@TumorBoardTues @PGrivasMDPhD 1/17 #TumorBoardTuesday #UrothelialCancer #OncTwitter @PGrivasMDPhD
73yo 👴🏼
PMH: HTN, CKD stage 3 (GFR 40), hearing loss
2 month hx flank pain, urinary hesitancy, & hematuria
🩻CT chest abd/pelvis: focal mass-like thickening of anterior bladder wall; no LN-pathy or other mets
@TumorBoardTues @PGrivasMDPhD 2/17 #TumorBoardTuesday #UrothelialCancer #BladderCancer @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter
👴🏼 underwent TURBT
🔬biopsy: high grade urothelial carcinoma, micropapillary variant (100%) with involvement of muscularis propria
🧐 What would you do for this pt?
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK 3/17 #TumorBoardTuesday
👨🏽🏫Mini tweetorial 1👨🏻🏫
📌Variant histology in #BladderCancer
📍10-20% present as pure or predominant variant histologies
From @fredhutch/@LDiamantMD:
📚sarcom: pubmed.ncbi.nlm.nih.gov/35101380/
📚plasm: pubmed.ncbi.nlm.nih.gov/34109262/
📚micropap: pubmed.ncbi.nlm.nih.gov/33160889/
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @LDiamantMD 4/17 #TumorBoardTuesday
👨🏽🏫Mini tweetorial 2👨🏻🏫
⚖️Comparing conventional urothelial carcinoma (CUC) to variant histology
🔬VH can be associated with
🔹more advanced dz at dx (higher rates of pT3/T4 / N+)
🔹higher positive margin %
🔹lower path response to neoadjuvant chemotherapy
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @LDiamantMD 5/17 #TumorBoardTuesday #BladderCancer
👨🏽🏫Mini tweetorial 3👨🏻🏫
📌neoadjuvant treatment options for VH BC?
@RishiSekarMD @PGrivasMDPhD
📚ascopubs.org/doi/10.1200/JC…
📚ascopubs.org/doi/abs/10.120…
📚pubmed.ncbi.nlm.nih.gov/29154041/
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @spsutkaMD @ReneeSaliby
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa 6/17 #TumorBoardTuesday
👨🏽🏫Mini tweetorial 4👨🏻🏫
🕵🏽♂️Currently 2 open neoadjuvant variant histology trials @fredhutch @UWMedicine
✨aMVAC + pembro ➡️ RC (cisplatin eligible):
🔗 clinicaltrials.gov/ct2/show/NCT04…
✨SG ➡️ RC (cisplatin ineligible)
🔗 clinicaltrials.gov/ct2/show/NCT05…
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @UWMedicine 7/17 #TumorBoardTuesday #BladderCancer
Back to our patient 🔎
👴🏼 Patient underwent upfront radical cystectomy ✂️
🔬Path: micropapillary variant urothelial carcinoma (100%) - pT3N0M0
👴🏼 Patient elected not to proceed with adjuvant treatment after discussion #SharedDecision
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @UWMedicine 8/17 #TumorBoardTuesday #UrothelialCancer
🗓️Restaging CT CAP 1 year later
🩻Multiple enlarged RP lymph nodes and lung nodule
🔬Biopsy of RP lymph node: metastatic urothelial carcinoma, micropapillary variant
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @UWMedicine 9/17 #TumorBoardTuesday #BladderCancer
Noting 👴🏼 patient has underlying hearing loss and CKD3 (GFR 40 cc/min)
🤨 What would you pick as 1L treatment for mUC in this patient?
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa 10/17 #TumorBoardTuesday
👨🏽🏫Mini tweetorial 5👨🏻🏫
Platinum & cisplatin eligibility in #BladderCancer
📍Cis @MattGalsky
ECOG P ≥2
CrCl <60ml/min
Hearing G ≥2
Neuropathy G ≥2
CHF NYHA Class III/IV
📍Plat @shilpaonc
ECOG PS ≥3
CrCl <30ml/min
Neuropathy G ≥2
CHF NYHA Class III/IV
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @MattGalsky 11/17 #TumorBoardTuesday
👨🏽🏫Mini tweetorial 6👨🏻🏫
👍🏽FDA grants accelerated approval for combo 1L EV + Pembrolizumab for cisplatin-ineligible aUC
📰fda.gov/drugs/resource…
📚✨PURPOSE EV-103, cohorts A & K ascopubs.org/doi/10.1200/JC…
📚✨LBA73 EV-103 oncologypro.esmo.org/meeting-resour…
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @MattGalsky 12/17 #TumorBoardTuesday
👨🏽🏫Mini tweetorial 7👨🏻🏫
📌Common side effects with combination EV + Pembro
🖐️🦶🏽Neuropathy
👹Skin rash
🥱Fatigue
🍽️Anorexia
😝Dysgeusia
🚽Diarrhea
🤢Nausea
👀Ocular (e.g. dry eyes, blurred vision)
🍭Hyperglycemia
🧑🏼🦲Alopecia
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @MattGalsky 13/17 #TumorBoardTuesday #UrothelialCancer
👨🏽🏫Mini tweetorial 8👨🏻🏫
📌Carbo+ gem ➡️ avelumab maintenance
✨JAVELIN Bladder 100
📚nejm.org/doi/full/10.10…
📚pubmed.ncbi.nlm.nih.gov/37121850/
📚JAVELIN results ≥2yrs follow-up pubmed.ncbi.nlm.nih.gov/37071838/
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @MattGalsky 14/17 #TumorBoardTuesday #BladderCancer
👨🏽🏫Mini tweetorial 9👨🏻🏫
📌 cis/carbo + gem ➡️ avelumab maintenance
✨READY: Real-world data
📚ascopubs.org/doi/abs/10.120…
📚ascopubs.org/doi/abs/10.120…
📚ascopubs.org/doi/abs/10.120…
📚pubmed.ncbi.nlm.nih.gov/36484294/
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @MattGalsky 15/17 #TumorBoardTuesday #UrothelialCancer
🤨 How to choose: 1L carbo + gem ➡️ avelumab vs EV + pembro in cis-ineligible mUC?
❌No head to head…yet…
Tx decision based on:
📍ECOG PS, age, comorbs
📍cancer burden, met site
📍trial data
📍🧑🏻⚕️ exp
📍👴🏼 pref
📍#SharedDecision
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @MattGalsky 16/17 #TumorBoardTuesday
✍🏼Need
🔹data on regimens
🔹better molecular/genomics of VH #BladderCancer ➡️ identify ‘actionable’ targets & biomarkers
📚ERBB2 amp in micropap VH BC: pubmed.ncbi.nlm.nih.gov/24192927/
📚Anti-HER2 ADC in mUC: ascopubs.org/doi/abs/10.120…
clinicaltrials.gov/ct2/show/NCT04…
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa @MattGalsky 17/17 #TumorBoardTuesday
👴🏼Patient decides to start EV + Pembro (used EV-103 trial data for prior auth) 🙏🏼
👀 Close monitoring for AEs, working with PCP, Nutrition, Palliative Care
🩻Plan for repeat scans after 2 cycles
🧪Tumor NGS testing sent to check for “targets”
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK @fredhutch @neerajaiims @YuWeiChenMD @MarkTysonMD @IBCG_BladderCA @AmerUrological @uromc @UrogerliMD @JVentoMD @kauymartinez @MariaJRibal @mario_sofer @DRBakaloudiMD @betsykoehne @sginzbu @VigneshPackiam @wandering_gu @UroTouzani @urotoday @Tach164n @T_AlonsoGordoa #PostTest Q1️⃣ #TumorBoardTuesday
👉🏽#CME Eval integrityce.com/TBTeval23
🤔@PGrivasMDPhD @rafee_talukder taught us cis-ineligible mUC, test your 🧠 with a Q
🧐What 1L to NOT pick for 73yo👴🏽
mUC (predom UC hx with micropap)
RP LN-pathy
HTN
CKD (GFR 40 cc/min)
G3 hearing loss
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