Dr Petros Grivas chairs a discussion (Seattle Cancer Care Alliance, Seattle, USA) with Dr Alison Birtle (Lancashire Teaching Hospitals, Lancashire, UK), Dr Shilpa Gupta (Case Comprehensive Cancer Centre, Cleveland, USA) and Dr Joseph Jacob (Upstate Medical University, Syracuse, USA) about the latest updates in bladder cancer from ASCO GU 2020 in San Francisco.

Dr Birtle provides an overview of the NEO-BLADE study, which examined the neoadjuvant use of nintedanib with gemcitabine and cisplatin in locally advanced muscle-invasive bladder cancer. Dr Birtle points out that this study did not meet its primary endpoint and improve pathological response rate, but interestingly, met its secondary endpoints of overall and progression-free survival with no additional toxicities observed.

Dr Gupta also discusses the results from the BLASST-1 study, which assessed the combination of nivolumab, gemcitabine and cisplatin in patients with muscle-invasive bladder cancer. She points out that this novel triplet combination achieved significant pathologic downstaging rates with no added toxicities.

Dr Jacob also explains the use of comprehensive genomic profiling (CGP) to evaluate genomic alterations within histological subtypes of urethral carcinomas. This study revealed that these alterations may potentially predict the effectiveness of both targeted and immunotherapy in this disease type.

The panel discusses the real-world challenges of treating patients with urothelial carcinomas - especially elderly patients. Dr Grivas emphasises the need to consider physiological age, rather than chronological and appropriate tools are needed to assess these patients.

They conclude by discussing the latest advances in the metastatic setting, with exciting data surrounding the use of enfortumab vedotin plus pembrolizumab for locally advanced or metastatic urothelial carcinoma - which could potentially be practice-changing in the future.

This programme has been supported by an unrestricted educational grant from Janssen Pharmaceutica (A Johnson & Johnson Company).