AUA 2018: Treatment for MIBC for Cis-Platinum Ineligible Patients: Other Systemic Options and Trials

San Francisco, CA (UroToday.com) Evan Yu, MD, a medical oncologist from the University of Washington, provided a rebuttal to Dr. Jonathan Wright’s ‘immediate cystectomy’ for platinum ineligible patients presentation. Yu started by highlighting two classic trials assessing the efficacy of neoadjuvant chemotherapy for bladder cancer.

AUA 2018: High Risk BCG Recurrent/Refractory Disease: Immediate Cystectomy

San Francisco, CA (UroToday.com) Nick Liu, MD from SUNY Upstate provided the rebuttal to Dr. Sima Porten’s presentation on secondary therapy for high risk BCG recurrent/refractory disease. His opinion is that immediate cystectomy saves lives in BCG failure bladder cancer patients. Although there are broad/many definitions for BCG failure, Liu defines BCG failure as any recurrent disease after initiation of BCG therapy.
 

AUA 2018: Phase 3 Study of Vicinium in BCG-Unresponsive Non-Muscle Invasive Bladder Cancer: Initial Results

San Francisco, CA (UroToday.com) Radical cystectomy remains a major operation with significant implications on patient quality of life (QOL). For non-muscle invasive bladder cancer, especially high-grade disease, the mainstay of the therapy is intravesical BCG – while it has been demonstrated to help reduce progression to muscle-invasion, we have limited alternative options for patients who progress despite BCG. Many agents are in development, but few have demonstrated adequate efficacy and tolerability to become an established therapy. 

AUA 2018: Results of CALIBER: A Phase II Randomized Feasibility Trial of Chemoablation vs Surgical Management in Low Risk Non-Muscle Invasive Bladder Cancer

San Francisco, CA (UroToday.com) Non-muscle invasive bladder cancer represents approximately 70% of bladder cancer diagnoses. In addition to preventing progression to muscle-invasive disease, a significant focus of management is reducing recurrence rates – unfortunately, due to high rates of recurrence, patients undergo frequent surveillance with cystoscopy and intermittent upper tract evaluations. These repeated interventions are not without risks, and anything to reduce recurrence and thereby reduce the need for interventions has significant patient and the health system implications.

AUA 2018: Non-Surgical Management of Low Grade Upper Tract Urothelial Cancer: an Interim Analysis of the International Multicenter OLYMPUS Trial

San Francisco, CA (UroToday.com) Upper tract urothelial carcinoma (UTUC) is a difficult disease process to manage. With understaging, a major problem in the evaluation of patients, and biopsy of lesions technically difficult, management is often based on biopsy, urine cytology, and imaging. Management options are also broad, depending on risk stratification. High grade disease is recommended for radical nephroureterectomy due to the risk of understaging. However, for low-grade UTUC, management options are more varied – nephron-sparing options are preferred, as patients are at persistent risk of bladder and contralateral disease.

AUA 2018: CG0070, an Oncolytic Adenovirus, for BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer: 12 Month Interim Results from a Multicenter Phase II Trial

San Francisco, CA (UroToday.com) CG0070 is a selective oncolytic adenovirus that targets bladder tumor cells through their defective retinoblastoma pathway. It is a cancer selective, replication competent adenovirus. Burke et al.1 first demonstrated its safety and efficacy as an intravesical therapy in a phase I study – they assessed single vs. multiple doses of CG0070 in 35 patients with NMIBC. Four dose levels were assessed (1 × 1012, 3 × 1012, 1 × 1013 or 3 × 1013 viral particles).

AUA 2018: High Risk BCG Recurrent/Refractory Disease: Secondary Intravesical Therapy

San Francisco, CA (UroToday.com) Dr. Sima Porten from UCSF provided a discussion of secondary intravesical therapy for patients with high-risk BCG recurrence/refractory disease at the SUO bladder cancer session. Dr. Porten started by noting several important definitions:

  • BCG refractory: patients who do not reach a disease-free state at 6 months after starting BCG (at least induction + maintenance) for high risk NMIBC (Ta/T1/CIS)
  • BCG relapsing: patients who reach a disease-free state at 6 months, and continue on BCG, but later recur within 6 months of the last dose of BCG
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