SUO 2020

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SUO 2020

SUO 2020: Patterns of Recurrence After Inguinal Lymph Node Dissection for Penile Squamous Cell Carcinoma

(UroToday.com) Inguinal lymph node dissection is a core component in the management of penile squamous cell carcinoma with involvement, or a high risk of involvement, of the inguinal lymph nodes. Available information is lacking regarding the exact incidence, site, and timing of recurrence after inguinal lymph node dissection. Such knowledge would be critically useful to inform evidence-based post-inguinal lymph node dissection surveillance protocols, as well as patient counseling. Dr. Nicholas Chakiryan from the Moffitt Cancer provided a discussion at the Society of Urologic Oncology (SUO) virtual 2020 annual meeting regarding detailed data on incidence, site, and timing of recurrence after inguinal lymph node dissection in a large multi-institutional international cohort.

SUO 2020: Adverse Event Profile for Combination Chemoimmunotherapy Compared to Chemotherapy in Solid Organ Malignancies: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

(UroToday.com) Immunotherapeutic approaches have gained an increasingly large role in the treatment of many cancers. In urologic oncology, there is a large role in the first-line management of patients with metastatic renal cell carcinoma, in Bacillus Calmette-Guerin (BCG)-refractory non-muscle invasive bladder cancer, and in advanced bladder cancer. In addition to monotherapy, immunotherapy is increasingly being utilized in combination with chemotherapy. In a session of the Best Poster Presentations in Health Services and Other Research at this year's Society of Urologic Oncology (SUO) virtual annual meeting, Dr. Mary Hall presented data from a meta-analysis examining the relative toxicity associated with combined chemoimmunotherapy compared to chemotherapy alone.

SUO 2020: Perioperative Therapy for Muscle-Invasive Bladder Cancer

(UroToday.com) Dr. Kelly Stratton gave a presentation at the 2020 Society of Urologic Oncology (SUO) Annual Virtual Meeting on peri-operative therapy for muscle-invasive bladder cancer (MIBC). He began his talk by demonstrating that the outcomes after radical cystectomy differ significantly according to the pathological results of cystectomy (Figure 1).¹ Due to the fact that in some patients, radical cystectomy might not be enough, neoadjuvant chemotherapy (NAC) has been added as a standard of care. Based on level one evidence,² NAC showed an overall survival benefit of 14% at five years when compared to cystectomy alone (Figure 2).

SUO 2020: Clinically Node-Positive Bladder Cancer – Pro Surgery

(UroToday.com) During the 2020 Society of Urologic Oncology (SUO) annual meeting, Dr. Neema Navai presented on the management of “node only” metastatic bladder cancer, debating for the use of surgery following chemotherapy. The mechanism for metastatic disease is not entirely understood yet. There are several potential possibilities, which include:

SUO 2020: Real-World Application of Pre-Orchiectomy miR-371A-3P Test in Testicular Germ Cell Tumor Management

(UroToday.com) Current serum tumor markers for testicular germ cell tumor are limited by low sensitivity, with several drawbacks, including, (ii) low expression in seminoma, embryonal carcinoma, and teratoma and (ii) ~50% sensitivity. Taken together, pre-orchiectomy serum tumor markers are not ideal to diagnose malignant disease. However, there is growing evidence supporting the use of circulating miR-371a-3p as a superior marker for malignant (viable) germ cell tumor management. At the 2020 Society of Urologic Oncology (SUO) virtual meeting, Dr. Rohit Badia and colleagues presented results of their evaluation of the real-world application of serum miR-371a-3p levels in detecting viable germ cell tumors among patients undergoing partial or radical orchiectomy.

SUO 2020: Oncologic Outcomes of Mohs Surgery for Localized Penile Carcinoma: A 10-Year Retrospective Study

(UroToday.com) Penile cancer is a rare malignancy with an annual incidence of 0.1-0.7 in 100,000 men, which accounts for fewer than 1% of male cancers in the United States. Treatment is often associated with considerable mutilation and changes to quality of life. Organ sparing surgery for the management of localized penile cancer has the potential to maintain penile form and function while achieving equivalent oncologic control as partial or total penectomy. Furthermore, Mohs surgery is efficacious for the treatment of non-genital and cutaneous cancers first pioneered by Dr. Mohs for penile carcinoma in 1992 with a 5-year control rate of 94%. Although it is endorsed by the National Comprehensive Cancer Network (NCCN) guidelines for low-stage penile cancer management, there is a paucity of data on cancer outcomes in localized penile cancer. At the 2020 virtual annual meeting, 4th-year medical student Nicolas Alcala presented institutional work assessing oncologic outcomes in patients with localized penile carcinoma managed with Mohs surgery.

SUO 2020: Neoadjuvant Checkpoints: Exploring the Emerging Utility of Immune Checkpoint Inhibitors in Muscle-Invasive Bladder Cancer

(UroToday.com) At the 2020 Society of Urologic Oncology (SUO) virtual annual meeting, Dr. Neal Shore chaired a session examining the use of newer and emerging agents in bladder cancer, which highlighted a presentation by medical oncologist Dr. Arjun Balar discussing the emerging utility of immune checkpoint inhibitors in muscle-invasive bladder cancer (MIBC).

SUO 2020: Advanced Kidney Cancer Update – “A Glimpse into the Future"

(UroToday.com) In this state-of-the-art presentation, Dr. Toni Choueiri gave an overview of the management of advanced kidney cancer.

SUO 2020: Systemic Therapy for Metastatic Urothelial Carcinoma

(UroToday.com) At this year's Society of Urologic Oncology (SUO) annual meeting Vadim S. Koshkin presented on systemic therapy for metastatic urothelial carcinoma. The current state of first-line metastatic urothelial carcinoma is shown in Figure 1.

SUO 2020: The Future of Prostate Cancer Screening

(UroToday.com) At this year's Society of Urologic Oncology (SUO) annual meeting Dr. Klein was awarded the prestigious Richard D. Williams prostate cancer research excellence award. In this session, he gave a presentation on prostate cancer screening and cancer screening in general.

SUO 2020: Management of “Node Only” M1 Metastatic Bladder Cancer- Against Surgery

(UroToday.com) During the 2020 Society of Urologic Oncology (SUO) annual meeting, Dr. Arjun Balar presented on the management of “node only” metastatic bladder cancer, debating against the use of surgery following chemotherapy beginning with a series of fundamental principles.

SUO 2020: Debate: Neoadjuvant vs. Adjuvant Chemotherapy for Upper Tract Urothelial Carcinoma - Adjuvant

(UroToday.com) In this debate, Dr. Tracy Rose presented why adjuvant chemotherapy should be used in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy. She began with a description of the POUT trial.¹ This is a landmark trial, which was a phase 3, open-label prospective randomized-controlled trial conducted at 71 hospitals in the UK. This trial showed that gemcitabine–platinum combination chemotherapy initiated within 90 days after nephroureterectomy significantly improved disease-free survival in patients with locally advanced UTUC. The primary endpoint was disease-free survival. The arms of this trial were mostly well balanced. 64% of the patients were still able to receive cisplatin following surgery.

SUO 2020: Genomic Characterization of Residual Disease at Radical Cystectomy Following Neoadjuvant Chemotherapy in Patients with Muscle-Invasive Bladder Cancer

(UroToday.com) During the Best of Bladder Cancer session during the 2020 Society of Urologic Oncology (SUO) annual meeting, Dr. Andrew Lenis presented on his group’s experience with genomic characterization of cystectomy patients. Currently, the standard of care for muscle-invasive bladder cancer is neoadjuvant chemotherapy followed by radical cystectomy. The majority of studies in this space have focused on chemotherapy treatment-naïve patients with the aim of preoperative risk stratification and treatment selection. However, current trials are investigating the role of adjuvant immunotherapy in patients with the chemo-resistant disease. For this reason, the group at Memorial Sloan Kettering Cancer Center (MSKCC) sought to elucidate the molecular biology of chemo-resistant disease in order to help expand therapeutic options.

SUO 2020: Factors Associated with Decision Regret in Patients Undergoing Radical Cystectomy and Urinary Diversion

(UroToday.com) Dr. Elizabeth Green was invited to speak during the last bladder cancer session of the 2020 Society of Urologic Oncology (SUO) annual meeting. Her group has investigated factors associated with decisional regret in patients undergoing radical cystectomy and urinary diversion.

SUO 2020: Racial and Socioeconomic Disparities In Adjuvant Therapy and Survival In Nonseminomatous Germ Cell Tumor: A Population-Based Study

(UroToday.com) Though testicular cancer is the most common cancer in young men, there is a paucity of epidemiologic studies examining sociodemographic disparities in adjuvant therapy and outcomes. Non-clinical and non-biologic factors, such as race, socioeconomic status, and insurance have known associations with survival among men with testis cancer.

SUO 2020: Debate: Neoadjuvant vs. Adjuvant Chemotherapy for UTUC - Neoadjuvant

(UroToday.com) Neoadjuvant chemotherapy (NAC) is the standard of care for muscle-invasive bladder cancer. However, upper tract urothelial carcinoma (UTUC) is not the same as bladder cancer, with a higher rate of invasive disease. The survival of high grade and high stage disease UTUC remains poor (Figure 1), and downstaging in urothelial cancer is highly predictive of improved survival¹.

SUO 2020: Emerging Management of Von Hippel-Lindau-associated Renal Cell Carcinoma

(UroToday.com) Von Hippel-Lindau (VHL) syndrome is a rare, inherited disorder that causes tumors and cysts to grow in various parts of the body. Patients with VHL syndrome have an increased risk of certain types of cancer, especially kidney cancer and pancreatic cancer. The signs and symptoms of von Hippel-Lindau syndrome usually do not appear until young adulthood. Some of the manifestations of VHL include:

SUO 2020: Optimizing Management of High Risk Non-Muscle-Invasive Bladder Cancer – Case Based Discussion

(UroToday.com) The plenary session of the last day of the 2020 Annual Meeting of the Society of Urologic Oncology (SUO) began with a panel discussion stepping through the case of a patient with non-muscle invasive bladder cancer.

SUO 2020: Molecular Characterization of NMIBC in the Clinical Context

(UroToday.com) In this presentation, opening the session on bladder cancer at the Society of Urologic Oncology (SUO) 2020 meeting, Dr. Sfakianos gave a summarized overview of the molecular characterization of non-muscle invasive bladder cancer (NMIBC).

SUO 2020: Next Generation Clinical Trial Design BCG-Unresponsive NMIBC

(UroToday.com) There have been several recent single-arm trials in the Bacillus Calmette-Guerin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) setting (Table 1).

The first question that arises is whether these single-arm trials are enough or do we need to randomize patients for our future trials. As seen in Table 1, these treatments are given for a minimum of two years, requiring a high number of physician visits during these treatment years. To get more accurate information, we may need to consider randomizing these patients in the long run and compare these treatments head to head before making any informed decisions.