Michael S. Cookson, MD, MMHC, outlines the purpose, methodology, and background for recently released guidelines for treating muscle invasive bladder cancer, including cisplatin-based chemotherapy. He highlights recommendation statements regarding patient counseling, neoadjuvant/adjuvant chemotherapy, radical cystectomy, pelvic lymphadenectomies, and more.
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Phillip J. Koo, MD, briefly reviews several clinical trials examining the use of radium 223, focusing on its use in combination with second generation AR inhibitors. He also reviews the data from the ERA 223 trial that was recently reported at ESMO 2018 and discuss lessons learned, including the optimal use of radium 223 in patients with endocrine resistant prostate cancer.
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Steven E. Finkelstein, MD, FACRO, describes how hydrogel spacing is becoming standard of care for prostate cancer radiotherapy. He reviews the clinical investigations of adjacent prostate indications, as well as indications in other organs throughout the body, for this technology.
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Erik P. Castle, MD, highlights recent advances in surgery, individualized medicines, and immunotherapies for patients with renal cell carcinoma (RCC). He reviews updates in genetic sequencing and CAR-T cell therapy, as well as developing role of cancer-associated macrophage-like cells (CAMLs), in these patients.
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Michael S. Cookson, MD, MMHC, suggests that the primary evidence does not provide convincing evidence in favor of 3 years of bacillus Calmette-Guérin (BCG) maintenance for non-muscle-invasive bladder cancer (NMIBC). He also notes that long-term BCG often leads to toxicities, contributing to low patient compliance.
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E. David Crawford, MD, reviews the findings and recommendations of the Radiographic Assessments for Detection of Advanced Recurrence (RADAR) I and II working groups. Phillip J. Koo, MD, then discusses the rationale for RADAR III and the expansion in recommendations from the first two iterations, focusing on updates regarding next generation imaging.
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E. David Crawford, MD, reviews the historical developments in androgen deprivation therapy (ADT) for prostate cancer and the emergence of the non-metastatic castration-resistant, or M0, prostate cancer. He then describes future directions for treatment options for these patients with a focus on androgen pathway inhibitors.
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Michael S. Cookson, MD, argues that neoadjuvant chemotherapy (NAC) is not appropriate or necessary for all patients with muscle invasive bladder cancer (MIBC) prior to cystectomy. Instead, physicians should use a selective approach to NAC to avoid unnecessary harms, toxicities, and delays in local therapy.
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Daniel P. Petrylak, MD, argues the advantages of using neoadjuvant chemotherapy prior to cystectomy to treat patients with muscle invasive bladder cancer (MIBC). He reviews evidence including the SWOG 87-10 trial and a meta-analysis to support this stance.
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Daniel P. Petrylak, MD, provides an overview of immunotherapy treatment options for non-muscle invasive bladder cancer (NMIBC) including BCG, intravesical therapies, and checkpoint inhibitors. He also discusses clinical trials investigating alternative immunotherapy options for NMIBC other than BCG.
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Raoul S. Concepcion, MD, FACS, provides an overview of the epidemiology of upper tract urothelial carcinoma (UTUC). He discusses the most recent efforts in improving management for the disease, particularly focusing on neoadjuvant chemotherapy when treating high-grade tumors and nonsurgical ways to combat low-grade UTUC.
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Alan H. Bryce, MD, surveys data from three phase III trials on adjuvant therapies for high-risk renal cell carcinoma. He discusses the controversies following the conclusions of the completed trials and emphasizes the need for research in further adjuvant therapies beyond those that target the VEGF pathway.
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