Keypoints:
• The distinction between muscle invasive and non-muscle invasive bladder cancer and their respective treatment approaches.
• The role of BCG treatment and emerging options for BCG-refractory disease.
• The significance of the NIAGARA trial and its implications for neoadjuvant chemotherapy and perioperative immunotherapy.
• Current strategies for managing muscle invasive bladder cancer, including the use of cisplatin-based therapies and the introduction of immunotherapy.
• Insights into the metastatic space, including the use of enfortumab vedotin (EV) and pembrolizumab, and the importance of next-generation sequencing (NGS) in treatment decisions.
• Key side effects to monitor with various treatments and the importance of maintaining quality of life for patients.
In this episode of treatment algorithm series, Drs. Rahul and Rohit Gosain had the pleasure of speaking with Dr. Joaquim Bellmunt, a medical oncologist and director of bladder cancer at Dana-Farber Cancer Institute. We delved into the rapidly evolving landscape of bladder cancer treatment, particularly focusing on muscle invasive and non-muscle invasive disease.
Dr. Bellmunt emphasized the importance of distinguishing between muscle invasive and non-muscle invasive bladder cancer, as the treatment approaches differ significantly. For non-muscle invasive disease, BCG treatment remains the cornerstone, but we discussed emerging options for patients who are BCG refractory, including new therapies and ongoing trials.
When it comes to muscle invasive bladder cancer, Dr. Bellmunt outlined a comprehensive treatment paradigm that includes chemotherapy, immunotherapy, and aggressive surgery. He highlighted the significance of the NIAGARA trial, which has introduced a new approach involving perioperative use of immunotherapy with chemotherapy, showing promising survival benefits.
We also explored the role of adjuvant therapies, particularly nivolumab and pembrolizumab, in high-risk patients post-surgery. Dr. Bellmunt pointed out the importance of patient selection and the need for ongoing research to refine treatment strategies, especially for those with specific genomic alterations.
As we transitioned to the metastatic space, we discussed the impressive results of the EV-Pembro regimen, which has become a standard in frontline treatment, and the considerations for second-line therapies, including the use of targeted therapies based on genomic testing.
Throughout the conversation, we stressed the importance of managing side effects and maintaining quality of life for patients undergoing treatment. Dr. Bellmunt's insights provided a thorough overview of the current treatment landscape for bladder cancer, and we are excited to see how these advancements will continue to shape patient care.
Thank you for joining us in this informative discussion. If you found this episode helpful, please share it with colleagues and leave us a review to help us reach more oncologists and improve patient care. Don't forget to check out our other episodes in the treatment algorithm series!
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