BCa18: Experts examine gaps in actual practice and guidelines for NMIBC

08 June 2018

Refining current guidelines to reflect the evolving treatment strategies in non-muscle invasive bladder cancer (NMIBC) and the need for a more collaborative and responsive multidisciplinary teamwork were among the main topics examined at the first plenary session of the two-day EAU Update on Bladder Cancer (BCa18) which opened today in Munich, Germany.

Thomas Powles (GB) made the welcome remarks with co-chairs Alberto Lopez Beltran (PT) and Sharouk Shariat (AT) during the opening session which gathered around 250 participants coming from Europe and other regions. They noted that recent and new developments in BCa management require a more critical look on the relevance and role of current treatment practices.

“An advantage of meetings like these is that we don’t only critically look into current practice but also make an attempt to identify prospects brought about by new research findings. The very interactive format of the programme should enable us to assess various issues and clinical challenges,” said Powles.

Dr. Joan Palou, European School of Urology (ESU) chairman and faculty spoke on the EAU and ESMO Guidelines on NMIBCC and gave a comprehensive overview of new developments and what needs to change in current BCa management. He addressed issues such as cystology reporting, risk strategies, transurethral resection (TUR), adjuvant chemotherapy and T1-High grade disease, among others.

“Re-TUR may not be necessary in patients with T1HG/G3, if muscles is present in the specimen. There are no differences in recurrence, progression and cancer-specific survival (CSS), “ Palou said in one of his take-home messages regarding potential trends in NMIBC management.

He also noted that sub-staging in T1 can be considered as indicator for re-TUR (in high grade tumours). He also mentioned that the most significant factor for a higher risk of residual disease are multifocal tumours and tumours less than 3cm.

“The 25.3% progression rate of patients with T1 disease after re-TUR is far lower than that previously reported,” added Palou.

Rodolfo Montironi (IT) gave a report on the WHO 2016 classification and the implications of pathological findings on diagnostic and clinical management. “The correct characterization of the non-invasive and invasive neo-plasms has diagnostic, prognostic and therapeutic inplications, significantly impacting management of individual patients,” he said.

Ashish Kamat (USA) presented a succinct overview on immunotherapy in NMIBC and underscored its role to further boost multidisciplinary partnership. He noted however that there are still hurdles to face and overcome in integrating immunotherapy in urology.

Among the issues he mentioned are the urologist’s capability to maintain an applicable patient population, and aspects such as the clinical appropriateness of practice setting and demographic considerations.

Other issues he mentioned are educational (CME) strategies and adaptability within an evolving treatment landscape. Kamat also noted the need for access to necessary tools and resources.

“Urologists should be not too guarded or shy of being part when it comes to systemic immuno-oncology management. It is a multidisciplinary effort. It is teamwork and we have to collaborate with the medical oncologists,” said Kamat.

Article by Joel Vega