Volume 23, Number 2Bladder CancerManagement of Adverse Events From Checkpoint Inhibitors in Urologic Practice: Where Are We Today?Caroline BranchDaniel CanterGautam JayramUrologic oncology has seen a tremendous impact from the emergence of checkpoint inhibitors in the management of malignant conditions of the urinary tract. These therapies are now in the nonmetastatic setting, and there is ample opportunity to integrate them into urologic practice. The most common barrier to starting a checkpoint inhibitor therapy program is concern about immune-related adverse event management. The evaluation and management of immune-related adverse events can be part of the treatment protocol and centralized to promote safety and success. The key components of implementing an in-office infusion program that includes checkpoint inhibitors are the use of a team-based approach, with a champion physician; appropriate patient education before and during treatment; and timely evaluation and treatment of all adverse events, with subspecialty consultation, if needed.ImmunotherapyUrologyurinary bladder neoplasms
Volume 23, Number 2Bladder CancerIntegrating JELMYTO (Mitomycin) for Pyelocalyceal Solution Into Community Practice: Practical Tips for the UrologistMichael J. ShannonSandip M. PrasadTreatment options for upper-tract urothelial carcinoma are based on whether the patient has high-risk or low-risk disease. Low-grade tumors can be managed with nephron-sparing approaches, including ureteroscopic resection and ablation, although most patients undergoing endoscopic treatment of upper-tract urothelial cancers face a risk of recurrence. Mitomycin gel for pyelocalyceal solution provides an effective alternative therapy. In OLYMPUS, a phase 3, single-arm, open-label study, 58% of patients with low-grade disease experienced a complete response to induction therapy at 3 months. Kaplan-Meier analysis revealed an estimated 12-month durable response rate of 82%. The most common treatment-emergent adverse events were ureteric stenosis, urinary tract infection, hematuria, and flank pain (grade <3). Mitomycin gel offers a novel, kidney-sparing, nonoperative approach to managing low-grade upper-tract urothelial carcinoma.MitomycinUrologyDrug therapyUrinary tractCarcinomaUrologic neoplasmsurinary bladder neoplasms