We ask ourselves if there is any place for surgical treatment post systemic therapy with chemotherapy or with ICPI? This includes cytoreductive surgery or consolidative surgery. After completion of first line platinum based chemotherapy, patients can either be referred to clinical trials, receive maintenance therapy, be actively monitored or undergo postchemotherapy surgery. Patients referred for postchemothearpy surgery should generally have no pulmonary metastasis, have only pelvic metastasis, and be ECOG-PS status 0. Patients with multiple visceral metastasis or retroperitoneal lymph nodes involved, at any ECOG-PS status should be actively monitored. Patients with visceral metastasis could also receive maintenance therapy, while patients with a high ECOG-PS status, with multiple visceral metastasis, and with driver molecular alterations should be referred for clinical trials.
Trials assessing the role of surgery, in all its forms, should be conducted to understand its tole in this advanced state of disease.
Figure 1: Evolution of Bladder Cancer Treatments:
Figure 2: Current Treatment Algorithm for Metastatic Bladder Cancer:
Figure 3: Recruiting Trials for First-line Metastatic Bladder Cancer:
Speaker: Andrea Necchi, MD Department of Medical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands