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Highlights from the 2025 European Association of Urology Annual Meeting |
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| Management of Positive Soft Tissue Margins After Radical Cystectomy: What About Isolated Pelvic Recurrences after Radical Cystectomy? – Radiotherapy versus Systemic Therapy as the Optimal Approach
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| Comron Hassanzadeh, MD, MPH, and Andrea Necchi, MD
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| Comron Hassanzadeh and Andrea Necchi debated the optimal approach for isolated pelvic recurrence following radical cystectomy with positive soft tissue margins. Dr. Hassanzadeh advocated for radiotherapy, citing the BART trial, which demonstrated manageable toxicity and potential locoregional control benefits. In contrast, Dr. Necchi emphasized systemic therapy as the standard for metastatic disease, referencing trials like CheckMate-901 and EV-302.
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| Patient with High-Grade Upper Tract Disease: Neoadjuvant or Adjuvant Systemic Therapy?
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| Arnulf Stenzl, MD, and Alison J. Birtle, MD
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| Arnulf Stenzl and Alison Birtle debated whether neoadjuvant or adjuvant systemic therapy is best for high-risk upper tract urothelial carcinoma (UTUC) patients. Dr. Stenzl supported neoadjuvant therapy, highlighting the potential for better outcomes and preservation of renal function, while Dr. Birtle favored adjuvant therapy, citing strong evidence from the POUT trial and concerns about overtreatment due to inaccurate pre-operative staging.
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| PIVOT-006- A Phase 3, Randomized Study of Adjuvant Intravesical Cretostimogene Grenadenorepvec versus Surveillance for the Treatment of Intermediate-Risk Non-Muscle Invasive Bladder Cancer
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| Sia Daneshmand, MD
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| Sia Daneshmand presented the ongoing Phase 3 PIVOT-006 trial, which evaluates the efficacy of adjuvant intravesical cretostimogene grenadenorepvec versus surveillance for IR-NMIBC. The trial, which began in January 2024, randomizes patients to receive either cretostimogene after TURBT or surveillance, with the primary endpoint being recurrence-free survival.
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| BOND-003 Cohort P- a Multi-National, Single-Arm Study of Intravesical Cretostimogene Grenadenorepvec for the Treatment of High-Risk, Papillary Only, BCG-Unresponsive Non-Muscle Invasive Bladder Cancer |
| Sia Daneshmand, MD |
| Sia Daneshmand presented the ongoing BOND-003 Cohort P study, a Phase 3, multi-national, single-arm trial investigating intravesical cretostimogene grenadenorepvec for high-risk, BCG-unresponsive, papillary-only non-muscle invasive bladder cancer (NMIBC). |
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| ctDNA Testing for Guiding Treatment Decisions in GU Cancers |
| Alexander Wyatt, BSc, DPhil |
| Alexander Wyatt presented a state-of-the-art lecture on using ctDNA testing to guide treatment decisions in genitourinary cancers. He discussed how ctDNA tests, both tumor-informed and tumor-naïve, could influence clinical decisions, such as de-escalating treatment in ctDNA-negative patients or escalating treatment for ctDNA-positive ones. |
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| Intravesical Drug Delivery: Devices Versus Vectors - The Bladder as an Ideal Organ for Cutting-Edge, Device-Assisted Intravesical Drug Delivery
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| Felix Guerrero-Ramos, MD, PhD, FEBU
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| Felix Guerrero-Ramos discussed the bladder's suitability for device-assisted intravesical drug delivery in the treatment of bladder cancer. He highlighted recent FDA-approved treatments for BCG-unresponsive high-risk non-muscle invasive bladder cancer (NMIBC) and ongoing trials, such as the SunRISe-1 trial, which assess therapies like TAR-200.
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| Combination Therapy: Systemic Versus Intravesical - BCG Unleashed: Harnessing Local Immunomodulators for Maximum Impact |
| Trinity Bivalacqua, MD, PhD |
| Trinity Bivalacqua discussed the potential of combining BCG therapy with local immunomodulators, particularly PD-1 inhibitors, to enhance the immune response against bladder cancer. He presented the CREST trial, which is investigating the combination of BCG and the PD-1 inhibitor sasanlimab for BCG-naïve non-muscle invasive bladder cancer, showing promising improvements in event-free survival. |
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| A Real-World Evidence Study Evaluating the Prevalence of FGFR Alterations in Patients with Intermediate Risk Non-Muscle Invasive Bladder Cancer, as Defined by the International Bladder Cancer Group (IBCG) |
| Morgan Rouprêt, MD, PhD |
| Morgan Rouprêt presented a real-world evidence study on the prevalence of FGFR alterations (FGFRalt) in patients with intermediate-risk NMIBC, as defined by the updated 2022 International Bladder Cancer Group (IBCG) guidelines. The study used data from the BRIDGE Clinical Routine Register (BRIDGister), analyzing 719 NMIBC samples, with 192 classified as intermediate risk. |
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| Bladder EpiCheck-Triggered Photodynamic Diagnosis Biopsies Detect High Grade Recurrences Missed by White Light Cystoscopy |
| Param Mariappan, MBBS (Hons), FRCS (Urol), FRCSEd, FEBU |
| Param Mariappan presented a study comparing Bladder EpiCheck-triggered photodynamic diagnosis biopsies with white light cystoscopy for detecting high-grade recurrences in high-risk non-muscle invasive bladder cancer. The study aimed to overcome WLC's moderate sensitivity, especially for carcinoma in situ recurrences, by integrating Bladder EpiCheck, a urine-based marker with high sensitivity for HG tumors. |
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| Artificial Intelligence System for Detecting Flat Bladder Tumors in Cystoscopic Images |
| Jun Mutaguchi, MD |
| Jun Mutaguchi presented a study on an artificial intelligence system using the YOLO framework to detect flat bladder tumors in cystoscopic images, aiming to reduce intravesical recurrence rates following TURBT. The system demonstrated high accuracy, with 90% sensitivity, 90.6% specificity, and an area under the receiver operating characteristic curve of 93.4%, showing potential for improving tumor detection and outcomes in NMIBC patients. |
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