ASCO GU 2019

ASCO GU 2019: Trimodality Therapy is the Best Option for Muscle-Invasive Bladder Cancer

San Francisco, CA (UroToday.com)  Dr. Jason Efstathiou provided the argument for trimodal therapy (TMT) for muscle-invasive bladder cancer (MIBC) during the Challenges and Advances in Perioperative and Local Therapy for Urothelial Carcinoma session at GU ASCO. Dr. Jeanny Aragon-Ching from the Inova Schar Cancer Institute started the debate by presenting a case of a 64-year-old healthy male who presented with hematuria and underwent a CT scan demonstrating a 4-cm tumor at the left posterior wall. There was no hydronephrosis and no clinical lymphadenopathy. The patient’s eGFR was 74 ml/min. Cystoscopy confirmed the tumor and no other mass was notable on examination under anesthesia. Complete transurethral resection of the bladder tumor achieved an R0 resection. The clinical pathology was T2 high-grade urothelial cancer with pathology showing carcinoma with squamous features.

ASCO GU 2019: Interim Analysis of Ibrutinib Plus Paclitaxel for Patients with Metastatic Urothelial Carcinoma Previously Treated with Platinum-Based Chemotherapy

San Francisco, CA (UroToday.com)  Patients with advanced urothelial carcinoma who progress on platinum-based chemotherapy generally have a poor prognosis and limited treatment options. Immunotherapy has recently moved into both the first and second line space1. However, the majority of patients do not respond to immune checkpoint inhibition. For example, in KEYNOTE-045, only 21% of patients had an objective response with pembrolizumab. The objective response rates for chemotherapy remain low – in that same study where the control group received investigators choice of chemotherapy which included paclitaxel, docetaxel, or vinflunine, the ORR was only 11.4%. Thus, there is an unmet need for additional therapies for patients who have progressed on platinum-based chemotherapy. 

ASCO GU 2019: Fierce-21: Phase II Study of Vofatamab, a Selective Inhibitor of FGFR3, as Salvage Therapy in Metastatic Urothelial Carcinoma

San Francisco, CA (UroToday.com)  Dr. Necchi presented the Fierce-21 phase 2 study of vofatamab, a selective inhibitor of FGFR3, as salvage therapy in metastatic urothelial carcinoma. Patients with metastatic urothelial carcinoma who have failed platinum-based chemotherapy have a poor prognosis. Approximately 20% of these patients harbor fibroblast growth factor receptor 3 (FGFR3) mutations or fusions. FGFR3 alterations have been shown preclinically to be oncogenic drivers of bladder cancer. FGFR3 inhibitors are revolutionizing the clinical management of metastatic urothelial carcinoma in biomarker-selected and potentially poor immunoncology responding patients.  

ASCO GU 2019: Radical Cystectomy is the Best Option for Muscle-Invasive Bladder Cancer

San Francisco, CA (UroToday.com) The Challenges and Advances in Perioperative and Local Therapy for Urothelial Carcinoma session was highlighted by a debate regarding the optimal treatment of muscle-invasive bladder cancer. Dr. Jeanny Aragon-Ching from the Inova Schar Cancer Institute started the debate by presenting a case of a 64-year-old healthy male who presented with hematuria and underwent a CT scan demonstrating a 4-cm tumor at the left posterior wall. There was no hydronephrosis and no clinical lymphadenopathy. The patient’s eGFR was 74 ml/min. Cystoscopy confirmed the tumor and no other mass was notable on examination under anesthesia. Complete transurethral resection of the bladder tumor achieved an R0 resection. The clinical pathology was T2 high-grade urothelial cancer with pathology showing carcinoma with squamous features. At this point in the presentation, Dr. Aragon-Ching polled the audience, who overwhelmingly voted (73% vs 27% for trimodal therapy) that radical cystectomy was the best treatment of choice.

ASCO GU 2019: Multimodality Treatment in Challenging Cases of Urothelial Carcinoma: Case Panel Discussion

San Francisco, CA (UroToday.com) In this case panel discussion, 3 patient cases were reviewed highlighting important points in the management of bladder cancer. The text below includes a summary of each case presented and key points made by the panelists.

Case 1: Small Cell Bladder Cancer: 65-year-old man who presents feeling lethargic, 10 lb weight loss, poor appetite. He has microscopic hematuria. Cystoscopy and subsequent TURBT demonstrates small cell bladder cancer.

ASCO GU 2019: Genomic Insights and Biomarkers for Treatment Selection in Muscle-Invasive and Non-Muscle-Invasive Bladder Cancer

San Francisco, CA (UroToday.com) Dr. Yair Lotan presented on Genomic Insights and Biomarkers for Treatment Selection in Muscle-Invasive and Non-Muscle-Invasive Bladder Cancer. He discussed the role of markers in bladder cancer and how they add independent information that can impact patient care. The markers can either be prognostic which provide information about patient’s overall cancer outcome, regardless of therapy, or predictive markers that provide information about the effect of the therapeutic intervention and can be a target for therapy.

ASCO GU 2019: Immunotherapy Across Genitourinary Malignancies

San Francisco, CA (UroToday.com)  Dr. James L. Gulley presented the Keynote Lecture for the GU ASCO 2019 annual symposium discussing immunotherapy across genitourinary malignancies. Dr. Gulley started by highlighting that GU cancers are the original immune responsive tumors, dating back to the 1980’s when interferon was used for renal cell carcinoma (RCC), to BCG for bladder cancer in 1990, and IL-2 for RCC in 1992. More recently, we have seen Sipuleucel-T for castrate-resistant prostate cancers (CRPC) in 2010, PD-1 and PD-L1 inhibitors for RCC in 2015 and in bladder cancer in 2016. As Dr. Gulley depicts, the pathway (with associated inhibitors) for immunogenic cell death are as follows:
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