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 hosts Manojkumar Bupathi, MD, MS, and Benjamin Garmezy, MD, traveled to the 2025 World Conference on Genitourinary Cancers (World GU) to speak with different experts about important advances and key takeaways related to the care of patients with genitourinary malignancies. Bupathi is executive cochair of the Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI) and medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers. Garmezy is associate director of genitourinary research and executive cochair of the Genitourinary Cancer Research Executive Committee at SCRI and medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers.

In this episode, Bupathi and Garmezy sat down with Sam S. Chang MD, MBA, and Jeff Yorio, MD, to exchange knowledge on elevating the efficacy of multidisciplinary care for patients with prostate cancer, kidney cancer, and bladder cancer in a community-based setting. Chang is the chief surgical officer and the Urologic Oncology division chief at the Vanderbilt Ingram Cancer Center. Yorio is a medical oncologist who serves as the Central Texas Research Site Leader for Texas Oncology and SCRI.

The conversation partly focused on overcoming challenges associated with prostate cancer management in a community practice. Chang highlighted strategies for risk stratifying disease based on previously published guidelines, noting the importance of surveillance depending on a patient’s observed degree of risk. Additionally, the experts discussed how factors such as Decipher® Prostate scores, MRI scans, and prostate-specific antigen (PSA) levels may factor into the decision to surveil patients with prostate cancer.

Regarding kidney cancer, the group spoke about strategies for deciding between monitoring patients or expediting intervention with modalities like nephrectomy or cryoablation. An observed mass of less than 2 cm, for example, represented a situation where surveillance could be optimal. The experts also detailed appropriate circumstances for offering immunotherapy and tyrosine kinase inhibitor (TKI)–based regimens upfront prior to surgery.

As part of the discussion on bladder cancer management, the group emphasized improving systemic therapies and locally assessing the bladder more efficiently. Additionally, with a newfound “embarrassment of riches and possibilities” regarding the development and approval of novel intravesical therapies, the experts discussed how medical oncologists can best collaborate with urologists to monitor patients undergoing this type of treatment.

A group of community and academic oncologists exchanged ideas on optimizing therapy across different prostate, kidney, and bladder cancer populations.

Elevating Community Oncology Care: Insights From World GU 2025

Episode 13: Perspectives on Optimizing Community Care at World GU 2025

World GU Ep 2

At the 2025 World Conference on Genitourinary Cancers (World GU), 

 hosts Manojkumar Bupathi, MD, MS, and Benjamin Garmezy, MD, spoke with different experts about critical developments in the treatment of those with genitourinary cancers. Bupathi is executive cochair of the Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI) and medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers. Garmezy is associate director of genitourinary research and executive cochair of the Genitourinary Cancer Research Executive Committee at SCRI and medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers.

In this episode, Bupathi and Garmezy met with Sam S. Chang MD, MBA, and Jeff Yorio, MD, to share ideas on improving the efficacy of multidisciplinary care for patients with prostate cancer, kidney cancer, and bladder cancer in a community practices. Chang is the chief surgical officer and the Urologic Oncology division chief at the Vanderbilt Ingram Cancer Center. Yorio is a medical oncologist who serves as the Central Texas Research Site Leader for Texas Oncology and SCRI.

The conversation first touched upon optimizing prostate cancer management in a community-based setting. Chang highlighted strategies for risk stratifying disease based on previously published guidelines, noting how the utility of surveillance may depend on a patient’s observed degree of risk. Additionally, the experts discussed how factors such as Decipher® Prostate scores, MRI scans, and prostate-specific antigen (PSA) levels may influence the decision to surveil patients with prostate cancer.

The group also spoke about strategies for deciding between monitoring patients or expediting intervention with modalities like nephrectomy or cryoablation for those with kidney cancer. An observed mass of less than 2 cm, for example, represented a situation where surveillance could be more preferable. The experts also detailed appropriate conditions for administering immunotherapy and tyrosine kinase inhibitor (TKI)–based regimens upfront prior to surgery.

Regarding bladder cancer management, the group emphasized improving systemic therapies and locally assessing the bladder more efficiently. Additionally, with a newfound “embarrassment of riches and possibilities” related to the development and approval of novel intravesical therapies, the experts discussed how medical oncologists can effectively collaborate with urologists to monitor patients undergoing this type of treatment.

Experts discuss considerations for improving the care of patients with prostate, kidney, and bladder cancer in community-based practices at World GU 2025.

Episode 13: Perspectives on Optimizing Community Care at World GU 2025  

hosts Manojkumar Bupathi, MD, MS, and Benjamin Garmezy, MD, traveled to the 2025 World Conference on Genitourinary Cancers (World GU) to speak with various experts about key advances in genitourinary oncology. As part of one discussion, Bupathi and Garmezy sat down with Bradley G. Somer, MD, to exchange ideas about the management of genitourinary cancers harboring variant histologies, which included such populations as those with prostate cancer, bladder cancer, and kidney cancer.

Regarding prostate cancer, the group highlighted potential treatment strategies for patient subgroups such as those with small cell histology or neuroendocrine differentiation. The discussion explored how modalities such as androgen deprivation therapy, chemotherapy, and radiation may factor into the care of patients with prostate cancer harboring variant histologies, especially in the context of a community oncology setting.

Next, the conversation focused on methods for managing papillary, plasmacytoid, small cell, and other disease variants in the context of bladder cancer. Based on previously published data and prior clinical experience, the group discussed the appropriate circumstances for implementing regimens such as enfortumab vedotin-ejfv (Padcev) plus pembrolizumab (Keytruda) or other immunotherapy approaches depending on how a patient presents with bladder cancer.

Additionally, the group reviewed strategies for managing clear cell, papillary, and chromophobe variants in kidney cancer along with other disease histologies. The experts considered key factors for deciding on when to administer VEGF inhibitors and other tyrosine kinase inhibitor combinations based on the observed histology.

Bupathi is executive cochair of the Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI) and medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers. Garmezy is associate director of genitourinary research and executive cochair of the Genitourinary Cancer Research Executive Committee at SCRI and medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers. Somer is a medical oncologist, senior partner on the Executive Cancer Council, and president at West Cancer Center & Research Institute.

At World GU 2025, experts discussed forming treatment strategies for patients with variant histologies across prostate, bladder, and kidney cancer.   

Optimizing Care Planning for Variant Histology Populations at World GU 2025

, hosts Manojkumar Bupathi, MD, MS, and Benjamin Garmezy, MD, spoke with Nabil Adra, MD, about testicular cancer care. The discussion gave a comprehensive overview of managing germ cell tumors, offering practical pearls for community oncologists.

The conversation opened with the initial approach to a patient presenting with a testicular mass. The doctors emphasize the importance of a thorough workup, including a CT scan of the chest, abdomen, and pelvis, and the use of tumor markers: AFP and hCG. Adra noted that while AFP and hCG are elevated in about 60% of cases, it’s crucial to understand their half-lives—about 5 to 7 days for AFP and 1 to 2 days for hCG—to properly assess their decline post-orchiectomy. He clarified that an AFP level under 25 ng/mL is considered normal and that mild elevations in hCG can be linked to marijuana use or cross-reactivity with luteinizing hormone, which should be investigated before initiating chemotherapy. The panel also touches on the use of lactate dehydrogenase as a prognostic marker, cautioning against using it as the sole basis for starting treatment.

A central part of the discussion revolves around the bleomycin, etoposide, cisplatin (BEP) vs etoposide and cisplatin chemotherapy regimens for good-risk disease. Adra explained the rationale behind the preference for BEP for 3 cycles at his institution, arguing that it avoids the long-term toxicities of neuropathy and ototoxicity associated with a fourth cycle of platinum therapy, a concern with the EP for 4 cycles. He stressed that with careful patient selection—avoiding bleomycin in patients over 50, with renal dysfunction, or pre-existing lung disease—the risk of pulmonary toxicity is minimal. He also influenced Garmezy’s practice by highlighting the importance of monitoring tumor markers with every cycle of chemotherapy, noting that a rising marker could signal a need to pivot to second-line therapy.

The conversation shifted to the role of surgery in stage II disease. For patients with non-bulky (less than 3 cm) stage II seminoma or non-seminoma, the panel discusses the preference for a retroperitoneal lymph node dissection (RPLND) over upfront chemotherapy or radiation to spare patients from long-term side effects. Adra highlighted that a proper RPLND at an experienced center can be curative in 80% of cases. The doctors stressed the importance of referring patients to surgeons with extensive experience in these complex procedures.

Finally, the hosts and guest tackled the management of relapsed/refractory disease. They discussed the 3 main options: salvage surgery, standard-dose chemotherapy, or high-dose chemotherapy with stem cell transplant. Adra shared that his institutional preference is for high-dose chemotherapy due to published data showing high cure rates, mentioning the ongoing phase 3 TIGER trial (NCT02375204), which is directly comparing standard-dose paclitaxel, ifosfamide, and cisplatin with high-dose chemotherapy. The episode concluded with a key pearl on managing patients with a high burden of pulmonary metastases, where a "cycle 0" of EP is sometimes used before starting a full course of vinblastine, ifosfamide, and cisplatin to mitigate the risk of hemoptysis.

Bupathi, is executive cochair of the Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI) and medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers; Garmezy, is associate director of genitourinary research and executive cochair of the Genitourinary Cancer Research Executive Committee at SCRI and medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers, and Adra is associate professor of Clinical Medicine and Clinical Urology, service line leader in medical oncology, medical director of Indiana University Health Simon Cancer Center, and program leader-genitourinary.

Discover key takeaways on tumor markers, the BEP vs. EP debate, and the role of surgery in stage II testicular cancer. 

Beyond the BEP: A Deep Dive into Testicular Cancer Management

, hosts Manojkumar Bupathi, MD, MS, and Benjamin Garmezy, MD, discussed the highly anticipated 2025 American Society of Clinical Oncology (ASCO) Annual Meeting.

Bupathi is the executive cochair of the Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI) and medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers, and Garmezy is the associate director of genitourinary research and executive cochair of the Genitourinary Cancer Research Executive Committee at SCRI and medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers, underscored the curative potential of adjuvant therapy in kidney cancer.

During the discussion, the experts highlight the abstracts that have caught their eye and offer their predictions on the data that could reshape the landscape of genitourinary oncology.

Several intriguing abstracts are highlighted, with a focus on the evolving role of immunotherapy and the potential for novel combinations.

Phase 3 PDIGREE trial (NCT03793166): Immunotherapy plus nivolumab (Opdivo) and ipilimumab (Yervoy) followed by nivolumab alone or nivolumab with cabozantinib (Cabometyx) for patients with advanced kidney cancer. This will be presented by Tian Zhang, MD, MHS, on May 31 from 1:27-1:33 pm CDT.

Phase 1b STELLAR-002 trial (NCT05176483): Zanzalintinib plus nivolumab and relatlimab in patients with advanced solid tumors. This will be presented by Benjamin Garmezy, MD, in a poster presentation on June 2 at 2:30 pm CDT.

The Bupathi and Garmezy suggest we should be on the lookout for data that could refine treatment algorithms and identify new biomarkers to guide therapy selection.

The potential impact of neoadjuvant therapy and the role of circulating tumor DNA (ctDNA) analysis were key discussion points. The experts anticipated seeing updates from ongoing trials exploring the utility of ctDNA as a predictive and prognostic biomarker, potentially allowing for more personalized treatment approaches.

Phase 3 NIAGARA trial (NCT03732677): ctDNA will be assessed in those who received perioperative durvalumab (Imfinzi) for muscle-invasive bladder cancer. This will be presented by Thomas Pwles, MD, PhD, FCRP, on June 1 from 10:45-10:57 am CDT.

Phase 3 Checkmate901 (NCT03036098): Nivolumab plus ipilimumab vs gemcitabine/carboplatin in patients who are previously untreated with unresectable or metastatic urothelial carcinoma. This will be presented by Michael Simon Van Der Heijden, MD, PhD, on June 1 from 9:45-9:57 am CDT.

A significant portion of the discussion revolves around prostate cancer, with several potentially practice-changing abstracts generating excitement.

Artificial intelligence (AI): The use of a multimodal AI model to determine the benefit from a second-generation androgen receptor pathway inhibitor for patients who are high-risk and have non-metastatic prostate cancer and were enrolled on the phase 2/3 STAMPEDE trial (NCT00268476). This will be presented by Nicholas David James, PhD, FRCP, MBBS, on June 3 from 9:57-10:09 am CDT.

Radiation therapy: A phase 3 trial assessing CAN-2409 plus prodrug and standard of care external beam radiation therapy in patients with newly diagnosed localized prostate cancer. This will be presented by Theodore L. De-Weese, MD, on June 3 from 9:45-9:57 am CDT.

Furthermore, the conversation touched upon anticipated phase 3 data in hormone-sensitive prostate cancer. Specifically, there’s excitement around upcoming results for patients with high-risk or high-volume metastatic hormone-sensitive prostate cancer harboring 

 mutations. This data could be practice-changing and offer a new therapeutic avenue for this specific subset of patients.

Beyond these specific disease areas, the podcast highlighted the broader themes expected at 2025 ASCO, including the continued development and refinement of immunotherapy, the integration of multimodal AI in oncology, and the ongoing investigation of novel targets, like TROP2 inhibitors.

Manojkumar Bupathi, MD, MS, and Benjamin Garmezy, MD, highlight exciting trials in the genitourinary cancer space expected to be presented at 2025 ASCO. 

A Sneak Peek at 2025 ASCO From the GU Perspective

Maha H. Hussain, MD, and Sarah E. Fenton, MD, PhD, spoke with 

 about developments in their careers and the evolution of research in the genitourinary oncology (GU) field. Additionally, they discussed their personal experiences in the field, which ranged from applying key pieces of advice from former mentors, handling challenges, and maintaining a healthy work/life balance.

Hussain is a Genevieve E. Teuton Professor of Medicine at Northwestern Medicine, and her mentee and fellow colleague, Fenton, is an assistant professor of Medicine at Northwestern Medicine.

The conversation partly focused on how the GU oncology landscape has evolved over time. According to Hussain, funding for new research and clinical trials has grown due to partnerships with pharmaceutical companies, which has accompanied a growth in median survival for patients with metastatic castration-resistant and metastatic hormone-sensitive prostate cancer. Looking ahead, Fenton said she hopes to see a greater proportion of patients achieve improved disease control, thereby leading to more treatment discontinuations or longer treatment-free intervals.

Additionally, Fenton described some of the advice she received that impacted the trajectory of her career and helped her decide to specialize in GU oncology.

“You need to stick with things that are important to you, worth your time, and are going to help people,” Fenton said. “That is the best piece of advice that Maha has given me as I’ve been moving through and thinking about what projects I’m going to start and where I am going to work hard.”

Hussain and Fenton also spoke about some of the personal challenges they have encountered in genitourinary oncology, including the difficulty of balancing their personal lives with professional aspirations. Both spoke to the importance and possibility of caring for their families while establishing priorities for their work.

“You can parallel-track your career and your personal life. I would say motherhood is wonderful; it’s a wonderful opportunity to be a mother,” Hussain said. “At the same time, it was a wonderful opportunity to be a physician and move the field there and work hard. Don’t forget that your personal life is very important because a happy personal life also reflects on your work life.”

Leaders in genitourinary oncology spoke about key research advances as well as personal experiences in navigating the field.

Finding Ways to Break the Mold in GU Oncology

CancerNetwork examines research from the October issue of the journal 

Value of Geriatric Assessment in Patients With Genitourinary Carcinoma

” alongside lead author of the substudy, which was based on the previously published PERATECS3 project (NCT01278537), Quirin Zangl, MD, from the Department of Neuroanesthesia, at the Christian Doppler Hospital in Salzburg, Austria.

The research featured 111 patients with urogenital carcinomas with the goal of evaluating comprehensive geriatric assessment tools that may be utilized to better guide these individuals perioperatively. Patients were divided into 2 groups, consisting of prostate cancer (n = 88) and distal urinary tract cancer (n = 29). In this episode, Zangl discussed the relationships between comprehensive geriatric assessment tools and complications, hospital duration, death rate, and baseline characteristics were analyzed.

Don’t forget to subscribe to the "Oncology Peer Review On-The-Go" podcast on Apple Podcasts, Spotify or anywhere podcasts are available.

Lead author, Quirin Zangl, MD, spoke with CancerNetwork about research published in the journal ONCOLOGY focusing on the importance comprehensive geriatric assessment tools for patients with genitourinary carcinomas.

Oncology Peer Review On-The-Go: Value of Geriatric Assessment in Patients With Genitourinary Carcinomas

Today we are discussing immunotherapy approaches for the treatment of advanced urothelial cancer with Dr. Petros Grivas, MD, PhD, a medical oncologist who focuses on genitourinary cancers at the Seattle Cancer Care Alliance and the University of Washington. Grivas is an associate professor and clinical director of the Genitourinary Cancers Program at the University of Washington, and associate member of the Fred Hutchinson Cancer Research Center in Seattle. 

There have been at least five Food and Drug Administration (FDA) approvals of immunotherapies, and specifically of immune checkpoint inhibitor antibodies, for urothelial cancer. Could you briefly go through the agents now available for treatment and which patients are eligible?

I would start by saying that we have experienced a revolution in the treatment landscape for advanced urothelial cancer in the last few years and this has led to the FDA approval of five distinct immune checkpoint inhibitors that inhibit the PD1/PDL1 axis of the immune system. These five agents are pembrolizumab, atezolizumab, durvalumab, avelumab and nivolumab.

All of these agents are approved for patients who have advanced urothelial cancer, meaning locally advanced/unresectable or metastatic disease and have progressed despite treatment with platinum-based chemotherapy. These agents are approved by the FDA in what we call the “salvage setting” after prior platinum-based chemotherapy.

One of those agents, pembrolizumab, has shown overall survival benefit, as a primary endpoint of a phase 3III trial, compared to salvage chemotherapy in patients who progressed on platinum-based chemotherapy. The other agents were approved based on phase II trials. It is worth mentioning that another agent, atezolizumab, was also tested in a phase III trial that showed that in “all-comers," meaning in the entire study population, there was overall survival benefit compared to salvage chemotherapy.

However, this was not the primary endpoint; the primary endpoint was overall survival in the subset of patients who had higher PD-L1 expression and this particular primary endpoint was not met in this IMvigor211 trial.

So overall, we have five agents approved in this particular salvage setting, and one of them has Level 1 evidence based on NCCN [National Comprehensive Cancer Network] guidelines based on the phase III Keynote 045 trial, that compared pembrolizumab vs salvage chemotherapy. However, all of these therapy options are approved and available in this setting, but there is no data to use one after progression on another checkpoint inhibitor.

Moreover, in the first-line setting, especially for cisplatin-unfit patients, meaning patients who cannot safely receive cisplatin in the first-line, chemotherapy-naÃ¯ve for advanced disease setting, two of these agents are FDA approved: atezolizumab and pembrolizumab based on single arm, phase II studies (IMvigor 210, cohort 1, for atezolizumab, and Keynote 052 for pembrolizumab). These agents were initially approved regardless of tumor tissue PD-L1 expression.

However, more recently, around May and June of 2018, there were discussions with the FDA and EMA (European Medicines Agency) in Europe that ultimately led to the modification of the label of these two agents in the first-line setting. The chemotherapy naÃ¯ve cisplatin-unfit patients that restricted the use of these two checkpoint inhibitors to patients with high PD-L1 expression based on the companion corresponding assay for each agent.

For example, for pembrolizumab, this is the Agilent/Daco 22C3 assay, and for atezolizumab, the Ventana SP142 assay. However, in the US based on FDA clarification, if a patient is very frail and unfit for carboplatin, so not a good fit for any platinum-based chemotherapy, there is no need to check PD-L1 expression in these patients and they could get either approved checkpoint inhibitor in the first-line setting regardless of PD-L1 expression.

These are the approved agents, but there are a plethora of ongoing clinical trials that are looking at combination therapies in advanced urothelial cancer, while also looking at biomarkers. There is also evaluation of those and other immune checkpoint inhibitors in earlier disease settings, including the adjuvant and neoadjuvant settings as well as the non-muscle invasive bladder cancer setting.

You mentioned cisplatin-based chemotherapy has been the standard of care for urothelial carcinoma. In the context of the labels for the approved checkpoint inhibitors, how do you view the role of these agents in treatment? Are there also other options for the same line of therapy? How do you choose an immunotherapy vs a different type of treatment for patients?

There are a few points to make here. Number one is that in the front-line setting in the locally advanced/unresectable or metastatic urothelial cancer, the standard of care is cisplatin-based chemotherapy. Of course, we always want to do clinical trials and this is the optimal way to go regardless of treatment setting. But in the absence of trials, cisplatin chemotherapy, usually gemcitabine-cisplatin, or less frequently, accelerated, dose dense MVAC [methotrexate, vinblastine, doxorubicin, cisplatin] is used in this first-line setting.

The patients who cannot get cisplatin have the option of getting non-cisplatin chemotherapy and usually many of those patients end up getting carboplatin/gemcitabine or a checkpoint inhibitor, pembrolizumab or atezolizumab, which, as we just discussed, are approved in this first-line “chemotherapy naive for advanced disease” setting for cisplatin unfit patients. The decision depends on the fitness, candidacy, eligibility for cisplatin, and the availability of clinical trials. Right now, in advanced urothelial cancer we have chemotherapy and immunotherapy as approved options.

We don't have any other agents approved yet, however, we have many ongoing clinical trials looking at antibody drug conjugates. Agents like enfortumab vedotin and sacituzumab govitecan, which are being tested in very interesting phase II and III trials, with prior, early-phase, trial data looking very promising.

There are also targeted therapy trials, including inhibitors against FGF receptor, PARP, HER2, and other molecular targets. I think that these trials are very interesting, and hopefully we will have more agents approved in the future. Until then, I think clinical trials is the optimal way to go.

To summarize, cisplatin-based chemotherapy upfront is the standard of care for fit patients. For cisplatin-unfit patients we have either other chemotherapy, for example carboplatin/gemcitabine, or the two approved checkpoint inhibitors as first line therapy, based on the details we discussed above.

If a patient is progressing on platinum-based chemotherapy, a clinical trial is again the way to go. Outside of clinical trials, we have the five FDA-approved checkpoint inhibitors, with pembrolizumab having Level 1 evidence in this salvage therapy setting.

You mentioned that there are clinical trials of combinations and there are trials testing these immunotherapy agents in earlier disease settings, and also biomarkers. Of all of these questions that you and your colleagues are addressing with respect to checkpoint inhibitor antibodies, are there one or two questions that you could highlight?

I think there are multiple, very interesting clinical trials, really a huge list, and I don’t want to leave anything out. But overall, the main questions we are trying to answer are in the first-line setting, is chemotherapy or immunotherapy the way to start for advanced urothelial cancer?

In that context, there are four large, phase III trials asking this question of chemotherapy vs immunotherapy in the front-line setting. Two of these trials are asking an additional question, which is whether the combination of chemotherapy and immunotherapy is better than chemotherapy or immunotherapy alone. I think these trials may potentially impact the treatment landscape.

There are also two very important “switch maintenance” trials. One is a phase III trial that is testing an anti-PDL1 agent, avelumab), after 4 to 6 cycles of front-line platinum-based chemotherapy, with no progression. Patients get randomized to avelumab and best supportive care vs best supportive care alone.

There is also a phase II trial that has a very similar design that is randomizing patients to pembrolizumab vs placebo with a crossover design after front-line platinum-based chemotherapy to evaluate this “switch maintenance” question, whether this sequencing of therapies is of benefit. As I mentioned, there are numerous other trials with a plethora of agents, checkpoint inhibitors plus chemotherapy, radiation therapy, targeted therapies, antibody drug conjugates, vaccines, other immune related molecules, cytokines, epigenetic modulators, anti-angiogenesis agents, etc., that are all very interesting.

These trials are trying to build upon what we have already seen with checkpoint inhibitors and are trying to prospectively evaluate the clinical utility of biomarkers. The question is, could we try to select the right patients for the right treatment in the future? Because “one size may not fit all” and patient selection is critical. So far, with the exception of tumor tissue PD-L1 in the front-line setting, we do not have clinically useful biomarkers in advanced urothelial cancer.

There is definitely the opportunity to try to identify clinically useful biomarkers to select patients, but this requires multi-center collaborations and prospective validation of candidate biomarkers across clinical trials. This is something very hard to do, but we should all push through. Candidate biomarkers span across tumor tissue, urine and blood-based biomarkers, which are interesting and worth exploring further.

Thank you so much for joining us today Dr. Grivas.

My pleasure. Hopefully we will experience many more advances in the near future in the field of urothelial cancer with new agents and biomarkers.

Grivas has done consulting with Genentech, Merck & Co., Pfizer, Bristol-Myers Squibb, AstraZeneca, Biocept, Clovis Oncology, EMD Serono, Seattle Genetics, Foundation Medicine, Driver Inc., QED Therapeutics, Heron Therapeutics, and Janssen within the past 2 years. He was previously involved in an educational, unbranded program with Genentech and Bristol-Myers Squibb. His institutions have received research support from Genentech, Bayer, Merck & Co., Mirati, OncoGenex, Bavarian Nordic, Pfizer, AstraZeneca, Clovis Oncology, and Immunomedics.

Cancer Network spoke with Dr. Petros Grivas about emerging immunotherapy approaches for the treatment of advanced urothelial cancer.

Emerging Immunotherapy Approaches For Urothelial Cancer

Ahead of the American Association for Cancer Research annual meeting, being held April 14–18 in Chicago, Illinois, we spoke with Elizabeth Plimack, MD. Dr. Plimack is chief of the division of genitourinary medical oncology and director of genitourinary clinical research at the Fox Chase Cancer Center in Philadelphia, where she specializes in the treatment of genitourinary cancers, including bladder cancer. At the meeting, she will be discussing recent advances in systemic therapy for bladder cancer, in a presentation entitled, “Systemic Therapy for Locally Advanced and Metastatic Bladder Cancer: A Rapidly Evolving Landscape.”

First, can you talk about the standard surgical and therapy options for locally advanced disease that have been around now for a while, and then how these contrast with the options for metastatic bladder cancer patients?

Sure. Bladder cancer has a variety of presentations. And in fact, the majority of people who develop bladder cancer have what is called noninvasive or localized bladder cancer, which can be treated with topical instillations and procedures done to the bladder itself.

Beyond that, there is a subset of patients with muscle-invasive bladder cancer, and that is what we talk about as locally advanced bladder cancer. Those patients can be cured of their cancer, but it requires what we call multimodality treatment with both chemotherapy and surgery and, in some cases, chemotherapy with radiation. The difference between that state and the metastatic state is that the locally advanced state we are treating with a curative intent and in the metastatic setting, although treatable, the cancer is not curable.

So the goals of care are different and the treatment paradigm is different. I can speak first about best practices for patients with locally advanced muscle-invasive bladder cancer. The treatment algorithm for those patients is fairly well defined, with multiple guideline groups-NCCN [National Comprehensive Cancer Network], the AUA [American Urological Association], and the European groups recommending chemotherapy prior to surgery to increase the chance of a cure, defined as being disease-free at 5 years. We know that adding chemotherapy prior to treatment (typically surgery), helps. Recently, novel developments suggested that chemotherapy alone may be curative for a subset of patients, perhaps 10% to 30% of patients, and we are finding trials in that space to allow for patients to keep their bladders when chemotherapy is curative. I will be speaking about that in my talk at AACR.

What are some of the new treatment modalities that have recently been approved for either locally advanced or metastatic bladder cancer?

Dr. Elizabeth Plimack discusses her 2018 AACR meeting presentation on recent advances in systemic therapy for bladder cancer.

Genitourinary Cancers

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