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PEER-TO-PEER CLINICAL CONVERSATIONS
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Intermediate-Risk Bladder Cancer Management Through Risk Stratification, Office Ablation, and Chemoablation
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Joan Palou, MD, PhD, FEBU FRCS (GlasG), and Akshay Sood, MD
Joan Palou and Akshay Sood debate management of intermediate-risk non-muscle invasive bladder cancer, covering the spectrum from active surveillance to chemoablation.
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Rethinking Recurrence Burden in Low-Grade and Intermediate-Risk NMIBC
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Sarah Psutka, MD, MS, FACS
Sarah Psutka discusses the burden and management of intermediate-risk non-muscle invasive bladder cancer. Dr. Psutka highlights that most patients experience three recurrences in five years and require near-indefinite surveillance.
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Intravesical Mitomycin Hydrogel: Patient-Reported Outcomes Data from OPTIMA II, ATLAS, and ENVISION
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Charles (Chas) Peyton, MD
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| Charles (Chas) Peyton reports patient-reported outcomes data from the OPTIMA II, ATLAS, and ENVISION trials of UGN-102, covering once-weekly intravesical mitomycin in a reverse thermal hydrogel formulation for low-grade intermediate-risk non-muscle invasive bladder cancer.
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| Clinical Validation of the International Bladder Cancer Group's Intermediate-Risk Nonmuscle-Invasive Bladder Cancer Stratification Model
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| Jayant Siva, MD
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| Jayant Siva discusses a large single-institution validation of 2,980 patients with intermediate-risk NMIBC treated with TURBT plus adjuvant intravesical chemotherapy, in which, the IBCG clinical risk model reliably stratified patients into IR-low, IR-intermediate, and IR-high groups. At 3 years, recurrence rates rose stepwise from 16% in IR-low to 48% in IR-intermediate and 95% in IR-high, while progression rates increased from 3% to 9% to 30%, respectively.
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| Patient Time Toxicity from Management Options for NMIBC
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| Veerain Gupta, MD
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| In a SEER-Medicare study of 32,934 patients aged ≥65 with NMIBC diagnosed 2010–2019, median healthcare contact days in the first year after diagnosis were 16 overall, ranging from 15 for TURBT alone to 17 for BCG, 19 for intravesical chemotherapy, and 34 for radical cystectomy. Multivariable regression showed that, compared with TURBT alone, BCG added 0.52 contact days, intravesical chemotherapy added 4.6 days, and radical cystectomy added 20.3 days, with low-income subsidy recipients experiencing 5.5 additional contact days.
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| Treatment with UGN-102 in Patients with Recurrent Low-Grade Intermediate Risk Nonmuscle-Invasive Bladder Cancer: 24-Month Duration of Response Data from the Phase 3 ENVISION Trial
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| Mark Schoenberg, MD
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| In the phase 3 ENVISION trial of 240 patients with recurrent low-grade intermediate-risk NMIBC, UGN-102 given as 6 weekly intravesical instillations achieved a 3-month complete response rate of 79.6%. Among responders, the probability of remaining in response was 82.4% at 12 months and 72.2% at 24 months after complete response, indicating durable disease control with an event rate that remained stable through 24 months.
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| The COBRA Study: Chemoablation or Bladder Resection with Adjuvant Chemotherapy in Recurrent Nonmuscle-Invasive Bladder Cancer
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| Søren Klingenberg
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| Søren Klingenberg discusses the COBRA study, an international multicenter randomized controlled trial comparing dose-dense mitomycin C chemoablation to standard TURBT or office-based procedures followed by adjuvant mitomycin C or BCG in patients with recurrent Ta low-grade NMIBC without prior intravesical therapy.
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