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PEER-TO-PEER CLINICAL CONVERSATIONS |
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The Clinical Application of Circulating Tumor DNA in Bladder Cancer Prognosis and Surveillance
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Nirmish Singla, MD, MSc, FACS,
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| Nirmish Singla reviews circulating tumor DNA utility across urothelial carcinoma disease states with Sam Chang. The biomarker has a two-hour half-life enabling real-time disease burden assessment using personalized tumor-informed platforms like Signatera.
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Biomarkers for Guiding Bladder Cancer Treatment Decisions
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Andrea Necchi, MD
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| Ashish Kamat interviews Andrea Necchi about biomarkers in bladder cancer management. Dr. Necchi reviews immunotherapy biomarkers including tumor mutational burden, emphasizing its continuous value relationship with checkpoint inhibitor efficacy, while acknowledging measurement standardization challenges.
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Survey Uncovers Evolving Trends in Advanced Bladder Cancer Care
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Ali Khaki, MD
Zachary Klaassen speaks with Ali Khaki about a survey examining treatment decisions after prior immune checkpoint inhibitor exposure in urothelial carcinoma. With the boom in immunotherapy moving into earlier disease stages—including EV-pembrolizumab approval for first-line metastatic disease and various non-muscle invasive studies—the key question became whether immunotherapy remains viable after prior exposure.
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| Real-World Use and Effectiveness of First-Line Enfortumab Vedotin with Pembrolizumab in Patients with Advanced Urothelial Carcinoma in the US
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| Zeynep Irem Ozay, MD
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| First-line enfortumab vedotin plus pembrolizumab has been rapidly adopted in US clinical practice for advanced urothelial carcinoma, rising to 62% of first-line regimens by 2025. In this large real-world cohort, median overall survival was 17 months and median time to next therapy was 11 months, broadly aligning with trial data and supporting EV+P as an effective standard-of-care option.
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| Opportunities for Precision Oncology: Real-World Patterns and Disparities in FGFR3 Testing Among US Patients with Locally Advanced/Metastatic Urothelial Cancer
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| Emily Smyth, PharmD
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| Emily Smyth presents a large US real-world cohort of 3,661 patients with locally advanced/metastatic urothelial carcinoma, fewer than half ever underwent FGFR3 genomic testing, and under one-third were tested before starting first-line therapy, despite guideline recommendations and an actionable alteration rate of about 19%.
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| Treatment Patterns and Outcomes with Second-Line Therapies in Patients with Advanced Urothelial Carcinoma Previously Treated with First-line Enfortumab Vedotin with Pembrolizumab
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| Georges Gebrael, MD
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| Second-line options after first-line enfortumab vedotin plus pembrolizumab for advanced urothelial carcinoma are highly heterogeneous and yield only modest outcomes, with median overall survival generally under 1.5 years across platinum-based regimens, EV rechallenge, and targeted/ADC-based therapies.
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| Outcomes with Subsequent Therapies Post-Enfortumab Vedotin/Pembrolizumab in Patients with Advanced Urothelial Carcinoma: Analysis of the UNITE Study
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| Cindy Y. Jiang, MD
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| Second-line therapies after first-line enfortumab vedotin plus pembrolizumab (EVP) in advanced urothelial carcinoma showed modest activity, with a 24% response rate, median progression-free survival of ~2.8 months, and median overall survival of ~9 months from second-line start. Platinum-based chemotherapy was the most commonly used approach, but no second-line strategy demonstrated a clear survival advantage, highlighting the need for better post-EVP options.
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| Circulating Tumor DNA in Muscle-Invasive Bladder Cancer: Promise, Pitfalls, and Path Forward - Beyond the Abstract
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| Clara Cerrato, MD, and Maria Carmen Mir, MD
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| Circulating tumor DNA is emerging as a powerful but still imperfect tool to guide adjuvant immunotherapy and surveillance in muscle‑invasive bladder cancer, with tumor‑informed assays offering high sensitivity but practical and cost limitations, and tumor‑agnostic panels trading sensitivity for speed and flexibility.
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