Bladder Cancer

"With intravesical chemotherapy, there aren't the side effects we see with intravenous chemotherapy because the drugs only treat the bladder lining and very little, if any, of the medicine gets absorbed in the bloodstream," said Nitin Yerram, MD.

An overview of the study design, patient populations, and eligibility of the KEYNOTE-057 trial, which studied pembrolizumab in patients with high-risk NMIBC.

Eric A. Singer, MD, MA, FACS, an expert urologic oncologist, discusses the use of Bacillus Calmette-Guerin (BCG) as a first-line therapy for non-muscle-invasive bladder cancer (NMIBC), and reviews subsequent treatment options for patients with high-risk NMIBC who are found to be unresponsive to BCG.

Siamak Daneshmand, MD, discusses the safety profile for TAR-200 from the phase 2b SUNRISE-1 trial, which explored the novel intravesical chemo delivery system in patients with BCG-unresponsive on–muscle-invasive bladder cancer.

Siamak Daneshmand, MD, discusses initial findings from the phase 2b SUNRISE-1 trial exploring the novel intravesical chemotherapy delivery system TAR-200 in non–muscle-invasive bladder cancer.

In the study, 69% of patients who underwent complete ablation had no visible disease at first endoscopic evaluation, compared with 40% of patients who underwent chemoablation therapy.

Of all malignant bladder cancer lesions, 28% were only identified with blue light.

"This study looks at comparing BCG, which is our classic mainstay in the treatment of high-risk non-muscle–invasive bladder cancer to intravesical gemcitabine-docetaxel," says Diana Magee, MD.

“The medication is given once a week for 6 weeks. It is an outpatient procedure with general anesthesia. And it is typically covered by insurance,” said Joseph Brito, MD.

"What was great about this partnership is we recognized that this is going to be the future of medicine at some point, and we want to be able to be a part of that cutting edge technology," says Nitin K. Yerram, MD.

The FDA has issued a complete response letter to ImmunityBio regarding its biologics license application for N-803 (Anktiva) for use in combination with BCG for the treatment of patients with non–muscle-invasive bladder cancer.

"Proxies for social determinants of health that we found to be associated with higher overall mortality included living in a more deprived area, as well as having Medicaid or Medicare insurance," says David Miller, MD.

The methylation-based urine test is performed on a qPCR platform and is intended for use in conjunction with cystoscopy.

Preliminary findings from the single-arm, phase 2 CORE-001 trial showed that the combination of the oncolytic immunotherapy cretostimogene grenadenorepvec (CG0070) and pembrolizumab (Keytruda) elicited a high complete response rate in patients with BCG–unresponsive non–muscle invasive bladder cancer.

“The results of the study imply that UGN-101 is not only a renal-preserving therapy for UTUC in this comorbid population, but could potentially delay the time to dialysis or radical nephroureterectomy," says Kyle M. Rose, MD.

The guideline updates span non-metastatic upper tract urothelial carcinoma, female stress urinary incontinence, urethral stricture disease, and prostate cancer.

"Our findings underscore the commercial and market factors that have been influencing bladder cancer care," says Brian Chun, MD.

Shilpa Gupta, MD, shares her expert insight on the evolving treatment paradigm for patients with muscle-invasive bladder cancer, along with obstacles that must be overcome to further advance the field.

"In the periods where BCG utilization dropped, we saw a concomitant increase in mitomycin C," says Brian Chun, MD.

"Our preliminary clinical trial found that TAR-200 was generally safe, well tolerated, and had beneficial effects on bladder cancer outcomes in a group of patients with limited treatment options," said Mark Tyson, MD, MPH.

“I think clinicians can really take away that we have more work to be done in this space of evaluating patients with microhematuria, specifically when it comes to looking at assessments of upper tract urothelial carcinoma or renal cell carcinoma,” says Jacob Taylor, MD, MPH.

The investigators identified several genetic factors, including ARID1A mutation, that correlated with survival outcomes in patients with advanced urothelial carcinoma treated with immune checkpoint blockade.

"Understanding work productivity and activity impairment in the context of the treatment decisions are vital, not just for the provider who has to counsel on treatment benefits and risks, but also to the patient who's making the ultimate decision," says Angela Smith, MD, MS.

The current study is welcome news as it lends further support to the use of intravesical Gem/Doce as a safe and effective option that has the potential to become a new standard of care for high-risk NMIBC.

"From a urology provider perspective, we should be discussing this with our patients [with bladder cancer] as they make their treatment decisions," says Angela Smith, MD, MS.

Arya Mariam Roy, MBBS, discusses the effect of neoadjuvant chemotherapy on overall survival in patients with sarcomatoid bladder cancer.

The approval of pembrolizumab plus enfortumab vedotin in urothelial cancer was supported by results from the EV-103/KEYNOTE-869 trial.

“The readers of our paper should really understand that in microhematuria specifically, a lot of the recommendations are based on small amounts of data,” says Jacob Taylor, MD, MPH.

“First, we found that we should not be using voided samples for bladder cancer research,” says Laura Bukavina, MD, MPH.

No CxM-negative patients had findings of a recurrent tumor on a follow-up cystoscopy.