What to Expect at the SUO 24th Annual Meeting: Bladder Cancer

Bladder cancer is a complex disease that continues to undergo changes in management on all fronts, including diagnostic and therapeutic advances. With these new advances come novel questions and issues to address. Multiple studies have shown consistent results on the benefits of patients undergoing cisplatin-containing neoadjuvant chemotherapy,¹ which is part of the American Urological Association guidelines.²

The 24^th Annual Meeting of the Society of Urologic Oncology (SUO) pays special attention to patients who responded well to neoadjuvant chemotherapy and approaches to patients who did or did not benefit from neoadjuvant chemotherapy. Secondly, an ongoing issue includes the Bacillus Calmette-Guerin (BCG) shortage³ and the recognition of the need to develop other treatment strategies for those who do not tolerate or are unresponsive to BCG. Finally, we are understanding more of the benefits and appropriateness of trimodal therapy, and the meeting will describe further considerations for it.

The schedule for the upcoming SUO meeting is incredibly exciting. The agenda includes many important discussions, debates, and abstracts on bladder cancer. On the first day, Dr. James McKiernan, from the Columbia University Medical Center, will moderate a debate over a topic that many urologists grapple with: the management of patients with bladder cancer who had a complete response to neoadjuvant chemotherapy and whether to proceed with surgery. The current standard of care for the management of muscle-invasive bladder cancer (MIBC) is to consider neoadjuvant chemotherapy followed by radical cystectomy.

We will hear from experts like Dr. Adam Feldman, from Massachusetts General Hospital, who will discuss trimodal and radiation therapy as an alternative when patients have a complete response. Dr. Anne Schuckman, from Keck Medicine of the University of Southern California, will also debate going forward with surgery in light of a complete response to neoadjuvant chemotherapy. In addition, several abstracts will be presented on this topic, including one shared by Dr. Benjamin Joffe, from Columbia University Medical Center, observing the rate of recurrence in patients with MIBC who achieved a complete response after neoadjuvant chemotherapy.

On Thursday, Dr. Mark Tyson, from the Mayo Clinic, will discuss the results of the BOND 003, a phase 3 trial investigating intravesical cretostimogene grenadenorepvec monotherapy for patients with high-risk BCG-unresponsive non-muscle invasive bladder cancer (NMIBC). Dr. Sandip Prasad, from Atlantic Health System, will also share the results of the ENVISION trial investigating primary chemoablation for recurrent low-grade intermediate-risk NMIBC. Dr. Prasad will present a poster on the recently published phase 3 ATLAS trial investigating the utilization of UGN-102 +/- TURBT for low-grade intermediate-risk NMIBC compared with management via TURBT alone.⁴

Similarly, Dr. Gautam Jayram, from Nashville, Tennessee, will present the findings of the ADVANCED-1, a phase 1a open-label study evaluating the safety and toxicity of intravesical instillation of TARA-002 for patients with high-grade NMIBC. Dr. Timothy Lyon, from the Mayo Clinic, will present on the phase 1b/2 trial of TARA-002. In addition, Dr. Siamak Daneshmand, from the University of Southern California, will share the latest and important updates in bladder trials.

Friday morning, during the young urologic oncologist program, Dr. Jacob Taylor, from the University of Texas Southwestern Medical Center, will share the results of a large, multicenter cohort with BCG-unresponsive NMIBC who received further BCG compared with patients who received docetaxel therapy. He will also discuss the long-term outcomes of bladder-sparing surgery versus radical cystectomy for BCG-unresponsive NMIBC. In addition, Dr. Taylor will present a poster detailing a large, multicenter cohort of patients with BCG-unresponsive bladder cancer who underwent bladder-sparing management.

There are nearly 100 abstracts being presented at the meeting related to bladder cancer or upper tract urothelial carcinoma (UTUC). Some notable abstracts include discussions on whether adopting an antibiogram-directed antimicrobial prophylaxis for robotic-assisted radical cystectomy reduced the incidence of postoperative infectious complications. An abstract investigating the efficacy of cytoreductive nephrectomy in the setting of metastatic bladder cancer and whether sites of metastasis influence its benefits or lack thereof will also be presented.

Dr. Justin Refugia, a Urology resident at Wake Forest University School of Medicine, will discuss a retrospective cohort study on patients with high-risk NMIBC treated with intravesical gemcitabine-docetaxel as an alternative to BCG. Dr. Ben David, a fellow at Mt. Sinai Icahn School of Medicine, will present on BCG induction plus maintenance gemcitabine and docetaxel compared with gemcitabine and docetaxel induction and maintenance for patients with NMIBC. He will also present on gemcitabine and docetaxel induction plus maintenance versus only maintenance for patients with low- and intermediate-risk NMIBC.

Bolstering the topic, Drupad Annapureddy, from the University of Texas Southwestern Medical Center, will present a poster observing a large, multinational cohort of patients with BCG-unresponsive NMIBC who underwent intravesical gemcitabine-docetaxel (bladder-sparing treatment) compared with patients who underwent upfront radical cystectomy. Finally, Dr. Boorjian, from the Mayo Clinic, will present a poster on a phase 3 36-month follow-up trial on the efficacy of intravesical nadofaragene firadenovec for patients with BCG-unresponsive carcinoma in-situ.

David Ambinder, MD is a urology resident at New York Medical College/Westchester Medical Center. His interests include surgical education, GU oncology and advancements in technology in urology. A significant portion of his research has been focused on litigation in urology.

References

1. International Collaboration of Trialists: Neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: a randomised controlled trial. Lancet 1999; 354:533.
2. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, Lotan Y, Meeks JJ, Michalski JM, Morgan TM, Quale DZ, Rosenberg JE, Zietman AL, Holzbeierlein JM. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline. J Urol. 2017 Sep;198(3):552-559. doi: 10.1016/j.juro.2017.04.086. Epub 2017 Apr 26. Erratum in: J Urol. 2017 Nov;198(5):1175. PMID: 28456635; PMCID: PMC5626446.
3. Grabe-Heyne K, Henne C, Mariappan P, Geiges G, Pöhlmann J, Pollock RF. Intermediate, and high-risk non-muscle-invasive bladder cancer: an overview of epidemiology, burden, and unmet needs. Front Oncol. 2023 Jun 2;13:1170124. doi: 10.3389/fonc.2023.1170124. PMID: 37333804; PMCID: PMC10272547.
4. Prasad SM, Huang WC, Shore ND, Hu B, Bjurlin M, Brown G, Genov P, Shishkov D, Khuskivadze A, Ganev T, Marchev D, Orlov I, Kopyltsov E, Zubarev V, Nosov A, Komlev D, Burger B, Raju S, Meads A, Schoenberg M. Treatment of Low-grade Intermediate-risk Nonmuscle-invasive Bladder Cancer With UGN-102 ± Transurethral Resection of Bladder Tumor Compared to Transurethral Resection of Bladder Tumor Monotherapy: A Randomized, Controlled, Phase 3 Trial (ATLAS). J Urol. 2023 Oct;210(4):619-629. doi: 10.1097/JU.0000000000003645. Epub 2023 Aug 7. PMID: 37548555.