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Highlights from the 36th Annual EAU Virtual Congress |
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| Is There A Role For Neoadjuvant Immunotherapy In Muscle Invasive Bladder Cancer?
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| Francois Audenet, MD
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| The advanced bladder cancer session of the 2021 European Association of Urology annual meeting included a presentation by Francois Audenet discussing the role of neoadjuvant immunotherapy in muscle-invasive bladder cancer (MIBC). Cisplatin-based chemotherapy before radical cystectomy is the gold standard for localized MIBC, given that it improves overall survival by 5% and disease-free survival by 9%. Recently, there has been success with immunotherapy for advanced bladder cancer.
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| State-of-the-Art Lecture: Does Every Metastatic Patient Need Immunotherapy in a First-Line Setting?
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| Enrique Grande, MD
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| Enrique Grande from Madrid, Spain provided a state-of-the-art lecture at the European Association of Urology (EAU) 2021 annual meeting’s advanced bladder cancer session discussing immunotherapy in the first-line setting for metastatic bladder cancer. Dr. Grande notes that over the last several years, it seems that immunotherapy covers the entire spectrum of first-line treatment of metastatic bladder cancer. In cisplatin eligible patients, avelumab maintenance therapy is standard of care for those that respond to first-line cisplatin-based chemotherapy.
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| State-of-the-Art Lecture: Safe and Optimal Management of MIBC in the Time of SARS-COV-2
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| James Catto, MD, Ph.D.
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| James Catto discussed the safe and optimal management of muscle-invasive bladder cancer (MIBC) in the time of the COVID-19 pandemic at the European Association of Urology (EAU) 2021 annual meeting’s plenary session on advanced bladder cancer. Dr. Catto highlights that during different waves of the pandemic we have had to change priorities and strategies for managing patients and provides considerations for management going forward.
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| Confederación Americana De Urología Lecture: What Is the Role of TUR in Muscle Invasive Bladder Cancer?
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| Alejandro R. Rodriguez, MD
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| The 2021 European Association of Urology (EAU) Annual meeting’s Confederación Americana de Urología lecture was provided by Dr. Alejandro R. Rodriguez discussing the role of TUR in muscle invasive bladder cancer (MIBC). The role of TUR in MIBC is to obtain tissue for histopathologic diagnosis, grading and clinical staging. In very selected patients, TUR alone may be a reasonable alternative to more invasive options. Maximal TUR with concurrent chemoradiotherapy is a primary treatment option for patients that desire bladder preservation as an alternative to radical cystectomy.
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| Circulating Tumor Cell-Driven Use of Neoadjuvant Chemotherapy in Patients With Muscle-Invasive Bladder Cancer: Final Results of the CirGuidance Study
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Nick Beije, MD, Ph.D.
Discussant: Morgan Roupret, MD, Ph.D.
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| The first talk of the game-changing session at the 2021 European Association of Urology (EAU) annual meeting, Nick Beije 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 Morgan Roupret.
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| DANUBE Post-Hoc Analysis: Outcomes for Durvalumab with or Without Tremelimumab by Cisplatin Eligibility and PD-L1 Biomarker Status in Metastatic Urothelial Carcinoma
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Thomas Powles, MBBS, MRCP, MD
Discussant: Maria De Santis, MD
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| Thomas Powles provides an exploratory analysis of the DANUBE trial, with a focus on the outcomes of durvalumab (Durva) with or without tremelimumab (Treme) stratified by cisplatin eligibility and PD-L1 biomarker status in metastatic urothelial carcinoma (mUC). Maria De Santis follows this discussion of the data and provides clinical context.
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| ctDNA Guiding Adjuvant Immunotherapy in Urothelial Carcinoma
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Jürgen E. Gschwend, MD
Discussant: Arnulf Stenzl, MD
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| In this session at the 2021 European Association of Urology (EAU) virtual annual meeting, Jürgen E. Gschwend presents data from the IMvigor010 study, specifically an analysis of ctDNA tested patients and their outcomes. Arnulf Stenzl follows this up with a discussion of the data and provides clinical context.
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| Pembrolizumab vs. Placebo as Post Nephrectomy Adjuvant Therapy for Patients with RCC: Randomized, Double-Blind, Phase 3 KEYNOTE-564 Study
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| Thomas Powles, MBBS, MRCP, MD
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| Tom Powles presented results of the KEYNOTE-564 trial evaluating pembrolizumab versus placebo as adjuvant therapy for patients with RCC. Adjuvant pembrolizumab post nephrectomy demonstrated a statistically significant and clinically meaningful improvement in DFS versus placebo in patients with intermediate-high, high risk, or M1 no evidence of RCC. KEYNOTE-564 is the first positive phase III study with a checkpoint inhibitor in adjuvant RCC, and these results support pembrolizumab as a potential new standard of care for patients with RCC in the adjuvant setting.
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| KEYNOTE-564: Phase 3 Trial of Pembrolizumab in the Adjuvant Treatment of Renal Cell Carcinoma Discussion
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| Alberto Breda, MD
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| The Game-Changing session at the European Association of Urology’s (EAU) 2021 virtual annual meeting included a discussion by Dr. Alberto Breda of the phase 3 KEYNOTE-564 clinical trial. Additional follow-up is needed to assess the impact on overall survival despite adjuvant pembrolizumab post nephrectomy/metastasectomy positively impacting DFS. Safety results were acceptable with an expected immune-mediated adverse event profile.
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| Society of Urologic Oncology Lecture The VHL Kidney Cancer Gene: Discovery, Oxygen Sensing and Therapy |
| William Marston Linehan, MD |
| William Marston Linehan provides a lecture on the discovery, mechanism, and treatment paradigm for VHL kidney cancer as the invited Society of Urologic Oncology (SUO) lecturer at the European Association of Urology. Dr. Linehan emphasized that understanding the underlying biology helps us understand the appropriate treatment for each patient. In particular, in patients with localized disease, an understanding of the underlying biology can help guide us whether to observe or to intervene and, when intervening, how to do so. |
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| Cytoreductive Nephrectomy in the Management of Metastatic Clear Cell RCC: The Ideal Case - Cytoreductive Nephrectomy First
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| George Thalmann
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| George Thalmann presented an argument for cytoreductive nephrectomy as upfront therapy for metastatic clear cell RCC. His discussion was brief but balanced. He emphasizes that cytoreductive nephrectomy is defined as the removal of the primary tumor in the presence of synchronous metastatic disease. Recent randomized trials have demonstrated similar survival among patients receiving systemic therapy alone. So the question before us, is cytoreductive nephrectomy necessary? This has been an ongoing debate.
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| Cytoreductive Nephrectomy in the Management of Metastatic Clear Cell RCC: Systemic Treatment Without or With Delayed Nephrectomy - When and How?
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| Axel Bex, MD, Ph.D.
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| Axel Bex presents his take on the management of metastatic clear cell RCC with systemic therapy, with or without delayed nephrectomy – specifically focusing on the when and how. Patients who require systemic therapy should receive immune checkpoint inhibitor combination therapy first in analogy to CARMENA/SURTIME, as these are the new standard of care.
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| State-of-the-Art Lecture Immunotherapy-Based Management of Metastatic Clear-Cell and Variant RCC: What Can We Achieve? |
| Ignacio Durán, MD |
| Ignacio Durán provides an excellent state-of-the-art lecture on the current immunotherapy-based management of metastatic clear cell RCC and variant RCC. He provides a historical perspective, the current status of therapy, and what we can potentially achieve. |
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| To view our full coverage of the 2021 EAU Virtual Congress, visit the Conference Coverage section on UroToday.com
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