Navigating Treatment Options for Elderly Patients with High-Risk NMIBC
Sam S. Chang MD, MBA leads a discussion of various treatment approaches for a hypothetical case of a 74-year-old female patient with T1 bladder cancer and associated CIS, exploring the necessity of repeat resections. The conversation emphasizes the importance of personalized treatment plans, considering BCG therapy, clinical trials involving immunotherapy, and the possibility of cystectomy, while also addressing the complexities and risks associated with high-grade bladder cancer in elderly patients.
EP: 1.Overview of Non-Muscle Invasive Bladder Cancer (NMIBC)
EP: 2.Appropriate Risk Stratification Intermediate and high-risk Risk Classification
EP: 3.Adapting Urology Practices in the Face of BCG Shortages
EP: 4.Initial Treatment Selection for NMIBC in the Era of BCG Shortage
EP: 5.Strategies for the Management of Recurrent Low-Grade Bladder Tumors
EP: 6.Navigating Treatment Options for Elderly Patients with High-Risk NMIBC
EP: 7.Investigational Novel Strategies in High-Risk BCG-Unresponsive NMIBC
EP: 8.Review of Cretostimogene Grenadenorepvec (CG) Clinical Trials in High-risk BCG-unresponsive NMIBC
This is a synopsis of the Viewpoints video series featuring moderator, Sam S. Chang, MD, MBA, from Vanderbilt University School of Medicine, and panelists Gary Steinberg, MD, FACS, from Rush University Medical Center, Mark Tyson, MD, of Mayo Clinic Phoenix, Roger Li, MD, from Moffitt Cancer Center, and Sandip M. Prasad, MD, MPhil, of Morristown Medical Center.
Episode 6 presents a comprehensive discussion about the treatment strategies for an elderly female patient diagnosed with T1 bladder cancer and associated Carcinoma in Situ (CIS). The panel unanimously agrees on the necessity of a repeat TURBT in cases where the initial resection may have understaged the patient, especially considering the higher risk associated with T1 bladder cancer plus CIS. They emphasize the importance of thorough resection in managing the disease effectively. Discussing treatment options, the experts consider Bacillus Calmette-Guérin (BCG) therapy as a frontline treatment for this patient. They explore the potential of enrolling the patient in clinical trials, particularly those involving immunotherapy agents in combination with BCG. However, the panel also recognizes the risks and side effects associated with immunotherapy, as reported in trials like KEYNOTE-57. Gary Steinberg highlights his experience with BCG therapy, noting its effectiveness in the right patient profile. However, he also acknowledges the potential risks of disease recurrence and progression. The conversation then shifts to addressing the challenges of managing high-grade T1 patients, with the panelists contemplating the appropriate use of cystectomy and its timing. The panelists discuss the intricacies of treating high-grade bladder cancer in elderly patients, stressing the need for personalized treatment plans. They acknowledge that while surgical interventions like cystectomy are options, the decision must be balanced with the patient's overall health, age, and specific tumor characteristics.
In summary, Episode 6 offers valuable insights into the multifaceted approach required in treating elderly patients with high-risk bladder cancer. The expert panel delves into the complexities of treatment selection, emphasizing personalized care, the role of clinical trials, and the careful consideration of surgical options.
*Video synopsis is AI-generated and reviewed by Urology Times® editorial staff.
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