishoy Faltas examining novel immunotherapy approaches across the spectrum of urothelial cancer stages.
Presented by Jason Efstathiou, MD, DPhil

Closing this course on TMT, Dr. Efstathiou presented on Biomarkers, Immunotherapy and Future Directions in TMT. He began by emphasizing, as many of the prior presentations in the course had done, that clinical-pathologic features affect TMT decisions, including tumor size, T stage, hydronephrosis, renal function, and bladder function. The question then is whether genomic factors may be able to inform bladder sparing therapy.

 

Presented by Alex Kutikov, MD, FACS
The State of the Art lecture at the 2021 virtual annual meeting of the Southeastern Section of the AUA was provided by Dr. Alex Kutikov who discussed the current applications for radical cystectomy and perhaps to spare certain bladders while minimizing risk of disease progression.
Presented by Petros Grivas, MD, PhD
In Best of Podium presentation at this year’s Southeast Section of the American Urologic Association Virtual Annual Meeting, Dr. Grivas presented pre-specified subgroup analyses of the JAVELIN Bladder 100 trial.
Presented by Dean F. Bajorin, MD
For patients with muscle-invasive bladder cancer who are eligible for curative-intent treatment, cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is a standard of care with improved pathologic response and overall survival (OS) compared to RC alone.
Presented by Arlene O. Siefker-Radtke, MD
In this presentation, Arlene O. Siefker-Radtke, MD provided a discussion on two presentations on Enfortumab Vedotin (EV)  in previously treated urothelial cancer. Primary results of EV-301 and EV-201 Cohort 2: Enfortumab vedotin in cisplatin-ineligible patients with locally advanced or metastatic urothelial cancer who received prior PD-1/PD-L1 inhibitors.
Presented by Andrea Necchi, MD
Muscle-invasive bladder cancer is a systemic disease as >40% of patients ultimately develop recurrence after radical cystectomy. For patients who cannot receive or refuse cisplatin-based chemotherapy, there is no standard-of-care neoadjuvant therapy.
Presented by Thomas Powles, MBBS, MRCP, MD
Cisplatin chemotherapy is the standard of care for medically fit patients in advanced urothelial carcinoma. Up to 50% of these patients are medically ineligible for cisplatin due to low performance status, renal dysfunction, or other medical comorbidities.
Presented by Yohann Loriot, MD, PhD
Avelumab first-line maintenance therapy is approved in the United States for patients with advanced urothelial carcinoma that has not progressed with first-line platinum-containing chemotherapy based on significantly prolonged overall survival versus best supportive care alone (median 21.4 months versus 14.3 months; HR 0.69, 95% CI 0.56-0.86) as reported in the phase III JAVELIN Bladder 100 trial.
Presented by Petros Grivas, MD, Ph.D.
In a presentation at the 2021 ASCO GU, Dr. Grivas described the design of the confirmatory phase III trial, TROPiCS-04. TROPiCS-04 is a global, multicenter, open-label, randomized controlled trial, performed among patients with locally advanced unresectable or metastatic urothelial carcinoma.
Presented by Neal Shore, MD, FACS, and Robert Dreicer, MD
At the 2020 Society of Urologic Oncology (SUO) Annual Virtual Meeting, Dr. Neal Shore chaired a session examining the use of newer and emerging agents in bladder cancer, which highlighted a presentation by medical oncologist Dr. Robert Dreicer discussing novel treatment options for patients with advanced bladder cancer.
Presented by Andrea Necchi, MD,
In an oral presentation in a session examining neoadjuvant versus adjuvant strategies in locally advanced bladder cancer at the 12th European Multidisciplinary Congress on Urological Cancers (EMUC), Dr. Andrea Necchi led a discussion of neoadjuvant strategies in advanced bladder cancer.
Presented by Matthew Galsky, MD
In an oral presentation in the Refining the Treatment of Bladder Cancer session at the 12th European Multidisciplinary Congress on Urological Cancers (EMUC), Dr. Matthew Glasky presented an overview of optimal first-line approaches to the treatment of metastatic bladder cancer. Dr. Galsky began by highlighting the treatment approach in what he called the “not too distant past:
Presented by Michiel S. van der Heijden, MD, PhD
Platinum-based chemotherapy is the mainstay of first-line treatment for medically eligible patients with advanced urothelial carcinoma (UC). Unfortunately, up to 50% of patients are unable to receive cisplatin, and disease progression often develops even for patients who receive cisplatin.
Presented by Yohann Loriot, MD, MSc
Treatment options for advanced urothelial cancer that has progressed through platinum chemotherapy and immune checkpoint blockade consist of (1) single agent chemotherapy, (2) FGFR inhibitor therapyfor tumors harboring susceptible alterations, and (3) the antibody-drug conjugate enfortumab vedotin.
Presented by Thomas B. Powles, MBBS, MRCP, MD
Urothelial carcinoma has a substantial impact on patient qualify of life. Patients may experience a multitude of disease-related symptoms, including pain, urinary frequency, physical changes, and mental health issues, with all affect quality of life. 
Presented by Petros Grivas, MD, Ph.D.
Advanced urothelial carcinoma has among the worst prognosis for tumors treated by genitourinary oncologists. Standard of care dictates that patients receive platinum-based induction chemotherapy.
Presented by Bishoy M. Faltas, MD
(UroToday.com) At the Society of Urologic Oncology (SUO) Summer Virtual Webcast, Bishoy Faltas, MD, from Weill Cornell compared the genetic components of the bladder and upper tract urothelial carcinoma. Upper tract urothelial carcinoma comprises 5-10% of all urothelial carcinomas with a unique epidemiologic association with Arsenic exposure and aristolochic acid.
Presented by Yohann Loriot, MD, PhD
(UroToday.com) Outcomes of immunotherapy have been the highlight of meetings over the last decade. At the 2020 European Association of Urology (EAU) Virtual Meeting, Yohann Loriot, MD, PhD, discussed novel treatment options beyond immunotherapy. As noted by Dr. Loriot, the vast majority of trials with new drugs are investigating immunotherapy, but a better understanding of the tumor biology is identifying new targets.
Presented by Cora N. Sternberg, MD, FACP
San Francisco, California (UroToday.com) To close the session entitled “Risk stratification and management of high-risk muscle invasive urothelial carcinoma,” Cora N. Sternberg
Presented by Wassim Kassouf, MD, FRCS
Treatment of patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC) remains a significant clinical challenge. At the session on Confronting Obstacles in Treating Nonmuscle-Invasive and UTUC at the 2020 ASCO GU, Dr. Wassim Kassouf presented an overview of treatment options available for these patients.
Presented by Jonathan E. Rosenberg, MD
San Francisco, CA (UroToday.com) There are limited effective treatments for patients with metastatic bladder cancer who are platinum ineligible. Single-agent immunotherapy
Presented by Karen M. Wheeler, MD
Washington, DC (UroToday.com) As part of the Research Scholars Update at the 20th Annual Meeting of the Society of Urologic Oncology, Dr. Karen Wheeler presented her work on
Presented by Robert Huddart, MA, MBBS, MRCP, FRCR
Washington, DC (UroToday.com) Organ preservation in bladder cancer has been a widely debated topic with polarizing views from different centers and researchers worldwide.
Presented by Roland Seiler, PhD
Athens, Greece (UroToday.com) Dr. Roland Seiler presented after Dr. Andrea Necchi, supporting the role of chemotherapy in the neoadjuvant setting of treating muscle invasive bladder cancer
Presented by Kelly Stratton, MD
Athens, Greece (Urotoday.com) Neoadjuvant chemotherapy (NAC) in bladder cancer has been proven to improve overall survival in patients with muscle-invasive bladder cancer
Presented by Joep J. de Jong
Aarhus, Denmark (UroToday.com) Joep J. de Jong from the Erasmus MC Cancer Institute in Rotterdam discussed efforts at developing a genomic classifier to predict clinically
Presented by Thomas Powles, MBBS
Barcelona, Spain (UroToday.com) Atezolizumab has received regulatory approval for patients with locally advanced or metastatic urothelial carcinoma. 
Presented by Enrique Grande, MD
Barcelona, Spain (UroToday.com) First-line metastatic urothelial carcinoma treatment includes cisplatin or carboplatin-based chemotherapy or checkpoint inhibitors, depending on patient eligibility and PD-L1 status.
Presented by Scott T. Tagawa, MD, MS
Barcelona, Spain (UroToday.com) Platinum-based chemotherapy has been the standard first-line therapy for patients with metastatic urothelial cancer (mUC). Historically, response to standard of care second-line chemotherapy regimens is < 15%.
Presented by Christopher J. Hoimes, DO
Barcelona, Spain (UroToday.com) Platinum-based chemotherapy remains the standard of care for patients with locally advanced or metastatic urothelial carcinoma. Despite the use of first-line PD-1/PD-1L inhibitors, 71–76% of patients who are cisplatin-ineligible do not respond to treatment.
Presented by Daniel Peter Petrylak, MD
Chicago, IL (UroToday.com) After cisplatin-based chemotherapy and immune checkpoint inhibitors, there exist a paucity of effective therapies for patients with metastatic urothelial carcinoma (mUC). Enfortumab vedotin (EV) is an antibody-drug
Presented by Arlene O. Siefker-Radtke, MD
Chicago, IL (UroToday.com) FGF receptor 3 (FGFR3) alterations are frequently encountered in urothelial carcinoma, both in non-muscle invasive and muscle-invasive disease.1 For patients with muscle-invasive disease, FGFR3 mutations have been observed in 2% of primary tumors and 9% of metastases.2
Presented by Bradley Alexander McGregor, MD
Chicago, IL (UroToday.com) Combination ipilimumab/nivolumab (ipi/nivo) has seen success in melanoma, MSI high colorectal cancer, and renal cell carcinoma (RCC).1 In urothelial carcinoma, CheckMate 032 evaluated the efficacy of ipi/nivo in an open-label, multicenter, phase I/II
Presented by Xinan Sheng, MD
Antibody-drug conjugates (ADCs) have made significant progress in several tumor types over the past few years, including brentuximab vedotin for Hodgkin lymphoma, TDM1 for breast cancer, and inotuzumab ozogamicin for non-Hodgkin lymphoma.1 Linking a targeted monoclonal