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PEER-TO-PEER CLINICAL CONVERSATIONS |
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| Integrating Genetic Variants and Clinical Factors for Improved Prostate Cancer Prognostication |
Susan Halabi, PhD
Susan Halabi discusses her presentation on prognostic factors in metastatic castration-resistant prostate cancer (mCRPC) based on the Alliance trial. The phase three trial, which enrolled 1,311 patients, compared the effects of enzalutamide alone to enzalutamide combined with abiraterone and prednisone. |
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| Variant Histology Bladder Cancer Challenges and Future Directions |
| Syed Hussain, MBBS, MSc, MD, FRCP |
| Leslie Ballas interviews Syed Hussain about histologic subtypes of bladder cancer. Dr. Hussain discusses the challenges in diagnosing and managing variant histologies, emphasizing their poor prognosis and the need for specialized research. |
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| Bladder-Sparing Chemoradiation for Localized Bladder Cancer: Addressing the Unmet Need |
Brent Rose, MD
Zach Klaassen speaks with Brent Rose about advances in bladder-sparing therapies for localized bladder cancer. Dr. Rose highlights the surprising underutilization of chemo-radiation in bladder cancer treatment, despite its established role in other cancers and the significant risks and quality of life issues associated with cystectomy. |
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| The Evolving Role of Radical Cystectomy in the Era of Bladder-Sparing Therapies |
Sima P. Porten, MD, MPH and Roger Li, MD
Ashish Kamat hosts Sima Porten and Roger Li to discuss the management of BCG-unresponsive bladder cancer. They emphasize personalized patient care, starting by understanding patients' goals and risk tolerance. |
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| Patient Perspectives on Bladder Cancer: Balancing Treatment Options and Shared Decision-Making |
| Roger Li, MD |
| Roger Li discusses findings from a patient panel at the BCAN Think Tank, focusing on decision-making in BCG-unresponsive and muscle-invasive bladder cancer treatment. He emphasizes the emotional journey patients undergo and the importance of empowering them with information. |
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| What Is Variant Histology Renal Cell Cancer and What Are the Available Treatment Options? |
| Sumanta Kumar Pal, MD, FASCO |
| Sumanta Kumar Pal discussed the challenges and evolving treatment landscape for variant histology renal cell carcinoma (RCC), particularly non-clear cell subtypes like papillary RCC (pRCC). He highlighted promising data from recent trials, such as the PAPMET study, showing Cabozantinib as a key option for pRCC, but emphasized the need for more randomized phase III trials. |
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| Initial Staging in Bladder Cancer: Histologic Subtype, Molecular Phenotype, and Biomarkers Are Enough |
| Eva Comperat, MD, PhD |
| Professor Eva Comperat emphasized the importance of histologic subtypes, molecular phenotypes, and biomarkers in the staging and treatment of bladder cancer. She highlighted that current histologic reports are sufficient for treatment decisions, but molecular subtyping can provide additional prognostic and predictive insights, guiding targeted therapies like FGFR inhibitors. The discussion also underscored the need for further research into treating multiple or partial subtypes and refining metastatic predictions based on molecular profiles. |
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| Histology Subtypes (variants) of Bladder Cancer |
| Syed Hussain, MBBS, MSc, MD, FRCP |
| Syed Hussain presents on the histologic subtypes of bladder cancer, focusing on their diverse and complex nature. He emphasized that variant histologies, such as squamous, glandular, micropapillary, and sarcomatoid, are often underreported by pathologists and are linked to poor prognosis, especially when associated with advanced disease. Hussain discussed the importance of central pathology review, highlighted clinical trial challenges, and noted that histologic subtype significantly affects treatment outcomes, with therapies like atezolizumab showing varying responses depending on the variant. |
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| BCG Unresponsive Disease: How Much Risk can my Patient Tolerate?
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| Sima Porten, MD, MPH, and Roger Li
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| This debate highlights the complexity of managing BCG unresponsive bladder cancer. Dr. Porten emphasized the importance of timely cystectomy to avoid progression to muscle-invasive disease, while Dr. Li stressed that bladder-sparing therapies, when carefully managed, could provide comparable outcomes, with less impact on quality of life. The ongoing challenge remains in selecting the most appropriate treatment approach based on individual patient factors and available therapeutic options.
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| Very High Risk NMIBC with Variant Histology |
| Paolo Gontero, MD, and Michael Cookson, MD |
| Experts debate the management of very high-risk non-muscle invasive bladder cancer with variant histology. Dr. Gontero advocated for early radical cystectomy, particularly for aggressive subtypes like plasmacytoid, due to their high risk of progression, while Dr. Cookson suggested conservative management with intravesical therapy could be considered in select cases, though more evidence is needed. The consensus leaned toward early cystectomy for variant histologies, but better molecular profiling and clinical trials are essential to refine treatment strategies. |
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