Are You Developing an ABC: Advanced Bladder Cancer Clinic?

LUGPA News Are You Developing an ABC: Advanced Bladder Cancer Clinic? Neal D. Shore, MD, FACS President, LUGPA; Atlantic Urology Clinics, Myrtle Beach, SC [Rev Urol. 2017;19(4):246–247 doi: 10.3909/riu0777] ® © 2018 MedReviews , LLC F or 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-Guérinrefractory 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: • LUGPA initiated its first advanced bladder cancer continuing medical education (CME) program in 2016; 246 • Vol. 19 No. 4 • 2017 • Reviews in Urology 4170007_06_RiU0777_V4_rev04.indd 246 1/25/18 4:24 PM Are You Developing an ABC: Advanced Bladder Cancer Clinic? • LUGPA co-sponsored the inaugural Bladder Cancer Academy in June 2017 (http://medreviews. com/conferences/bca/2http:// medreviews.com/conferences /bca/2017); • In October 2017, LUGPA developed live educational programming via UroCare Live TV to further discuss initiating an Advanced Bladder Cancer Clinic. The educational program was exclusively offered to LUGPA member practices and includes instruction with renown experts: Ashish Kamat, MD (MD Anderson Cancer Center; Houston, TX), Noah Hahn, MD (Johns Hopkins University Medical School, Baltimore, MD), and Jonathan Henderson, MD (Regional Urology, Shreveport, LA); • LUGPA completed its second CME program, entitled Updates for Optimizing GU Oncology Cancer Clinics of Excellence, held in Chicago, Illinois, on November 9, 2017, at the LUGPA Annual Meeting; • In 2018, LUGPA will introduce a new program that offers inpractice educational forums to members on how to establish your advanced bladder cancer clinic and how to understand the role of IO therapy. Our association will organize and conduct these educational programs at a member practice site. The interactive forums will cover additional, important member topics (eg, business integration, collaboration models) led by nationally renowned faculty. LUGPA will be reaching out to all interested member practice sites to complete registration. Please contact Maureen Lyons at mlyons@lugpa. org or (312) 515-3084 to communicate your interest in LUGPA arranging an in-practice educational forum at your practice site. On behalf of the LUGPA Board of Directors and all our LUGPA Committee members, thank you very much for your continued feedback and support. Vol. 19 No. 4 • 2017 • Reviews in Urology • 247 4170007_06_RiU0777_V4_rev04.indd 247 1/25/18 4:24 PM