ESOU18: Is There a Role for Localized Treatment in Metastatic Bladder Cancer? - The Medical Oncologist Approach

Amsterdam, The Netherlands ( The multimodal approach should be used in treating metastatic bladder cancer (BC) patients. The therapeutic area has evolved rapidly for metastatic BC since the approval of the immune checkpoint inhibitor (ICPI) Atezolizumab (Figure 1). The current treatment algorithm for metastatic urothelial BC patients (Figure 2) involves chemotherapy at the first stage, immune checkpoint inhibitor (ICPI) and 2nd line chemotherapy. This field continues to evolve as there are currently a plethora of clinical trials for first line metastatic BC (Figure 3).

We ask ourselves if there is any place for surgical treatment post systemic therapy with chemotherapy or with ICPI? This includes cytoreductive surgery or consolidative surgery. After completion of first line platinum based chemotherapy, patients can either be referred to clinical trials, receive maintenance therapy, be actively monitored or undergo postchemotherapy surgery. Patients referred for postchemothearpy surgery should generally have no pulmonary metastasis, have only pelvic metastasis, and be ECOG-PS status 0. Patients with multiple visceral metastasis or retroperitoneal lymph nodes involved, at any ECOG-PS status should be actively monitored. Patients with visceral metastasis could also receive maintenance therapy, while patients with a high ECOG-PS status, with multiple visceral metastasis, and with driver molecular alterations should be referred for clinical trials.

Trials assessing the role of surgery, in all its forms, should be conducted to understand its tole in this advanced state of disease.

Figure 1: Evolution of Bladder Cancer Treatments:

Figure 2: Current Treatment Algorithm for Metastatic Bladder Cancer:

Figure 3: Recruiting Trials for First-line Metastatic Bladder Cancer:

 Andrea Necchi, MD Department of Medical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

Written By:
 Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands