Optimizing Care Planning for Variant Histology Populations at World GU 2025

In this episode of Oncology Decoded, 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.