BCG Unresponsive NMIBC: What s Available?
|
|
- Godwin Farmer
- 5 years ago
- Views:
Transcription
1 BCG Unresponsive NMIBC: What s Available? Michael S. Cookson, MD, MMHC, FACS Professor and Chair Department of Urology University of Oklahoma
2
3 Professional Practice Gap Gap 1: There is incomplete understanding of the definition of BCG unresponsive or BCG failure Gap 2: Management options for patients with BCG unresponsive NMIBC are not well understood and are currently evolving
4 Learning Objectives Upon completion of this session, participants will improve their competence and performance by being able to: 1. Recognize the definitions of BCG failure 2. Outline the management options for patients with BCG failure 3. Discuss future clinical trial in BCG failure patients
5 BCG Indications Any pa1ent with high risk NMIBC TaHG, T1, and all CIS; also op1on for mul1focal and recurrent and >3cm Ta LG Recurrent BCG naïve AKer BCG induc1on if no indica1on for cystectomy or medically unfit FDA approved for CIS and high risk Ta,T1 Chang SS et al. J Urol 2016: 196(4); 1021
6 Has Become U.S. Standard of Care SWOG BCG Maintenance 2-year RFS 82% vs. 62% with/without p < maintenance 5-year RFS 60% vs. 41% with/without maintenance Lamm DL, et al. J Urol 2000; 163:1124
7 The Problem: Some Will Fail BCG Despite benefits of BCG, long-term disease-free and progression-free survival may be difficult to achieve 50% will recur aher inducion BCG, and while 20-30% may be salvaged with addiional BCG BCG failure may be lethal if untreated Key: To idenify those failures early Logan C, et al. BJU Int 2012; 110:12
8 Consider Extravesical Sites Retrospec4ve analysis of 110 pa4ents with high-risk disease and BCG NMIBC repeatedly treated with intravesical BCG 52% had UUT and/or urethral carcinoma 48% had intravesical recurrence alone Giannarini G, et al: Eur Urol 2014; 65(4):825
9 Importance of Prostatic Involvement BCG treatment failed in 62 high-risk cases; patients underwent cystectomy Prostatic urethra TCC most important predictor of muscle-invasive cancer Hazard ratio, 12.2 ( ) P=.003 Sampling from the urethra in high-risk patients is essential! Huguet J, et al. Eur Urol 2005; 48:53
10 BCG Unresponsive Failure to achieve a disease free state 6 months after initial BCG therapy with either maintenance or retreatment at 3 months due to either rapidly recurrent or persistent high grade disease Time 0 BCG Induction Time: 3 months Tumor + Re-induction or Maintenance Time: 6 months Tumor + Herr HW. J Urol 169: , 2003 Nieder AM, et al. Urology 66(S6A): , 2005
11 Why is 6 Months Important? 6 months is the treatment period to identify high-risk tumors as truly refractory Herr HW and Dalbagni G. J Urol 169: , 2003
12 Defini&on: BCG Unresponsive Recurrent/persistent high grade urothelial carcinoma after completion of at least induction and one cycle maintenance BCG ( 5+2 ) for high grade Ta/T1 or CIS Never achieved CR or recurred within 6 months of last BCG dose T1HG at first evaluation after induction BCG at least 5 of 6 induction doses These patients are extremely unlikely to respond to further BCG Lerner S, et al, Bladder Cancer 1:29, 2015
13 High-grade disease T1 at the first evaluation following an induction BCG course BCG 5/6 3 mos cysto: HG T1 Persistent or recurrent CIS alone +/- Ta/T1 disease within 12 months of completion of adequate BCG therapy BCG 5/6 + BCG 2/3 or 2/6 CIS +/- Ta or T1 1 year of last BCG Recurrent high-grade Ta/T1 disease within 6 months of completion of adequate BCG therapy Ta or T1 BCG 5/6 + BCG 2/3 or 2/6 6 mos of last BCG FDA 2018, Center for Drug Evaluation and Research (CDER) Center for Biologics Evaluation and Research (CBER)
14 Novel Definition: Molecular Failure Goal: Incorporate marker (FISH) to predict BCG failure before it becomes clinically apparent 143 patients treated with BCG therapy followed prospectively for 2 years FISH assays collected at 6 weeks and 3 months Results of the FISH assays were correlated with clinical outcomes Kamat AM, et al. BJU Int. 2016; 117:
15 Recurrence and Progression-Free Survival based on FISH Kamat AM, et al. BJU Int. 2016; 117:
16 Novel Defini+on: Molecular Failure Result: FISH results correlated with recurrence Conclusion: Patients with an early positive FISH and a negative cystoscopy at 3 months should be considered molecular BCG failures and could enroll in prospective RCT s Kamat AM, et al. BJU Int. 2016; 117:
17 For Certain High Risk, NMIBC: The Most Definitive Therapy
18 Treatment Dilemma Cystectomy recommended as a standard of care a3er BCG failure Cystectomy: high rate of cure if performed before progression to muscle invasion Supported by AUA, NCCN, EAU Guidelines Unfortunately, morbidity remains high And, many with high risk NMIBC who fail BCG are not candidates for cystectomy Babjuk M,et al.eur Urol 2014; 59: Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Joint Guideline
19 Intravesical Therapy when BCG Fails BCG/IFN Valrubicin only FDA approved drug Gemcitabine Docetaxel Gemcitabine/MMC Gemcitabine/Docetaxel
20 Treatment Response Efficacy Endpoints: 6 mo CR of 50% in CIS 1 year Recurrence free survival of 30% 18 mo Recurrence free survival of 25% No home-runs in this space
21 BCG + IFN Multicenter Phase II: 1,007 patients (BCG naïve and failure At 24 months, 45% of BCG failure were disease-free Those with 2 or more prior courses of BCG or BCG-refractory had worse outcomes Rosevear, J Urol 2011; 186:817
22 Valrubicin: Pivotal Study Open-label, phase III trial 90 patients with CIS after prior IVe therapy 21% CR at 6 months 32% CR at 6 months if you consider that with low grade recurrences (10 pts) Overall progression was low But, only 8% remained NED at 30 months Steinberg G et al. J Urol. 2000;163:761-7.
23 Valrubicin: Take Home Message FDA-approved for patients with CIS who fail BCG and are unfit or unwilling to undergo a radical cystectomy Despite FDA approval, long-term DFS remains poor and highlights the need for additional bladder-conserving therapies
24 Gemcitabine Trials Inhibits DNA synthesis Introduced by Dalbagni (2002) as safe Efficacy demonstrated in multiple Phase II trials with BCG naïve and some failure patients Brooks NA & O Donnell MA: Indian J Urol. 2015; 31:
25 Gemcitabine: SWOG S0353 U.S. Phase II Trial 47 patients all failed least 2 prior courses of BCG 89% high risk (HG Ta, T1 and/or CIS); 60% CIS Received 2 grams in 100cc NS q week x 6 weeks and the q month x 10 months Results: Recurrence-free 3 months: 47% CR 12 months: 28% CR 24 months: 21% CR Skinner J Urol 190:1200, 2013
26 Taxane Trials Inhibits microtubule depolymerization Introduced in BCG failures by McKiernan (2006) with no dose-limiting toxicity at 75 mg Efficacy demonstrated in several Phase I / II studies, most with some form of maintenance Brooks NA & O Donnell MA: Indian J Urol. 2015; 31:
27 Docetaxel 54 patients All failed prior BCG 22 had only one prior course 83% high grade, 53% with CIS Recurrence-free Survival DFS at 12 months = 40% DFS at 36 months = 25% Barlow et al, J Urol 189:834, 2013
28 Paclitaxel - Nanoparticle albumin bound (Nab) Phase II study of 28 patients recurrent Tis, T1 and Ta who failed at least 1 cycle of BCG 6 weekly nab-paclitaxel 500 mg/100 ml, and monthly maintenance for 6 months CR 35% at 6 mo RFS 1 year: 35% RFS 2 years: 31% McKiernan et al, J Urol. 2014; 192:1633-8
29 Combina(on Gem/Docetaxel 45 patients treated over 5 years Induction only TaLG (4); TaHG (13)CIS (20); T1HG (8) Steinberg, et al Bladder Cancer 1:65, 2015
30 Hyperthermia Delivery of hyperthermic chemotherapy with temp C Mechanism: -Direct cytotoxic effects -Enhanced penetration of chemo agent Hyperthermia Denatured Unfolded Protein Heat Shock Proteins Signal to Natural Killer Cells Cancer cell with Mitomycin C delivered at 43 C VasodilaCon Activated Heated Chemotherapy Agent Increased Intracellular Concentration of Chemotherapy Agent Damaged Impaired DNA Increased Permeability of Cell Membrane
31 MMC and Hyperthermia 160 patients: 129 (80.6%) BCG failures from a combined 10- year single center experience MMC induction plus maintenance Median F/U 75 months RFS: 60% (1 year) RFS: 47% (2 years) Progression to MIBC: 4.3% 6.3% discontinued due to side-effects Arends TJH et al. J Urol 2014
32 Hyperthermia Systems Synergo Intravesical microwave applicator 5 thermocouplers deliver hyperthermia to the bladder via direct contact Combat BRS Bladder Recirculation System External warmer van der Heijden AG et al. Eur Urol 2004 Souas A et al. Int J Hyperthermia 2014
33 Photodynamic Therapy PDT involves the administra5on of a photosensi5zing agent with ac5va5on of the agent by light at the appropriate wavelength 5 ALA HAL Radachlorin Phase 1 Trials Brooks NA & O Donnell MA: Indian J Urol. 2015; 31:
34 BCG BCG Unresponsive Unresponsive Clinical Trials Trials
35 BCG refractory or unresponsive CIS Initial CR rate of 50% at 6 months Durable response rate of 30% at 12 months and 25% at 18 months BCG refractory or unresponsive papillary disease: Recurrence-free rate of 30% at 12 months and 25% at 18 months FDA 2018, Center for Drug Evaluation and Research (CDER) Center for Biologics Evaluation and Research (CBER)
36 BCG Unresponsive Ad-IFN (FKD/SUO Clinical CTC) Trials A Phase III, Open Label Study to Evaluate the Safety and Efficacy of INSTILADRIN (rad-ifn/syn3) Administered Intravesically to PaMents with High Grade, BCG Unresponsive, NMIBC PI Steve Boorjian Primary aim: To evaluate the incidence of HG Event-Free Survival at 12 months Treatment: Ad/IFN 3 x 1011 vp/ml, 135paMents; 35 responding paments at 12 months (RR 25.2%, 95% CI = [18.1%, 33.4%])
37 S1605: Phase 2 Trial of Atezolizumab Rationale: High risk NMIBC responds to immunotherapy PDL1 is expressed in NMIBC (Inman et al. Cancer 2007) Encouraging results in metastatic disease (Powles et al. Nature 2015, Rosenberg et al. Lancet 2016) Hypothesis: checkpoint molecules facilitate immune evasion in BCG-unresponsive NMIBC and this can be overcome with checkpoint inhibitors
38 Keynote-057: Phase 2 Pembrolizumab de Wit, R: (Abstract #8640),ESMO 2018
39 Keynote-057: Phase 2 Pembrolizumab de Wit, R: (Abstract #8640),ESMO 2018
40 Conclusions and Clinical Pearls BCG induction + maintenance is a standard for high risk NMIBC Despite BCG therapy, a subgroup of patient will be unresponsive BCG 5+2 is considered minimum adequate therapy for Ta/CIS BCG unresponsive disease HG T1 after BCG induction CIS within within 6 months of last BCG HG Ta/T1 within 6 months of last BCG
41 Conclusion and Clinical Pearls Conclusions and Clinical Pearls If > 1 year from BCG, a0empt BCG again If unresponsive to BCG: consider Radical Cystectomy If unwilling or unfit for radical cystectomy Clinical trial preferred If HG Ta, intravesical chemotherapy (gemcitabine) For CIS, consider valrubicin AnIcipate FDA approval of new agents in the very near future
42 Stephenson Stephenson Cancer at OU Cancer Health Sciences Center Center
BCG Failure or BCG Unresponsive: Defining and Managing Difficult Patients
BCG Failure or BCG Unresponsive: Defining and Managing Difficult Patients Michael S. Cookson, MD, Professor and Chair Department of Urology University of Oklahoma Non-muscle Invasive Bladder Cancer Bladder
More informationBCG Unresponsive Disease A Roadmap for Drug Development and Integra;on of Novel Therapies
BCG Unresponsive Disease A Roadmap for Drug Development and Integra;on of Novel Therapies Seth P. Lerner, MD, FACS Professor of Urology Beth and Dave Swalm Chair in Urologic Oncology Baylor College of
More informationBC G Unresponsive Non- Muscle Invasive Bladder Cancer
BC G Unresponsive Non- Muscle Invasive Bladder Cancer Seth P. Lerner, MD, FACS Professor of Urology Beth and Dave Swalm Chair in Urologic Oncology ScoA Department of Urology Baylor College of Medicine,
More informationManagement of High-Risk Non-Muscle Invasive Bladder Cancer. Seth P. Lerner, MD, FACS
Management of High-Risk Non-Muscle Invasive Bladder Cancer Seth P. Lerner, MD, FACS Professor of Urology, Beth and Dave Swalm Chair in Urologic Oncology, Scott Department of Urology, Baylor College of
More informationNon-Muscle Invasive Bladder Cancer BCG Failures: University of Iowa Hospitals and Clinics Experience. Paul Gellhaus Assistant Clinical Professor
Non-Muscle Invasive Bladder Cancer BCG Failures: University of Iowa Hospitals and Clinics Experience Paul Gellhaus Assistant Clinical Professor Iowa??? none Disclosures Caveats Dr. Michael O Donnell
More informationManagement options for high-risk, BCG-refractory NMIBC. Alan M. Nieder, M.D. Columbia University Division of Urology Mount Sinai Medical Center
Management options for high-risk, BCG-refractory NMIBC Alan M. Nieder, M.D. Columbia University Division of Urology Mount Sinai Medical Center Bladder Cancer in U.S. 4 th most common cancer in men 9 th
More informationReviewing Immunotherapy for Bladder Carcinoma In Situ
Reviewing Immunotherapy for Bladder Carcinoma In Situ Samir Bidnur Dept of Urologic Sciences, Grand Rounds March 1 st, 2017 Checkpoint Inhibition and Bladder Cancer, an evolving story with immunotherapy
More informationNon Muscle Invasive Bladder Cancer. Primary and Recurrent TCC 4/10/2010. Two major consequences: Strategies: High-Risk NMI TCC
Intravesical Therapy 2010-When, with What, When to Stop Friday, April 9, 2010 Ralph de VereWhite, MD Director, UC Davis Cancer Center Associate Dean for Cancer Programs Professor, Department of Urolgoy
More informationRisk Adapted Treatment of Non-muscle Invasive Bladder Cancer. Eila C. Skinner, MD
Risk Adapted Treatment of Non-muscle Invasive Bladder Cancer Eila C. Skinner, MD Professor, Department of Urology Stanford University SWIU Winter Meeting January, 2015 Goals Minimize treatment for patients
More informationNovel therapeutic strategies for NMIBC. Peter Black Vancouver Prostate Centre University of British Columbia
Novel therapeutic strategies for NMIBC Peter Black Vancouver Prostate Centre University of British Columbia Financial and Other Disclosures I have the following financial interests or relationships to
More informationManagement of High Grade, T1 Bladder Cancer Douglas S. Scherr, M.D.
Management of High Grade, T1 Bladder Cancer Douglas S. Scherr, M.D. Assistant Professor of Urology Clinical Director, Urologic Oncology Weill Medical College-Cornell University Estimated new cancer cases.
More informationRITE Thermochemotherapy in the treatment of BCG refractory NMIBC
RITE Thermochemotherapy in the treatment of BCG refractory NMIBC Ben Ayres Consultant Urological Surgeon St George s Hospital London 1 Financial and Other Disclosures Off-label use of drugs, devices, or
More informationOptimising the management of non-muscle invasive bladder cancer from diagnosis to cure. Dr Richard Savdie Uro-Oncology Fellow BSc MBBS FRACS
Optimising the management of non-muscle invasive bladder cancer from diagnosis to cure Dr Richard Savdie Uro-Oncology Fellow BSc MBBS FRACS Objectives 1. Explore best practice diagnostic techniques 2.
More informationIntravesical Therapy for Bladder Cancer
Intravesical Therapy for Bladder Cancer Alexandre R. Zlotta, MD, PhD, FRCSC Professor, Department of Surgery (Urology), University of Toronto Director, Uro-Oncology, Mount Sinai Hospital Director, Uro-Oncology
More informationControversies in the management of Non-muscle invasive bladder cancer
Controversies in the management of Non-muscle invasive bladder cancer Sia Daneshmand, MD Associate Professor of Urology (Clinical Scholar) Director of Urologic Oncology Director of Clinical Research Urologic
More informationIssues in the Management of High Risk Superficial Bladder Cancer
Issues in the Management of High Risk Superficial Bladder Cancer MICHAEL A.S. JEWETT DIVISION OF UROLOGY, DEPARTMENT OF SURGICAL ONCOLOGY, PRINCESS MARGARET HOSPITAL & THE UNIVERSITY OF TORONTO 1 Carcinoma
More informationManagement of Superficial Bladder Cancer Douglas S. Scherr, M.D.
Management of Superficial Bladder Cancer Douglas S. Scherr, M.D. Assistant Professor of Urology Clinical Director, Urologic Oncology Weill Medical College-Cornell University Estimated new cancer cases.
More informationThe Rationale for Immunotherapy as an Adjuvant Treatment for Locally Advanced BC
The Rationale for Immunotherapy as an Adjuvant Treatment for Locally Advanced BC Seth P. Lerner, MD, FACS Professor, Scott Department of Urology Beth and Dave Swalm Chair in Urologic Oncology Baylor College
More informationOptions for first-line cisplatin-eligible patients
The Past Options for first-line cisplatin-eligible patients Metastatic urothelial cancer Cisplatin-eligible Gemcitabine/ cisplatin MVAC or high-dose intensity MVAC Paclitaxel/ cisplatin/ gemcitabine Bellmunt
More informationIntravesical Gemcitabine for High Risk, Nonmuscle Invasive Bladder Cancer after Bacillus Calmette-Guerin Treatment Failure
Intravesical Gemcitabine for High Risk, Nonmuscle Invasive Bladder Cancer after Bacillus Calmette-Guerin Treatment Failure Itay A. Sternberg, Guido Dalbagni,* Ling Y. Chen, Sherri M. Donat, Bernard H.
More informationUC San Francisco UC San Francisco Previously Published Works
UC San Francisco UC San Francisco Previously Published Works Title Multi-institutional analysis of sequential intravesical gemcitabine and mitomycin C chemotherapy for non-muscle invasive bladder cancer
More informationUrinary Bladder Cancer
Fellow GU Lecture Series, 2018 Urinary Bladder Cancer Asit Paul, MD, PhD 01/31/2018 Overview Non-muscle invasive bladder cancer Muscle invasive bladder cancer Bladder sparing chemo-radiation therapy T4b
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of intravesical microwave hyperthermia with intravesical chemotherapy for superficial
More informationSequential Intravesical Gemcitabine and Docetaxel for the Salvage Treatment of Non-Muscle Invasive Bladder Cancer
Bladder Cancer 1 (2015) 65 72 DOI 10.3233/BLC-150008 IOS Press Research Report 65 Sequential Intravesical Gemcitabine and Docetaxel for the Salvage Treatment of Non-Muscle Invasive Bladder Cancer Ryan
More informationNeoadjuvant vs. Adjuvant Chemotherapy for Muscle-Invasive Bladder Cancer
Neoadjuvant vs. Adjuvant Chemotherapy for Muscle-Invasive Bladder Cancer Andrew J. Stephenson, MD, FRCSC, FACS Director, Urologic Oncology Associate Professor of Surgery Glickman Urological and Kidney
More informationIntravesical gemcitabine in combination with mitomycin C as salvage treatment in recurrent non-muscle-invasive bladder cancer
Intravesical gemcitabine in combination with mitomycin C as salvage treatment in recurrent non-muscle-invasive bladder cancer Patrick A. Cockerill, John J. Knoedler, Igor Frank, Robert Tarrell and Robert
More informationRITE Thermo-chemotherapy for NON MUSCLE INVASIVE BLADDER CANCER (NMIBC) Ulrich K.Fr. Witzsch
Thermo-chemotherapy for NON MUSCLE INVASIVE BLADDER CANCER (NMIBC) Ulrich K.Fr. Witzsch Klinik für Urologie und Kinderurologie, Chefarzt Prof. Dr. med Dr. hc E. Becht Krankenhaus Nordwest, Stiftung Hospital
More informationBacille-Calmette-Guerin non-responders: how to manage
Review Article Bacille-Calmette-Guerin non-responders: how to manage Friedrich-Carl von Rundstedt 1,2, Seth P. Lerner 1 1 Scott of Department of Urology, Translational Biology and Molecular Medicine, Dan
More informationResearch Report. Keywords: Bladder Cancer, BCG failure, virtual clinical trial, mitomycin C
Bladder Cancer 1 (2015) 143 150 DOI 10.3233/BLC-150020 IOS Press Research Report 143 Novel Simulation Model of Non-Muscle Invasive Bladder Cancer: A Platform for a Virtual Randomized Trial of Conservative
More informationUpdates in Immunotherapy for Urothelial Carcinoma
Updates in Immunotherapy for Urothelial Carcinoma Andrew J Armstrong MD ScM FACP DUA 2018 Copyright 2006 SciMed. Talk Outline Immunotherapy progress in 2017: 5 new approved PD-1/PD-L1 inhibitory agents
More informationA Personal History NIH CWRU U of TN U of Miami Animal Model for Bladder Cancer Carcinogen induced FANFT Three Models Primary tumors individual tumors, simulates clinical scenario of locally advanced cancer
More informationCritical Evaluation of Early Post-operative Single Instillation Therapy in NMIBC
Critical Evaluation of Early Post-operative Single Instillation Therapy in NMIBC Levent N. Türkeri MD, PhD Professor of Urology Acıbadem University Faculty of Medicine Istanbul Conflict of Interest No
More informationTreatment of Invasive Bladder Cancer in the Elderly and Frail Pa9ent
Treatment of Invasive Bladder Cancer in the Elderly and Frail Pa9ent Jehonathan H Pinthus MD, Ph.D, FRCSC Associate Professor Department of Surgery/Urology McMaster University Life expectancy Current age
More informationMANAGING PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER: OLD DISEASE, NEW IDEAS
MANAGING PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER: OLD DISEASE, NEW IDEAS This symposium took place on 12 th March 2016 as part of the European Association of Urology Congress 2016 in Munich, Germany
More informationSociety for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of bladder carcinoma
Kamat et al. Journal for ImmunoTherapy of Cancer (2017) 5:68 DOI 10.1186/s40425-017-0271-0 POSITION ARTICLE AND GUIDELINES Society for Immunotherapy of Cancer consensus statement on immunotherapy for the
More informationUROTHELIAL CELL CANCER
UROTHELIAL CELL CANCER Indications and regimens for neoadjuvant systemic treatment Astrid A. M. van der Veldt, MD, PhD, medical oncologist Department of Medical Oncology Erasmus Medical Center Cancer Institute
More informationGUIDELINES ON NON-MUSCLE- INVASIVE BLADDER CANCER
GUIDELINES ON NON-MUSCLE- INVASIVE BLADDER CANCER (Limited text update December 21) M. Babjuk, W. Oosterlinck, R. Sylvester, E. Kaasinen, A. Böhle, J. Palou, M. Rouprêt Eur Urol 211 Apr;59(4):584-94 Introduction
More informationThe Impact of Blue Light Cystoscopy with Hexaminolevulinate (HAL) on Progression of Bladder Cancer ANewAnalysis
Bladder Cancer 2 (2016) 273 278 DOI 10.3233/BLC-160048 IOS Press Research Report 273 The Impact of Blue Light Cystoscopy with Hexaminolevulinate (HAL) on Progression of Bladder Cancer ANewAnalysis Ashish
More informationPredicting Response to Intravesical Immunotherapy (BCG) in NMIBC
Predicting Response to Intravesical Immunotherapy (BCG) in NMIBC Ashish M. Kamat, MD, MBBS, FACS Professor of Urologic Oncology Wayne B. Duddlesten Professor of Cancer Research President, International
More informationClinical significance of immediate urine cytology after transurethral resection of bladder tumor in patients with non-muscle invasive bladder cancer
International Journal of Urology (2011) 18, 439 443 doi: 10.1111/j.1442-2042.2011.02766.x Original Article: Clinical Investigationiju_2766 439..443 Clinical significance of immediate urine cytology after
More informationDiagnosis & Treatment of Non- Muscle Invasive Bladder Cancer: AUA/SUO Guidelines
Diagnosis & Treatment of Non- Muscle Invasive Bladder Cancer: AUA/SUO Guidelines Sam S. Chang, MD, MBA Patricia & Rodes Hart Chair Professor of Urologic Surgery & Oncology Vanderbilt University Medical
More informationCUA guidelines on the management of non-muscle invasive bladder cancer
Original cua guidelines research CUA guidelines on the management of non-muscle invasive bladder cancer Wassim Kassouf, MD, CM, FRCSC; * Samer L. Traboulsi, MD; * Girish S. Kulkarni, MD, FRCSC; Rodney
More informationMaintenance Therapy with Intravesical Bacillus Calmette Guérin in Patients with Intermediate- or High-risk Non-muscle-invasive
Jpn J Clin Oncol 2013;43(3)305 313 doi:10.1093/jjco/hys225 Advance Access Publication 9 January 2013 Maintenance Therapy with Intravesical Bacillus Calmette Guérin in Patients with Intermediate- or High-risk
More informationCUA guidelines on the management of non-muscle invasive bladder cancer
Original cua guidelines research CUA guidelines on the management of non-muscle invasive bladder cancer Wassim Kassouf, MD, CM, FRCSC; * Samer L. Traboulsi, MD; * Girish S. Kulkarni, MD, FRCSC; Rodney
More informationCheckpoint Inibitors for Bladder Cancer
Checkpoint Inibitors for Bladder Cancer Daniel P. Petrylak, MD Professor of Medicine and Urology Director, GU Translational Working Group Co Director, Signal Transduction Program Smilow Cancer Center,
More informationSeptember 10, Dear Dr. Clark,
September 10, 2015 Peter E. Clark, MD Chair, NCCN Bladder Cancer Guidelines (Version 2.2015) Associate Professor of Urologic Surgery Vanderbilt Ingram Cancer Center Nashville, TN 37232 Dear Dr. Clark,
More informationOptimal sequencing in treatment muscle invasive bladder cancer : oncologists. Phichai Chansriwong, MD Ramathibodi Hospital, Mahidol University
Optimal sequencing in treatment muscle invasive bladder cancer : oncologists Phichai Chansriwong, MD Ramathibodi Hospital, Mahidol University Slide 2 Presented By Andrea Apolo at 2018 Genitourinary Cancers
More informationT1HG Bladder Cancer What is the Best Therapy?
T1HG Bladder Cancer What is the Best Therapy? Ashish M. Kamat, MD, MBBS, FACS Professor of Urology Director, Urologic Oncology Fellowship Guidelines for T1HG Bladder Cancer AUA Recommendation: BCG induction
More informationROBOTIC VS OPEN RADICAL CYSTECTOMY
ROBOTIC VS OPEN RADICAL CYSTECTOMY A REVIEW Colin Lundeen December 14, 2016 Objectives Review the history of radical cystectomy Critically analyze recent RCTs comparing open radical cystectomy (ORC) to
More informationContemporary management of high-grade T1 bladder cancer Arnulf Stenzl
Contemporary management of high-grade T1 bladder cancer Arnulf Stenzl Dep. of Urology, Eberhard-Karls University, Tuebingen, Germany Treatment options in HG T1 BCa TUR-BT Primary and second resection (T0-status)
More informationNon Muscle-Invasive Bladder Cancer: Intravesical Treatments Beyond Bacille Calmette-Guerin
Non Muscle-Invasive Bladder Cancer: Intravesical Treatments Beyond Bacille Calmette-Guerin Vignesh T. Packiam, MD; Scott C. Johnson, MD; and Gary D. Steinberg, MD An unmet need exists for patients with
More information14th Meeting of the EAU Section of Oncological Urology (ESOU)
Is Bacillus Calmette-Guerin (BCG) still the best adjuvant treatment after Trans Urethral Resection (TUR) for Ta-T1 high grade (G3) bladder cancer M. Brausi, Modena (IT) Introduction Bacillus Calmette-Guerin
More informationINODIFTAGENE Gene Therapy for Bladder Cancer
INODIFTAGENE Gene Therapy for Bladder Cancer 1 Safe Harbor Statement This presentation contains forward-looking statements within the meaning of U.S. federal securities laws and Israeli securities laws
More informationTARGETING CANCER WITH POWER AND PRECISION
TARGETING CANCER WITH POWER AND PRECISION T h o m a s C a n n e l l, D. V. M., P r e s i d e n t a n d C E O A u g u s t 9, 2 0 1 8 NASDAQ: SESN FORWARD-LOOKING STATEMENTS This presentation contains forward-looking
More informationIntravesical radiofrequency-induced hyperthermia combined with chemotherapy for non-muscleinvasive
International Journal of Hyperthermia ISSN: 0265-6736 (Print) 1464-5157 (Online) Journal homepage: http://www.tandfonline.com/loi/ihyt20 Intravesical radiofrequency-induced hyperthermia combined with chemotherapy
More informationSUPERFICIAL BLADDER CANCER MANAGEMENT
A CME Webcast/TELECONFERENCE Case by Case: CRITICAL ISSUES IN SUPERFICIAL BLADDER CANCER MANAGEMENT An Interactive Case Format with Instant Audience Polling APRIL-MAY 2005 CME Program Slide Book Sponsored
More informationChemotherapy and Bladder Cancer. Blayne Welk UBC Urology Grand Rounds June 4, 2008
Chemotherapy and Bladder Cancer Blayne Welk UBC Urology Grand Rounds June 4, 2008 Outline Review of Incidence and Impact of bladder cancer Neoadjuvant chemotherapy Adjuvant chemotherapy Bladder preservation
More informationEarly radical cystectomy in NMIBC Marko Babjuk
Early radical cystectomy in NMIBC Marko Babjuk Dept. of Urology, 2nd Faculty of Medicine, Hospital Motol, Praha, Czech Republic We Are The European Association of Urology We Are Urologists, residents,
More informationOral Communications & Posters
Carcinoma uroteliale: Current and future directions of treatment of Muscle-Invasive Bladder cancer/ Multimodality approach of bladder cancer Oral Communications & Posters CRISTINA MASINI Oncologia Medica
More informationGuidelines for the Management of Bladder Cancer West Midlands Expert Advisory Group for Urological Cancer
Guidelines for the Management of Bladder Cancer West Midlands Expert Advisory Group for Urological Cancer West Midlands Clinical Networks and Clinical Senate Coversheet for Network Expert Advisory Group
More informationTHE USE OF HALF DOSE BCG FOR INTRAVESICAL IMMUNOTHERAPY IN NON MUSCLE INVASIVE BLADDER CANCER
THE USE OF HALF DOSE BCG FOR INTRAVESICAL IMMUNOTHERAPY IN NON MUSCLE INVASIVE BLADDER CANCER Mihály Zoltán Attila 1, Rusu Cristian Bogdan 2, Mihály Orsolya Maria 3, Bolboacă Sorana Daniela 4, Bungărdean
More informationIMMUNE CHECKPOINT THERAPY FOR GENITOURINARY CANCERS: KIDNEY CANCER AND TRANSITIONAL CELL CARCINOMA
IMMUNE CHECKPOINT THERAPY FOR GENITOURINARY CANCERS: KIDNEY CANCER AND TRANSITIONAL CELL CARCINOMA Kathleen Mahoney, M.D., Ph.D. Instructor of Medicine, Harvard Medical School Attending, Beth Israel Deaconess
More informationWhen to Integrate Surgery for Metatstatic Urothelial Cancers
When to Integrate Surgery for Metatstatic Urothelial Cancers Wade J. Sexton, M.D. Senior Member and Professor Department of Genitourinary Oncology Moffitt Cancer Center Case Presentation #1 67 yo male
More informationUpdated Phase 3 VISTA Trial Data in Patients with BCG-unresponsive Non-muscle Invasive Bladder Cancer. January 4, 2019 NASDAQ SESN
Updated Phase 3 VISTA Trial Data in Patients with BCG-unresponsive Non-muscle Invasive Bladder Cancer January 4, 2019 NASDAQ SESN FORWARD-LOOKING STATEMENTS This presentation contains forward-looking statements
More informationChallenges in systemic treatment for metastatic bladder cancer. Phichai Chansriwong, MD Ramathibodi Hospital, Mahidol University
Challenges in systemic treatment for metastatic bladder cancer Phichai Chansriwong, MD Ramathibodi Hospital, Mahidol University OS PCG 15.8 vs GC 12.7 NS Cisplatin ineligible Second-line chemotherapy
More informationManagement of Difficult Cases of Non-Muscle Invasive Bladder Cancer
Management of Difficult Cases of Non-Muscle Invasive Bladder Cancer 1 Bladder Cancer Recurrence is common Progression is uncommon Progression is more important than recurrence There are indicators of recurrence
More informationNMIBC. Piotr Jarzemski. Department of Urology Jan Biziel University Hospital Bydgoszcz, Poland
NMIBC Piotr Jarzemski Department of Urology Jan Biziel University Hospital Bydgoszcz, Poland 71 year old male patient was admitted to the Department of Urology First TURBT - 2 months prior to the hospitalisation.
More informationGenomics and Genetics in BC: Precise selection for chemotherapy and Immunotherapy. Raanan Berger MD PhD Sheba Medical Center, Israel
Genomics and Genetics in BC: Precise selection for chemotherapy and Immunotherapy Raanan Berger MD PhD Sheba Medical Center, Israel Disclosures Honoraria, Ad board BMS, MSD, Pfizer, Astra Zeneca, Bayer,
More informationRole of Re-Resection in Non Muscle-Invasive Bladder Cancer
Review Special Issue: Bladder Cancer TheScientificWorldJOURNAL (2011) 11, 283 288 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2011.29 Role of Re-Resection in Non Muscle-Invasive Bladder Cancer Harry W.
More informationRECENT DEVELOPMENTS in Muscle Invasive Bladder Cancer
RECENT DEVELOPMENTS in Muscle Invasive Bladder Cancer IX CIS and EURASIA ONCOLOGY and RADOLOGY CONGRESS, ONCOUROLOGY SESSION 16 June 2016 Richard E Greenberg, MD, FACS Chief Urologic Oncology, Fox Chase
More informationThe Clinical Impact of the Classification of Carcinoma In Situ on Tumor Recurrence and their Clinical Course in Patients with Bladder Tumor
Original Article Japanese Journal of Clinical Oncology Advance Access published December 17, 2010 Jpn J Clin Oncol 2010 doi:10.1093/jjco/hyq228 The Clinical Impact of the Classification of Carcinoma In
More informationProstate cancer Management of metastatic castration sensitive cancer
18 th Annual Advances in Oncology - 2017 Prostate cancer Management of metastatic castration sensitive cancer Urothelial carcinoma Non-muscle invasive urothelial carcinoma Updates in metastatic urothelial
More informationImmunotherapy for Breast Cancer. Aurelio B. Castrellon Medical Oncology Memorial Healthcare System
Immunotherapy for Breast Cancer Aurelio B. Castrellon Medical Oncology Memorial Healthcare System Conflicts Research support : Cascadian therapeutics, Puma biotechnology, Odonate therapeutics, Pfizer,
More informationINTRAVESICAL THERAPY AND FOLLOW-UP OF SUPERFICIAL TRANSITIONAL CELL CARCINOMA OF THE BLADDER
Clinical Urology Brazilian Journal of Urology Official Journal of the Brazilian Society of Urology Vol. 26 (3): 242-249, May - June, 2000 INTRAVESICAL THERAPY AND FOLLOW-UP OF SUPERFICIAL TRANSITIONAL
More informationCollection of Recorded Radiotherapy Seminars
IAEA Human Health Campus Collection of Recorded Radiotherapy Seminars http://humanhealth.iaea.org Conservative Treatment of Invasive Bladder Cancer Luis Souhami, MD Professor Department of Radiation Oncology
More informationBladder Preservation Strategies for Muscle Invasive Bladder Cancer
Bladder Preservation Strategies for Muscle Invasive Bladder Cancer Jeff M. Michalski, MD, MBA, FACR, FASTRO The Carlos A. Perez Distinguished Professor of Radiation Oncology Department of Radiation Oncology
More informationImmunotherapy for Genitourinary Cancers. Douglas McNeel, MD PhD Professor of Medicine University of Wisconsin Carbone Cancer Center Madison, WI
Immunotherapy for Genitourinary Cancers Douglas McNeel, MD PhD Professor of Medicine University of Wisconsin Carbone Cancer Center Madison, WI Disclosures Madison Vaccines Inc co-founder, IP, consultant
More informationCase 1. Receives induction BCG weekly x 6 without significant toxicity Next step should be:
Case 1 89 year old male with initial occurrence of gross hematuria Office flexible cystoscopy shows two papillary tumors with some surface necrosis Complete TURBT into muscle Florescence cysto shows two
More informationHaematuria and Bladder Cancer
Haematuria and Bladder Cancer Dr Pardeep Kumar Consultant Urological Surgeon Haematuria 3 Haematuria Macroscopic vs Microscopic Painful vs Painless Concurrent abdo pain/urinary symptoms Previous testing?
More informationINODIFTAGENE Recombinant DNA Gene Therapy for Bladder Cancer
INODIFTAGENE Recombinant DNA Gene Therapy for Bladder Cancer 1 Safe Harbor Statement This presentation contains forward-looking statements within the meaning of U.S. federal securities laws and Israeli
More informationThe Role of Bacillus Calmette-Guérin in the Treatment of Non Muscle-Invasive Bladder Cancer
EUROPEAN UROLOGY 57 (2010) 410 429 available at www.sciencedirect.com journal homepage: www.europeanurology.com Collaborative Review Bladder Cancer The Role of Bacillus Calmette-Guérin in the Treatment
More information5/2/2010. A New Paradigm for Drug Delivery: Intravascular Drug Release from Liposomes
Conflict of Interest Statement New initiatives in thermotherapy Mark W. Dewhirst, DVM, PhD Duke University Medical Center Consultant and Chair of SAB for Celsion Corporation Research grants from GSK, Varian
More informationBladder & Kidney Cancer In Western Australia An update with strategies for improving outcomes
Bladder & Kidney Cancer In Western Australia An update with strategies for improving outcomes Prof Dickon Hayne UWA Medical School, University of Western Australia Head of Urology, Fiona Stanley Hospital
More informationA Giant Leap in the Treatment Options for Advanced Bladder Cancer
A Giant Leap in the Treatment Options for Advanced Bladder Cancer Yohann Loriot, MD, PhD Department of Cancer Medicine & INSERM U981 Gustave Roussy Villejuif, France Clinical Features of Bladder Cancer
More informationOld and New Radiation for Bladder and Upper Tract Cancers. Bridget Koontz Radiation Oncology Duke Cancer Institute
Old and New Radiation for Bladder and Upper Tract Cancers Bridget Koontz Radiation Oncology Duke Cancer Institute Disclosures Janssen funded clinical research BlueEarth Diagnostics advisory board member
More informationChallenging Genitourinary Tumors: What s New in 2017
Challenging Genitourinary Tumors: What s New in 2017 David J. Vaughn, MD Genitourinary Medical Oncology Professor Please note that some of the studies reported in this presentation were presented as an
More informationTHE SEARCH FOR BIOMARKERS IN BLADDER CANCER
THE SEARCH FOR BIOMARKERS IN BLADDER CANCER CDDP and IO WORLD ALEJO RODRÍGUEZ-VIDA MD PhD Consultant Medical Oncologist Associate Professor Hospital del Mar, Barcelona November 23 rd 2018 DISCLOSURE OF
More informationCase Presentation 58 year old male with recent history of hematuria, for which he underwent cystoscopy. A 1.5 cm papillary tumor was found in the left lateral wall of the bladder. Pictures of case Case
More informationLargos Supervivientes, Tenemos datos?
Largos Supervivientes, Tenemos datos? Javier Puente, MD, PhD Medical Oncology Department. Hospital Clinico San Carlos Associate Professor of Medicine. Complutense University of Madrid. Summary Snapshot
More informationPanel: A Case-based Approach to the Management of Bladder Cancer
Panel: A Case-based Approach to the Management of Bladder Cancer ~ Moderator: Robert Donohue, MD Panel: David C. Beyer, MD E. David Crawford, MD Donald L. Lamm, MD Paul D. Maroni, MD TCC Cases Robert E.
More informationMetastatic NSCLC: Expanding Role of Immunotherapy. Evan W. Alley, MD, PhD Abramson Cancer Center at Penn Presbyterian
Metastatic NSCLC: Expanding Role of Immunotherapy Evan W. Alley, MD, PhD Abramson Cancer Center at Penn Presbyterian Disclosures: No relevant disclosures Please note that some of the studies reported in
More informationCase by Case: Critical Issues in Superficial Bladder Cancer Management 5/24/05 13:46 1
Case by Case: Critical Issues in Superficial Bladder Cancer Management 5/24/05 13:46 1 Case Study 1 A 22-year-old man with a history of gross total painless hematuria: two times in two months, both after
More informationDisclosures. The Importance of Pathology? Pathologic, Morphologic and Clinical Features. Pathologic Reproducibility
The Importance of Pathology? Seth P. Lerner, MD, FACS Beth and Dave Swalm Chair in Urologic Oncology Scott Department of Urology Baylor College of Medicine Support for research Disclosures Photocure, Imalux,
More informationOriginal Article APMC-276
Original Article APMC-276 The Clinical Value of Immediate Second Transurethral Resection in Patients with High Grade Non-Muscle Inasive Bladder Cancer (HG-NMIBC) Syed Saleem Abbas Jafri, Zafar Iqbal Khan
More informationCHEMO-RADIOTHERAPY FOR BLADDER CANCER. Dr Darren Mitchell Consultant Clinical Oncologist Northern Ireland Cancer Centre
CHEMO-RADIOTHERAPY FOR BLADDER CANCER Dr Darren Mitchell Consultant Clinical Oncologist Northern Ireland Cancer Centre AIMS Muscle invasive disease Current Gold-Standard Rationale behind Chemo-Radiotherapy
More informationUnderstanding Systemic Chemotherapy Options in Bladder Cancer. Part III: Chemoradiotherapy
Understanding Systemic Chemotherapy Options in Bladder Cancer Tuesday, July 25, 2017 Part III: Chemoradiotherapy Presented by Dr. Jean Hoffman-Censits is a genitourinary medical oncologist at the Sidney
More informationAdvances in Chemotherapy for Non-Small Cell Lung Cancer
Advances in Chemotherapy for Non-Small Cell Lung Cancer Evan W. Alley, MD, PhD Clinical Associate Professor Abramson Cancer Center at Penn Presbyterian Lung Cancer: Overview Second most common cancer in
More informationINMUNOTERAPIA I. Dra. Virginia Calvo
INMUNOTERAPIA I Dra. Virginia Calvo LBA62. Health-related quality of life (HRQoL) for Pembrolizumab or placebo plus Carboplatin and Paclitaxel or nab-paclitaxel in patients with metastatic squamous NSCLC:
More informationI Tumori della Vescica Inquadramento clinico Roberto Sabbatini Azienda Ospedaliero Universitaria Policlinico di Modena
I Tumori della Vescica Inquadramento clinico Roberto Sabbatini Azienda Ospedaliero Universitaria Policlinico di Modena XII Corso di aggiornamento AIRTUM per operatori dei Registri Tumori Reggio Emilia
More informationRadical Cystectomy Often Too Late? Yes, But...
european urology 50 (2006) 1129 1138 available at www.sciencedirect.com journal homepage: www.europeanurology.com Editorial 50th Anniversary Radical Cystectomy Often Too Late? Yes, But... Urs E. Studer
More information