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PEER-TO-PEER CLINICAL CONVERSATIONS |
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| The Future of Radiation and Anti-PD-1 Agents in Non-Muscle Invasive Bladder Cancer: An In-Depth Look at Ongoing Trials |
| Kent Mouw, MD, Ph.D. |
| Kent Mouw discusses the evolving role of radiation in treating non-muscle invasive bladder cancer, emphasizing that there's no standard role for definitive radiation yet. He presents data from various trials, including RTOG 0926 and a Chinese study involving tislelizumab, an anti-PD-1 agent. |
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A Clinical Exploration of Radiation and Trimodality Therapy in Bladder Cancer Presentation
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Scott Delacroix, Jr, MD
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| Scott Delacroix presents on the role of radiation therapy in treating non-muscle invasive bladder cancer, focusing on its potential and his personal experiences with trimodality therapy for muscle-invasive bladder cancer. He discusses a Single Arm Phase 2 study (RTOG 0926) and its outcomes and presents data on combining immunotherapy with radiation therapy, showing some promising results in small studies.
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| The Complex Case of a 46-Year-Old Smoker with High-Grade T1 Bladder Cancer Presentation |
| Jennifer Yates, MD |
| Jennifer Yates elaborates on the challenges of managing variant histology in bladder cancer, stressing the need for aggressive treatment and specialized pathology review. She also debates the efficacy of Bacillus Calmette-Guérin treatment in such cases. |
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| BCG-Unresponsive Non-Muscle Invasive Bladder Cancer: Immune Checkpoint Inhibitors
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| Rashid Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
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| The standard treatment for high-risk non-muscle invasive bladder cancer (NMIBC) is intravesical Bacillus Calmette-Guerin (BCG), but up to 50% of patients may develop BCG-refractory disease. Immune checkpoint inhibitors like pembrolizumab have shown promise in BCG-unresponsive NMIBC, with notable response rates in clinical trials. Ongoing research is evaluating combinations of these inhibitors with other agents to improve outcomes in this challenging disease space.
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| Pembrolizumab and Beyond for BCG-Unresponsive, High-Risk, Non-Muscle Invasive Bladder Cancer |
| Evan Yu, MD |
| Pembrolizumab's FDA approval marked a significant advancement for BCG-unresponsive high-risk NMIBC, offering an alternative to radical cystectomy. While showing a 41% complete response rate, sustained response remains limited, prompting ongoing trials exploring novel agents and combinations, such as N-803 with BCG, and investigating various modalities like intravesical chemotherapy and immunotherapy to address the persistent unmet need in this patient population. |
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| A Restaging Transurethral Resection of Bladder Tumor Is Always Necessary For High-Grade T1 Non-Muscle Invasive Bladder Cancer - Beyond the Abstract |
| Benjamin Lichtbroun, MD |
| The necessity of restaging transurethral resection of bladder tumor (TURBT) for high-grade T1 bladder cancer patients is emphasized due to its ability to unveil residual tumor and upstaging, which significantly influences treatment pathways and outcomes. Delaying diagnosis of muscle-invasive disease can decrease overall survival, as nearly half of patients initially diagnosed with non-muscle invasive disease are found to have muscle invasion upon cystectomy, often with variant histology missed in the initial TURBT. |
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| BCG-Unresponsive Disease
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| Seth Lerner, MD
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| Seth Lerner addresses BCG unresponsive disease in high-risk non-muscle invasive bladder cancer, emphasizing the revised definition and highlighting cystectomy as the standard of care. Dr. Lerner delves into alternative treatments like Valrubicin, Pembrolizumab, and Gemcitabine, as well as ongoing clinical trials exploring novel therapies such as intravesical gemcitabine plus systemic pembrolizumab.
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