Moderator: Roselyne A. Okumu

Speakers & Topics:

• Dr Melissa Reimers: Updates in the Management of Advanced Bladder Cancer
• Prof Peter Mungai: Superficial Bladder Cancer Management

Management of Non-Muscle-Invasive Bladder Cancer (NMIBC)

– NMIBC represents ~75% of new bladder cancer cases, typically presenting with painless hematuria.
– Diagnosis: Cystoscopy and TURBT; blue light cystoscopy improves detection.
– Risk-based treatment approach:
• Low/intermediate-risk: single post-op intravesical chemo (mitomycin C/gemcitabine)
• High-risk: 6-week BCG induction ± maintenance
– BCG-unresponsive NMIBC: radical cystectomy or emerging therapies.
– Promising bladder-sparing agents: TAR-200 (gemcitabine) and TAR-210 (erdafitinib).
– Trials (MoonRISe-3, SunRISe-5) show >80% DFS in high-risk patients.

Updates in Advanced and Metastatic Bladder Cancer

– Bladder cancer is the 4th most common male cancer globally.
– Molecular profiling is critical: test for FGFR3 and HER2.
– 1st-line standard: Enfortumab vedotin + Pembrolizumab (EV-302/KEYNOTE-A39).
– Platinum-eligible: Cis/gem ± nivolumab; Carb/gem → Avelumab maintenance.
– 2nd/3rd-line: Erdafitinib (FGFR+), T-DXd (HER2+).
– Novel ADCs (Enfortumab, Sacituzumab) offer superior outcomes to chemo.
– Trial enrolment is encouraged for all patients.

Key Clinical Takeaways

– Intravesical innovation is changing NMIBC treatment beyond BCG.
– Biomarker-driven therapy is now essential for managing advanced bladder cancer.
– Routine molecular testing is critical for individualized care