Let’s Keep the Momentum Going

Ashish M. Kamat | May 23, 2019

In 2019, more than 80,000 Americans will be diagnosed with bladder cancer, and more than 17,000 patients will die from it.1 Whether it’s the neighbor we greet each morning, the aunt we joke with at family reunions, or even the face we see each day in the mirror, bladder cancer affects us all. It is a complex, challenging disease, and its prognosis has improved only recently after three decades of relative stagnancy.

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Ashish Kamat

Ashish Kamat, MD, MBBS, is a Professor of Urology and Wayne B. Duddleston Professor of Cancer Research at MD Anderson Cancer Center in Houston, Texas. Dr. Kamat serves as; President of International Bladder Cancer Group, Co-President of International Bladder Cancer Network, and Associate Cancer Center Director. Dr. Kamat served as the Program Director, of the MD Anderson Urologic Oncology Fellowship from 2005-2016.

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Everyday Urology - Oncology Insights
Publications focusing on urologic cancer treatments through original manuscripts
By Ashish M. Kamat, MD, MBBS

More than 81,000 individuals are diagnosed with bladder cancer in the United States every year, of whom 75% have non-muscle invasive disease.1,2 Unfortunately, half these cases recur despite transurethral resection of bladder tumor (TURBT), and from 5% to 25% of repeated recurrences progress to muscle-invasive disease.3,4,5

By Arjun Balar, MD
Until recently, decades had elapsed with little progress in treating metastatic urothelial cancer (mUC). Cisplatin-based chemotherapy, the best available treatment option, had a median overall survival (OS) of 12-15 months, an overall response rate (ORR) of 50-60%, and was curative in about 10% of cases, but also was associated with potentially serious toxicities.12, 13, 2, 7, 3 
By Petros Grivas, MD, PhD
Urothelial cancer (UC), also known as transitional cell carcinoma, is the 5th most common cancer in the United States, and it arises more commonly in the bladder than in other parts of the urinary tract. An estimated 79,030 new cases of UC are expected in 2017. Of these cases, there will be about 12,240 deaths in men and 4630 in women.
By Ashish M. Kamat, MD, MBBS and Janet B. Kukreja, MD, MPH,
Bladder cancer presents an ever increasing health care burden across the globe. The large majority of patients diagnosed with bladder cancer are over the age of 55, with an average age at the time of diagnosis of 73 and an increasing percentage 80 years and older.1 Men are about three to four times more likely to get bladder cancer during their lifetime than women.1
By Badrinath Konety, MD, MBA
Voided urine cytology has been the gold standard for detecting bladder cancer since 1945. Its specificity nears 90%, meaning that a positive result is highly reliable. But cytology is unreliable for detection of low grade tumors such that only about 20% to 30% of low grade bladder tumors are identified using cytology. 
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Written by Noah M. Hahn, MD
Recent years have seen an explosive rate of transformative advances in both pre-clinical and clinical urothelial carcinoma research.  With the public dissemination of comprehensive molecular data from The Cancer Genome Atlas (TCGA) urothelial carcinoma cohort,
Written by Ashish Kamat, MD, MBBS
For those of us who take care of patients with the sixth most common malignancy in the United States and the seventh most common cause of cancer-related death,it was disheartening that, as recently as 2015, patients with advanced bladder cancer had no effective alternatives to cisplatinum-based chemotherapy, a status quo that had persisted for three decades.2
Written by Justin T. Matulay, MD, and Ashish Kamat, MD, MBBS
Bladder cancer is the most common malignancy of the urinary tract and second only to the prostate in the entire genitourinary system. The most updated available global estimate, based on registry data collected through the year 2012,
Written by Roger Li, MD and Ashish Kamat, MD, MBBS
In the previous sections, we have covered Epidemiology, Diagnosis, and Pathology of Bladder Cancers. As noted, most patients present at a potentially curative stage non-muscle invasive bladder cancer (NMIBC). Although NMIBC can generally be managed...
Written by Justin T. Matulay, MD and Ashish Kamat, MD, MBBS
There are no reliable screening tests available for detecting bladder cancer; hence the diagnosis is usually made based on clinical signs and symptoms. Painless hematuria – microscopic or gross – is the most common presentation...
Conference Coverage
Recent data from conferences worldwide
Presented by Axel S. Merseburger, MD
Barcelona, Spain (UroToday.com) Dr. Axel Merseburger presented the preliminary results of the Safety of Atezolizumab in locally advanced or metastatic UrotheliaL and non-urothelial carcinoma of the urinary tract (SAUL) study at the EAU 2019 Breaking News Session.
Presented by Ricardo Leão, MD
Barcelona, Spain (UroToday.com) Up to 3/4 of non-muscle invasive bladder cancer (NMIBC) patients will endure recurrence during their lifetime. Disease follow up is invasive, costly and long and consists of cystoscopy, cytology, and imaging. The most prevalent non-invasive approach for the diagnosis of recurrence remains urinary cytology, 
Presented by Yair Lotan, MD
Barcelona, Spain (UroToday.com) At the urogenital cancer treatment session, Dr. Yair Lotan discussed the impact of blue light flexible cystoscopy and utilization in the clinic setting. Dr. Lotan notes that there are several unmet medical needs with regards to non-muscle invasive bladder cancer (NMIBC). First, it is associated with a high risk of recurrence, with up to 61% of patients recurring in the first year, and up to 78% within 5 years.
Presented by Arlene O. Siefker-Radtke, MD
San Francisco, CA (UroToday.com) Immune checkpoint inhibitors are approved both in the first line and second line for patients with metastatic urothelial carcinoma. In the first line, KEYNOTE 052 showed that pembrolizumab as significant anti-tumor activity for cisplatin ineligible patients with UC1, for a 38% objective response rate for patients with a combined positive score of 10% or more (PD-L1 positive).
Presented by Scott T. Tagawa, MD, MS
San Francisco, CA (UroToday.com) Sacituzumab govitecan (SG) is a humanized antibody-drug conjugate, made from anti-Trop-2 monoclonal antibody linked with SN-38, the active metabolite of irinotecan.Trop-2 is transmembrane glycoprotein encoded by the Tacstd2 gene, and is differentially expressed in a wide range of tumor types, including gastric, pancreatic, triple-negative breast, colonic, prostate, and lung cancer.2
Presented by Yair Lotan, MD
San Francisco, CA (UroToday.com) Dr. Yair Lotan presented on Genomic Insights and Biomarkers for Treatment Selection in Muscle-Invasive and Non-Muscle-Invasive Bladder Cancer. He discussed the role of markers in bladder cancer and how they add independent information that can impact patient care.
Presented by Ananya Choudhury, MA, Ph.D., MRCP, FRCR
San Francisco, CA (UroToday.com) In this case panel discussion, 3 patient cases were reviewed highlighting important points in the management of bladder cancer. The text below includes a summary of each case presented and key points made by the panelists. The cases detail patients with small cell bladder cancer, upper tract urothelial carcinoma and recurrent NMIBC, respectively. 
Presented by Robert A. Huddart
Toronto, Ontario (UroToday.com) In this discussion, the topic of bladder preservation was presented by Dr. Huddart from the Royal Marsden NHS Foundation Trust in the United Kingdom. Muscle invasive bladder cancer, after diagnosis using TURBT, is usually treated with radical cystectomy with the option of neoadjuvant chemotherapy before surgery.
Presented by Joaquim Bellmunt, MD
Toronto, Ontario (UroToday.com) In this discussion, Dr. Bellmunt presented the standard of care in second-line management of advanced bladder cancer and gave an update on targeted therapies. He also discussed some of the phase 2 and phase 3 trials with PD-1/PD-L1 inhibitors, and associated biomarkers.
Presented by Jeff Holzbeierlein, MD, FACS
San Francisco, CA (UroToday.com)  Dr. Holzbeierlein began his discussion on the new muscle-invasive bladder cancer (MIBC) guidelines,a collaborative multi-disciplinary effort led by Dr. Sam Chang that involved input from all the major organizations, including AUA, ASCO, ASTRO, and patient advocates.
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