CUOS 2019: Neoadjuvant Chemotherapy Guided by Molecular Subtyping

Toronto, Ontario ( Dr. Peter Black presented on why we need to use molecular subtyping to decide which patients with muscle-invasive bladder cancer should get neoadjuvant chemotherapy before radical cystectomy.

CUOS 2019: Neoadjuvant Chemotherapy for All Muscle-Invasive Bladder Cancer

Toronto, Ontario ( Dr. Nimira Alimohamed presented her opinion of the question in debate: neoadjuvant chemotherapy for all muscle-invasive bladder cancer versus neoadjuvant chemotherapy guided by molecular subtyping.  Dr. Alimohamed believes all medically fit patients with muscle-invasive bladder cancer should be offered neoadjuvant chemotherapy before radical cystectomy. Furthermore, she strongly believes that neoadjuvant chemotherapy should not be guided by molecular subtyping at this point. Neoadjuvant chemotherapy has been shown to confer a survival benefit with a difference of more than 30 months (77 vs. 46 months).1 There are, however, still several unresolved issues with the current standard of care:

CUOS 2019: Robotic Radical Cystectomy, Controversial Topics in Urothelial Carcinoma

Toronto, Ontario ( Radical cystectomy is the gold standard surgical therapy for muscle-invasive bladder cancer and refractory non-muscle invasive bladder cancer. Open radical cystectomy is a highly morbid procedure, with a very extended recovery period. Robotic radical cystectomy is a procedure with a potentially faster recovery period, with potential greater benefit to the patients and the surgeon.

CUOS 2019: Open Radical Cystectomy, Controversial Topics in Urothelial Carcinoma

Toronto, Ontario ( Dr. Adrian Fairey provided his discussion supporting the use of open radical cystectomy instead of robotic radical cystectomy for the treatment of muscle-invasive bladder cancer. According to Dr. Fairey, open radical cystectomy is the standard of care surgical treatment modality for bladder cancer. In the Canadian universal healthcare system in 2019, robotic cystectomy should not be recommended as a surgical treatment modality outside of a clinical trial.

CUOS 2019: Immune-Checkpoint Inhibition with Radiation in Bladder Cancer: In Situ and Abscopal Effects

Toronto, Ontario ( Urothelial cell carcinoma is radiosensitive cancer. Bladder-sparing approaches are rising in practice in the western world. However, response optimization in this specific therapy is still being studied. 20-30% of patients treated with trimodal therapy will require salvage cystectomy, and 40-50% of muscle-invasive bladder cancer patients will develop metastases.

CUOS 2019: Photodynamic Therapy for Bladder Cancer: Results of a Phase Ib Clinical Trial

Toronto, Ontario ( Non-muscle invasive bladder cancer constitutes 75% of all bladder cancer cases. It has very high recurrence rates of 60-70% with a progression rate of 20-30%. Only three drugs have been approved in the last 30+ years for this entity: Bacillus Calmette–Guérin (BCG), Thiotepa, and Valrubicin. To date, there are no standard therapies for patients after BCG failure, other than radical cystectomy.

CUOS 2019: The Search for a Better Biomarker

Toronto, Ontario ( There is ample evidence demonstrating that immunotherapy works well in urothelial cancer with multiple phase 1,2, and three studies resulting in fast FDA approval of several immunotherapy agents in urothelial carcinoma. These agents are generally well-tolerated. Overall survival rates with these agents have been shown to improve when given in the 2nd line setting.
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