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Highlights from the 2024 South Central Section of the AUA Annual Meeting
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| BCG Shortage – An End in Sight? |
| Danica May, MD |
| Danica May discussed strategies to manage the ongoing BCG shortage for high-risk NMIBC, including prioritizing induction BCG for high-risk patients and using alternative intravesical therapies like gemcitabine and docetaxel. Merck’s upcoming facility, expected to be complete by 2025-2026, aims to triple production, potentially alleviating the shortage. Clinical trials, including those testing checkpoint inhibitors combined with BCG, offer promising new treatment avenues. |
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| BCG Will Always Be the First Line: Yes |
| Colin P. Dinney, MD |
| Colin Dinney argues that BCG remains the first-line treatment for high-risk non-muscle invasive bladder cancer (NMIBC), citing its proven benefits in preventing recurrence, progression, metastasis, and mortality. He discusses the risks associated with low-, intermediate-, and high-risk NMIBC and highlighted how BCG shortages have negatively impacted recurrence and cystectomy rates. |
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| Emerging Treatments for NMIBC |
| Neema Navai, MD |
| Neema Navai presented emerging treatments for BCG-unresponsive non-muscle invasive bladder cancer (NMIBC), highlighting promising results from immunotherapies, gene therapies, and targeted therapies like pembrolizumab, vicinium, and erdafitinib. Alternatives to BCG, such as the IL-15 agonist N-803 and TAR-200 gemcitabine, have shown significant response rates, offering potential new options amid BCG shortages and treatment limitations. |
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| High Risk NMIBC Treatment: The Case for Bladder Sparing Therapy
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| Cheryl Lee, MD
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| Cheryl Lee presents on bladder-sparing therapy for high-risk non-muscle invasive bladder cancer (NMIBC), discussing its viability as an alternative to radical cystectomy, especially given cystectomy's high complication rate and quality-of-life impact. The updated AUA guidelines and NCCN support intravesical therapies and systemic options like pembrolizumab for BCG-unresponsive patients unwilling or unfit for cystectomy.
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| The Top 10 Reasons Why BCG (as a Monotherapy) Will Cease to Exist |
| Cheryl Lee, MD |
| Cheryl Lee highlighted reasons why BCG monotherapy for high-risk NMIBC may phase out, citing issues such as administration challenges, side effects, global shortages, and the emergence of competitive therapies. New agents, including UGN-102, erdafitinib, and TAR-200, show promising efficacy and improved convenience, while combination therapies like BCG plus immunotherapy trials offer potential for better outcomes. As novel treatments reduce patient burden and enhance precision care, BCG monotherapy's role is expected to decline within the next five years. |
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| High-Risk NMIBC Treatment: The Case for Radical Cystectomy |
| Chad LaGrange, MD, FACS |
| Chad LaGrange presents the case for radical cystectomy in treating high-risk NMIBC, particularly for patients with very high-risk features like BCG unresponsiveness, variant histology, and lymphovascular invasion. He emphasizes that ideal candidates include young, healthy patients with high-volume, multifocal disease, and those with variant histology due to its aggressive nature. The BRAVO trial and other studies highlight that early radical cystectomy offers better survival outcomes compared to bladder-sparing approaches, particularly for patients with recurrent high-grade T1 disease or BCG-refractory carcinoma in situ. |
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| Indications and Outcomes for Radiation Therapy in Renal Masses |
| Tyler Robin, MD, Phd |
| Tyler Robin presents on the role of radiation therapy, specifically stereotactic body radiotherapy (SABR), for treating renal masses in patients with renal cell carcinoma (RCC). Key findings from several recent studies indicate SABR as a promising alternative for patients unsuitable for surgery due to medical comorbidities or tumor characteristics. |
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| Indications and Outcomes for Ablation Therapy in Renal Masses |
| Kelly Bree, MD |
| Kelly Bree highlights ablation as a strong alternative for managing small renal masses, especially in patients unfit for surgery. Ablation methods like cryoablation, radiofrequency, and microwave ablation show high cancer-specific survival rates (around 95%) and low recurrence, making them effective and less invasive options. Each approach offers advantages in specific patient populations, with low complication rates and feasibility for repeat treatments if needed. |
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