For the past three decades, urologists have been unsuccessful in our ability to avail our patients of significant therapeutic breakthroughs for the treatment of both non–muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer. Unfortunately, we also have not realized significant success with Bacillus Calmette-Guérin (BCG) combination intravesical therapies. Although we have witnessed the approval of valrubicin for BCG-refractory disease, this has failed to garner significant patient outcome benefit. Fortunately, overall patient benefit for perioperative chemotherapy has significantly increased with the addition of MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin), as well as platinum-based chemotherapy, especially for those patients who are chemotherapy fit and appropriate for the treatment. Also, there are several encouraging phase II intravesical trials for BCG-refractory disease that are now in phase III accrual (Shore ND, Boorjian SA, Canter DJ, et al. Intravesical rAd-IFNα/Syn3 for patients with high-grade, Bacillus Calmette-Guérin-refractory or relapsed non–muscle-invasive bladder cancer: a phase II randomized study. J Clin Oncol. 2017;35:3410-3416.).
As with the rapid approval of five new treatments for patients with castrate-resistant prostate cancer (CRPC), current bladder cancer research has resulted in five new approved checkpoint inhibitors, or immune-oncologics (IOs), for the treatment of metastatic bladder cancer. Notably, these IO therapies will revolutionize urologists’ approach to treating both bladder and kidney cancer. Each of the five treatments will be administered via clinic infusion, and offer a well-established and well-tolerated, immediate and long-term safety profile. Like most oncolytic therapies, specific immune-related adverse events may occur and must be learned, appropriately monitored, and managed. Of note, these new IOs initially have been approved for treatment of metastatic bladder and kidney cancers. In addition, numerous trials are currently evaluating these same IO therapies for bladder-sparing therapy as well as for patients with high-risk NMIBC. Urologists must be cognizant of the previous lessons learned from CRPC-approved agents, whereby some opinion leaders within and outside of urology and drug development were not confident in the ability of dedicated community-based urology to successfully adapt the breakthrough CRPC therapeutics. Today, there are some who share that same skepticism for interest and ability of community urology practices to adapt the most recently approved therapies for both bladder and kidney cancers.
LUGPA understands that it is critical for our members to receive up-to-date educational programs that will assist our members with the education and implementation of these new therapies. The following LUGPA initiatives have been developed to keep our member urologists current:
On behalf of the LUGPA Board of Directors and all our LUGPA Committee members, thank you very much for your continued feedback and support.