AUA 2018: Journal of Urology: Top Papers in Bladder and Renal Cancer

San Francisco, CA (UroToday.com) Badrinath Konety, MD, the editor responsible for bladder and kidney related papers at the Journal of Urology, presented the top articles in these areas in the past year from the journal. While not comprehensive, he felt they highlighted the most impactful of the papers. There were a total of 43 of these papers in 2017 and 35 in 2018. There were 5 that had the highest social media activity:

AUA 2018: Results of POUT - Phase III Randomized Trial of Peri-Operative Chemotherapy vs. Surveillance in Upper Tract Urothelial Cancer

San Francisco, CA (UroToday.com) The role of post-radical nephroureterectomy (RNU) treatment for upper tract urothelial carcinoma (UTUC) is unclear. POUT (CRUK/11/ 027; NCT01993979) is a UK led trial that addresses whether adjuvant chemotherapy improves disease-free survival (DFS) for patients with histologically confirmed pT2-T4 N0-3 M0 UTUC.  A total of 345 patients, with a WHO performance status 0-1, 90 days post-RNU were randomized (1:1) to 4 cycles of gemcitabine-cisplatin (gemcitabine-carboplatin if GFR 30-49ml/min) or surveillance with chemotherapy at recurrence if required. Pts had 6 monthly cross sectional imaging & cystoscopy for a duration of 2 years, then annually for 5 years. 

AUA 2018: Racial Disparities in Quality of Care and Overall Survival among Muscle-Invasive Bladder Cancer Patients treated with Radical Cystectomy

San Francisco, CA (UroToday.com)  Across the oncologic spectrum, patients of African-American (AA) race generally have inferior short and long-term outcomes compared to Caucasian patients. Specific to bladder cancer, previous studies have demonstrated that AA patients are more likely to present with metastatic bladder cancer [1]. Despite socioeconomic differences and presentation at advanced disease stages, these disparities may be due to lower utilization of radical cystectomy among AA patients [2]. However, studies assessing survival disparities explicitly in patients undergoing radical cystectomy for muscle invasive bladder cancer (MIBC) are limited. As such, Dr. Gild and colleagues at the invasive bladder cancer session at the 2018 AUA discussed findings of their population-based analysis examining the impact of race on quality of care and overall survival (OS) among patients with MIBC treated with radical cystectomy. 

AUA 2018: Neoadjuvant Pembrolizumab Before Radical Cystectomy for Muscle-Invasive Bladder Cancer: Interim Results from PURE-01

San Francisco, CA (UroToday.com) For the past 15 years, the urologic oncology community has had level 1 evidence suggesting a survival benefit among patients that receive cisplatin-based neoadjuvant chemotherapy for muscle invasive bladder cancer (MIBC) prior to radical cystectomy compared to immediate radical cystectomy1. However, for a variety of reasons, neoadjuvant chemotherapy is only administered to a minority of patients. With the recent reporting of KEYNOTE-045 in 20172, pembrolizumab was associated with significantly longer overall survival (by approximately 3 months) and a lower rate of treatment-related adverse events than chemotherapy as second-line therapy for platinum-refractory bladder cancer. As such, this piqued interest in using pembrolizumab in the neoadjuvant setting.  Dr. Necchi and colleagues presented results of their phase 2 PURE-01 trial assessing pembrolizumab before radical cystectomy for MIBC.

AUA 2018: Development of a Predictive Nomogram to Predict Overall Survival Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

San Francisco, CA (UroToday.com) The authors presented a study aiming to design a nomogram to predict patient-specific overall survival in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).

AUA 2018: Can Imaging Response Following Neoadjuvant Chemotherapy in Upper Tract Urothelial Cancer Be a Surrogate For Pathologic Response?

San Francisco, CA (UroToday.com) Pathological response following neoadjuvant chemotherapy (NAC) has been shown to be an excellent surrogate for survival in bladder cancer. However, in upper tract urothelial cancer (UTUC), unlike bladder, preoperative endoscopic and pathologic assessment of response is difficult. The authors presented a study aiming to determine whether imaging response following NAC predicted the final pathologic stage and outcomes following radical nephroureterectomy (RNU).

AUA 2018: Incidence of Lower Pathologic Stage in Patients Treated with Neoadjuvant Chemotherapy for High-Risk Upper Tract Urothelial Carcinoma

San Francisco, CA (UroToday.com) It is known that high-risk upper tract urothelial carcinoma (UTUC) has been associated with poor survival outcomes. There are limited retrospective data supporting the use of neoadjuvant chemotherapy prior to radical nephroureterectomy (RNU). In this study, the authors evaluated the change in pathologic stage distribution in patients with high-risk UTUC who underwent neoadjuvant chemotherapy followed by RNU to validate prior findings.
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