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Highlights from the 36th Annual EAU Virtual Congress |
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| Controversies in Bladder Cancer 2021 - Rapid-Fire Debates |
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| Elderly Patient with Recurrent TaLG Tumors, Small Size, Negative Cytology
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| Morgan Roupret, MD, Ph.D., Wassim Kassouf, MD, CM, FRCSC
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| During the first rapid-fire debate, the topic of focused is the management of small local recurrence low-grade bladder tumors with negative cytology. Morgan Roupret argues for formal TURBT with intravesical chemotherapy while Dr. Wassim Kassouf argues for active surveillance and fulguration. Below I highlight their main points.
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| Ileal Conduit or Continent Diversion; Which Is A Better Choice For a Patient with GFR ~ 60
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| Hugh Mostafid, FRCS (Urol), FEBU, Jens Bedke, MD
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| Peter Black reintroduces the classic debate of ileal conduit or content diversion in an unselected patients with normal kidney function. Hugh Mostafid of the United Kingdom argues for ileal conduit, while Jens Bedke of Germany argues for continent diversion.
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| Otherwise Healthy Patient with T1HG Disease plus CIS; What Is the Best Treatment?
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| Joan Palou, MD, J. Alfred Witjes, MD, Ph.D.
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| The focus of this debate is the management of HG T1 bladder cancer with concurrent CIS. Joan Palou argues for intravesical therapy while J. Alfred Witjes argues for upfront radical cystectomy.
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| Optimal Therapy for Patient with T0 After Neoadjuvant Chemotherapy
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| Kamal Pohar, MD, Ananya Choudhury, MA, Ph.D., Paolo Gontero, MD
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| In this rapid-fire debate, the focus is on the optimal therapy for patients with cT0 disease after neoadjuvant chemotherapy. With three debaters for this talk – Kamal Pohar arguing for cystectomy, Ananya Choudhury arguing for trimodal therapy, and Paolo Gontero arguing for observation/bladder sparing.
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| 52 Yr Old Female Patient, With Partial Response in Retroperitoneal Lymph Nodes After 6 Cycles of Platinum Based Chemotherapy
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| Seth Lerner, MD, FACS, Thomas Powles, MD, MBBS, MRCP
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| In this talk, the debaters discuss, management of retroperitoneal lymphadenopathy that has a partial response to platinum-based chemotherapy. Seth Lerner argues for surgical consolidation, while Thomas Powles argues for systemic therapy.
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Immunotherapy in Urothelial Cancer
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| Immunotherapy In Non-Muscle Invasive Urothelial Cancer of the Bladder
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| J. Alfred Witjes, MD, Ph.D.
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| J. Alfred Witjes kicked off the thematic session of immunotherapy in urothelial cancer with a talk on non-muscle invasive bladder cancer (NMIBC). To date, while we know that the immune system is involved to clear mechanism of action of BCG is not known. It does involve recruitment of both immune cells (macrophages, neutrophils) but also cytokines. Regardless BCG remains the first-line therapy for NMIBC.
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| Perioperative Immunotherapy in Muscle-Invasive Bladder Cancer |
| Michiel Van Der Heijden, MD, Ph.D. |
| Michiel Van Der Heijden focused the second talk of this thematic session at the 2021 European Association of Urology (EAU) annual meeting, on perioperative chemotherapy for muscle-invasive bladder cancer (MIBC). He began by noting the steady progression of immuno-oncology (IO) earlier in the MIBC disease course. It was first approved as second-line systemic therapy for metastatic bladder cancer, then was integrated as maintenance therapy following chemotherapy with stable disease/partial response. Therefore, it was only natural that it would be evaluated in the perioperative setting. |
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| Immunotherapy for Metastatic Urothelial Cancer (Including Upper Tract) |
| Ursula Vogl, MD |
| Ursula Vogl presented on immunotherapy for metastatic urothelial carcinoma as part of this thematic session on immuno-oncology (IO) therapy in urothelial cancer. She kicked off the session by reviewing the numerical burden of metastatic urothelial cancer reviewing the recent numbers and trends. She did highlight that there are numerous ongoing phase 3 trials that will likely change this landscape further. |
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| Predictive Markers for Response in Urothelial Cancer: Are We There Yet? |
| 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. First and foremost, he makes it very clear that the PD-L1 biomarker is faulty at best. Unfortunately, the “PD-L1 biomarker” consists of many different biomarkers and should be considered as such. |
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| Look in the Future: Ideal Combination Therapies in Urothelial Cancer |
| Matthew Galsky, MD |
| In this final talk from the thematic session at the 2021 European Association of Urology (EAU) annual meeting, focusing on immunotherapy for urothelial cancer, Matthew Galsky takes a look at the future – and discusses the ideal combination therapies. Combining drugs with single-agent activity is a pragmatic approach with a track record in oncology. Dissecting mechanisms of resistance still critical for major advances. We are on the verge of a new generation of PD-1/PD-L1-based combinations poised to enter our standard treatment algorithms. |
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UTUC: Molecular Characterization and Modern Management: Poster Session
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| Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-Stratify Patients Eligible for Kidney Sparing Strategies: An International Collaborative Study |
| Gautier Marcq, MD MSc |
| In the Upper Tract Urothelial Carcinoma: Molecular characterization and modern management session at the 2021 European Association of Urology (EAU) Annual Meeting, Gautier Marcq, and colleagues presented a novel classification system for upper tract urothelial carcinoma (UTUC) that may better risk stratify patients for kidney sparing strategies. |
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| PURE-02: An Open-Label, Single-Arm, Feasibility Study of Neoadjuvant Pembrolizumab Before Radical Nephroureterectomy (Rnu) in Patients With High-Risk, Upper-Tract Urothelial Carcinoma (UTUC) |
| Andrea Necchi, MD |
Andrea Necchi presents the preliminary, feasibility results of the PURE-02 study, which assesses the use of pembrolizumab before radical nephroureterectomy in patients with high-risk Upper tract urothelial cancer (UTUC). In the PURE-02 study, the authors aimed to explore the activity of preoperative pembro in a cohort of pts with UTUC. At present, no data had been reported with the use of the immune checkpoint inhibitors (ICI) in localized UTUC.
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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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