(Length of Discussion: 20 min)

There has been a limited number of new therapeutics, particularly in the area of patients who would benefit from advanced systemic bladder cancer treatments. Dr. Neal Shore reviews some pioneering work from the past such as MVAC and gemcitabine platinum based combinations but he notes those treatments are where things were left for many many years.  The development of immuno-oncology is revolutionizing how physicians should be thinking about bladder and renal cancer treatments.

Dr. Neal Shore feels it is important for urology professionals to recognize that in 2010 the field had the first break through in immuno-oncology in advanced prostate cancer with sipuleucel-T therapy. Interestingly, the oncologic community was very eager to embrace that therapy for M1-CRPC patients.  After that we saw five additional life prolonging agents in the CRPC space. Two of which were oral agents, two taxane based therapies, and a radiopharmaceutical.  Many in medical oncology industry thought the urology community would be reluctant to embrace these systemic therapies. Dr. Shore shared supportive feelings for immuno-onocolgy and he feels the urology community is absolutely posed to adapt to systemic therapies with five newly improved systemic therapies in bladder and kidney cancer.

Dr. Ashish Kamat and Dr. Neal Shore reflect on the speed at which these five newly approved therapies for advanced bladder cancer came, less than two years total.  Dr. Shore observes that physicians are all learning together, how to best administer, how to best observe toxicity levels, how to think about tissue integration and how to counsel patients.

While Dr. Shore explains the importance to recognize that there is still a role for platinum based chemotherapy and speaks of toxicities Dr. Kamat references the very high toxicities levels in earlier stages of CTLA-4 antagonist. Dr. Kamat continues, now with the improvements in toxicities it appears that it is fairly manageable if recognized early, he asked Dr. Shore for any suggestions for listeners on how to react and the appropriate time to call the patient in to get treated or to stop the drug.  Dr. Neal Shore reviews his own suggestions in a very general overview for patients and staff in regards to toxicities. 

When looking five to ten years ahead in immuno-oncology for bladder cancer, Dr. Shore sees it as an area that any GU oncologist, urologist, or medical oncologist is to be very attuned to for the present and immediate near term future, and thinks of it as being the standard of care for multiple disease states. 


Biographies:

Neal Shore, MD, FACS 

Ashish M. Kamat, M.D., MBBS 

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