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Bladder Cancer Highlights from the 2021 Genitourinary Cancers Symposium |
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| Avelumab First-Line Maintenance plus Best Supportive Care (BSC) Versus BSC Alone for Advanced Urothelial Carcinoma: JAVELIN Bladder 100 Japanese Subgroup Analysis
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| Norihiko Tsuchiya, MD
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| Norihiko Tsuchiya presents subgroup data from the JAVELIN Bladder 100 trial among Japanese patients. This study enrolled patients with advanced urothelial carcinoma, defined as those with unresectable locally advanced disease or metastatic disease. In this subset analysis, the authors examined 73 Japanese patients who were randomized to receive avelumab + BSC (n=36) or BSC alone (n=37), with PD-L1+ tumors found in 52.8% and 62.2%, respectively.
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| Post-Hoc Analysis of Long-Term Outcomes In Patients with CR, PR, or SD to Pembrolizumab Platinum-Based Chemotherapy as 1L Therapy for Advanced Urothelial Carcinoma in KEYNOTE-361 |
| Yohann Loriot, MD, Ph.D. |
| In a poster presentation at the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU), Yohann Loriot presented a post hoc landmark analysis to examine the durability of complete responses (CR), partial responses (PR), and stable disease (SD), as well as long-term survival among patients who achieved CR, PR, or SD at week 9 of the KEYNOTE-361 trial. |
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| Germline Alterations in Cancer Susceptibility Genes in Women with High-Risk Bladder Cancer: Implications for Germline Testing and Clinical Management
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| Hong Truong, MD, MS
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| In a presentation at the 2021 ASCO GU Cancers Symposium, Hong Truong sought to assess germline variants among women with bladder cancer which may explain their poor prognosis. Based on the data, it was concluded that pathogenic/likely pathogenic germline alterations are more common among women with bladder cancer, as compared to men. Some of these alterations are associated with tumors in other organs which may be suitable for screening or risk-reducing surgery, as well as familial counseling.
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| Impact of Subsequent Therapy on Survival in KEYNOTE-361: Pembrolizumab (Pembro) plus Chemotherapy (Chemo) or Pembro Alone Versus Chemo as First-Line Therapy for Advanced Urothelial Carcinoma |
| Ajjai Alva, MBBS, MD |
| Ajjai Alva presented an exploratory analysis of overall survival by subsequent therapy among patients enrolled in KEYNOTE-361 to assess how first and second-line therapy selection affected survival. It was found that this exploratory analysis suggests that the sequence of initial chemotherapy followed by anti–PD-(L)1 agent may optimize outcomes and emphasizes the role of second-line immunotherapy. |
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| CDKN2A Alterations as Markers of Immune Checkpoint Blockade Resistance In Urothelial Carcinoma |
| Amin Nassar, MD |
| Amin Nassar presented on the effect of CDKN2A alterations on clinical outcomes in patients with urothelial carcinoma received immune checkpoint blockade (ICB). CDKN2A alteration status may serve as a unique predictive biomarker in patients with urothelial carcinoma undergoing treatment with immunotherapy. However, these results require further validation and mechanistic study. |
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| Genomic Characterization of Bladder Cancer with Variant Histology |
| Andrew Thomas Lenis, MD, MS |
| While the preponderance of patients with bladder tumors have urothelial histology, up to 25% of tumors are of pure variant or mixed urothelial and variant histology. These variant histologies are associated with more advanced stage at presentation and worse response to systemic therapy. In a poster presentation at the 2021 ASCO GU Cancers Symposium, Andrew Lenis presented a genomic analysis of bladder cancers with variant histology. |
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| TROPiCS-04: Study of Sacituzumab Govitecan in Metastatic Or Locally Advanced Unresectable Urothelial Cancer That Has Progressed After Platinum and Checkpoint Inhibitor Therapy
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| Petros Grivas, MD, Ph.D.
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| Petros Grivas introduced and described the design of the confirmatory phase III trial, TROPiCS-04. TROPiCS-04 is a global, multicenter, open-label, randomized controlled trial, performed among patients with locally advanced unresectable or metastatic urothelial carcinoma. To be eligible for inclusion, patients must have had disease progression following prior platinum-based and CPI therapies. Specific inclusion criteria require Eastern Cooperative Oncology Group performance status 0–1 and adequate hematologic, hepatic, and renal function.
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| Treatment Patterns Among Patients with Advanced Urothelial Carcinoma Following Discontinuation of PD1/L1 Inhibitor Therapy |
| Alicia Morgans, MD, MPH
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In a presentation at the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU), Alicia Morgans presented the results of a retrospective chart review aimed at characterizing the clinical characteristics and treatments among patients with locally advanced and metastatic urothelial carcinoma following discontinuation of first-line or second-line PD-1/L1i therapy.
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| An Open-Label, Multicenter, Phase IIIb Study of Patients With Urinary Tract Carcinoma (STRONG): Final Analysis for Fixed-Dose Durvalumab Monotherapy (Module A) |
| Guru Sonpavde, MD |
| At this year's ASCO Genitourinary Cancers Symposium (ASCO GU), Guru Sonpavde presented data from the STRONG study, aimed at understanding of long-term safety and efficacy of durvalumab in platinum and non-platinum pretreated patients, using a fixed-dose every 4 weeks. To do so, the authors relied upon Module A of the phase IIIb STRONG study which investigated the safety of fixed-dose durvalumab (1500 mg, Q4W) in patients with both urothelial and nonurothelial urinary tract carcinoma who progressed on or after platinum/non-platinum CT. |
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| Efficacy of Enfortumab Vedotin in Advanced Urothelial Cancer: Retrospective Analysis of the Urothelial Cancer Network To Investigate Therapeutic Experiences (UNITE) Study |
| Vadim Koshkin, MD |
| Vadim Koshkin presented an assessment of enfortumab vedotin and its activity in particular patient subsets of interest including those with distinct histological variants. Using the Urothelial Cancer Network to Investigate Therapeutic Experiences (UNITE) cohort, a retrospective study was performed, of patients with advanced urothelial carcinoma treated with ≥1 dose of enfortumab vedotin as the standard of care (SOC) or on a clinical trial (if trial results already reported) at 12 US sites. |
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| Medical Oncology
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| Scot A. Niglio, MD, MS
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| During the Best of Journals: Urothelial Cancer Session at the 2021 American Society of Clinical Oncology Genitourinary (GU) Cancers Symposium, Scot Niglio provided the medical oncology perspective, highlighting what he felt to be the four key papers published in urothelial cancer in the past year.
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| Surgery |
| Lindsey A. Herrel, MD |
| Lindsey Herrel provided the surgical/urology perspective, highlighting what she felt to be the key papers published in urothelial cancer in the past year, emphasizing three key themes: new and emerging approaches to the treatment of Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer, evaluation of robotic radical cystectomy, and the feasibility of radical cystectomy following neoadjuvant immunotherapy. |
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| Radiation Oncology
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| Abhishek Solanki, MD
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| Abhishek Solanki provided the radiation oncology perspective, highlighting what he felt to be the key papers published in urothelial cancer in the past year, highlighting four main themes: Trimodal therapy for bladder cancer, and the resulting quality of life. Evolutions in radiotherapy (RT) for bladder cancer including adaptive RT and intensity-modulated RT. Increasing access to local therapy due to advances in technology. Finally, the role of stereotactic body radiotherapy in patients with oligometastatic disease.
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| To view our full coverage of the 2021 ASCO GU Symposium, visit the Conference Coverage section on UroToday.com
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