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Highlights from the 2025 European Association of Urology Annual Meeting |
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Rapid-Fire Debates: Common Problems and Controversies in Bladder Cancer
Thematic Session
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| Patient with High-Risk NMIBC - Is BCG Still the Best Option in 2025? Yes, BCG Is Still King |
| Gianluca Giannarini, MD |
| Gianluca Giannarini argued that BCG remains the best option for high-risk non-muscle invasive bladder cancer, using "BCG" as an acronym for its key advantages: Benefit, Cost, and Grounded. BCG offers high complete response rates (up to 85% for CIS) and strong long-term recurrence-free and progression-free survival. It is also cost-effective, widely accessible, and easy to administer without requiring specialized infrastructure. |
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| Patient with High-Risk NMIBC - Is BCG Still the Best Option in 2025? No, Time to Dethrone BCG |
| Laura S. Mertens, MD, PhD |
| Laura Mertens argued that while BCG has been the standard for high-risk non-muscle invasive bladder cancer, its efficacy needs improvement, with 5-year recurrence-free survival rates of 39-66% and high treatment discontinuation rates. She highlighted challenges such as the infeasibility of prolonged BCG maintenance, significant toxicity, and the need for better patient selection and response monitoring. |
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| BCG Unresponsive Disease - How Much Risk Can My Patient Tolerate? One Line of Salvage Therapy Before Proceeding to Radical Cystectomy |
| Maria Carmen Mir, PhD |
| Maria Carmen Mir argued that patients with BCG-unresponsive bladder cancer should receive one line of salvage therapy before radical cystectomy, as many patients prefer to delay surgery despite associated risks. However, she highlighted that salvage therapies have declining efficacy, with over 50% of patients eventually requiring cystectomy, and progression to muscle-invasive disease worsens survival outcomes. |
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| BCG Unresponsive Disease - How Much Risk Can My Patient Tolerate? Sequential Therapies Can Be Safely Offered |
| Ashish Kamat, MD, MBBS |
| Ashish Kamat argued that sequential therapies can be safely offered for BCG-unresponsive non-muscle invasive bladder cancer (NMIBC), emphasizing a personalized approach over a fixed number of treatment lines. He highlighted emerging therapeutic options, including TAR-200, cretostimogene + pembrolizumab, and gemcitabine + docetaxel, noting comparable survival outcomes between bladder-sparing approaches and early radical cystectomy. |
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| How Radical Should a TURBT Be in MIBC? A Maximal TURBT Is Needed
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| Fredrik Liedberg, MD
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| Fredrik Liedberg argued that a maximal transurethral resection of bladder tumor (TURBT) is essential for managing muscle-invasive bladder cancer (MIBC). He emphasized that, regardless of whether patients pursue radical cystectomy or trimodality therapy, an aggressive TURBT provides benefits.
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| How Radical Should a TURBT Be in MIBC? Only Diagnostic TURBT Is Sufficient
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| Marco Moschini, MD, PhD, FEBU
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| Marco Moschini argued that only a diagnostic TURBT is necessary for muscle-invasive bladder cancer (MIBC), as studies show no significant survival benefit from complete TURBT before radical cystectomy or neoadjuvant chemotherapy. He emphasized that TURBT should focus on confirming muscle invasion (T2) and identifying histological variants rather than achieving maximal resection.
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| Perioperative Outcomes of Neoadjuvant TAR-200 plus Cetrelimab or Cetrelimab Alone in Patients with MIBC Ineligible for or Refusing Neoadjuvant Cisplatin-Based Chemotherapy
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| Sarah Psutka, MD, MSc
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| Sarah Psutka presented perioperative outcomes from the SunRISe-4 trial, evaluating neoadjuvant TAR-200 + cetrelimab or cetrelimab alone in MIBC patients ineligible for or refusing cisplatin-based chemotherapy. TAR-200 + cetrelimab demonstrated higher pathological complete and overall response rates than cetrelimab monotherapy, with preserved health status and no significant delays in radical cystectomy.
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| NIAGARA: Surgical Outcomes and Neoadjuvant Safety with Perioperative Durvalumab for Muscle-Invasive Bladder Cancer |
| James Catto, MB ChB PhD FRCS(Urol) |
| James Catto presented surgical and safety outcomes from the NIAGARA trial, the first global phase 3 study evaluating perioperative durvalumab plus neoadjuvant chemotherapy in cisplatin-eligible MIBC patients. The trial demonstrated significant improvements in event-free survival (HR 0.68) and overall survival (HR 0.75), with a 10% increase in pathological complete response. |
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| Discussant - NIAGARA - Surgical Outcomes and Neoadjuvant Safety with Perioperative Durvalumab for Muscle-Invasive Bladder Cancer
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| Geraldine Pignot, MD
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| Geraldine Pignot discussed the surgical outcomes and neoadjuvant safety from the NIAGARA trial, focusing on the impact of perioperative durvalumab combined with chemotherapy for muscle-invasive bladder cancer (MIBC). She highlighted that the addition of durvalumab did not delay cystectomy or increase surgical complications.
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| On the Horizon: Ongoing Trials in Urology |
| A Phase 1/2 Study of Detalimogene Voraplasmid (EG-70) Intravesical Monotherapy for Patients with High-Risk Non-Muscle Invasive Bladder Cancer – Trial in Progress |
| Felix Guerrero-Ramos, MD, PhD, FEBU |
| Felix Guerrero-Ramos presented the ongoing Phase 1/2 study of detalimogene voraplasmid (EG-70) for BCG-unresponsive high-risk non-muscle invasive bladder cancer (NMIBC). The investigational therapy aims to stimulate both innate and adaptive immune responses locally within the bladder, offering a potential bladder-sparing alternative to radical cystectomy. |
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