Case 1: Non-Muscle Invasive, BCG-Refractory Bladder Cancer

EXPERT PERSPECTIVE VIRTUAL TUMOR BOARD

Arlene O. Siefker-Radtke, MD:Thank you for joining us for thisTargetedOncology™VirtualTumorBoard®, which is focused on bladder cancer. In today’sTargetedOncology™VirtualTumorBoard® presentation, my colleagues and I will review 4 clinical cases. We will discuss an individualized approach to treatment for each patient and will review key trial data that impact our decisions. Additional insight will be provided by Dr Thanos Papakostas during a separate interview.

I am Arlene O. Siefker-Radtke, a professor from the University of Texas MD Anderson Cancer Center in the Department of Genitourinary Medical Oncology. And I’m very privileged today to be joined by my colleagues who are well known in the field of urothelial cancer.

We have Dr Betsy Plimack, who’s the chief of the Division of Genitourinary Medical Oncology at Fox Chase Cancer Center in Philadelphia, Pennsylvania.

We also have Dr Tian Zhang, an assistant professor in the Division of Medical Oncology of the Department of Medicine at the Duke Cancer Institute in Durham, North Carolina.

To complete the group, we have Dr Gordon Brown, the director of Delaware Valley Urology’s Center for Advanced Therapeutics and the program director of robotic surgery, Jefferson Health, in Stratford, New Jersey.

Thank you for joining us, and let’s get started with our first case.

Gordon Brown, DO:All right, Arlene. Thank you for the introduction. Welcome, everybody. I look forward to a productive dialogue over the next 90 minutes or so. Our first case today is going to be about a patient who has non-muscle invasive BCG [bacillus Calmette-Guérin]-refractory bladder cancer. This 74-year-old man presented to his primary physician with a chief compliant of gross hematuria. He’s got a medical history that is significant for 20-pack years of smoking, hypertension, and coronary artery disease. In his initial evaluation, he obtained a CT [computed tomography] urogram, which revealed right bladder wall thickening, and underwent transurethral resection of a bladder tumor [TURBT], which demonstrated multifocal carcinoma in situ [CIS] on the left lateral wall.

He subsequently underwent induction BCG weekly for 6 weeks and that initial surveillance, cystoscopy at 3 months, had a negative evaluation by cystoscopy and negative cytology. Subsequently he underwent maintenance therapy, weekly 3 times, and unfortunately presented with repeat evaluation, with persistent red patchy erythema, or I should say recurrent erythema in the bladder, and a TURBT, which was positive for recurrent carcinoma in situ. So here we have a patient, 74 years old who has what would be described as BCG-refractory carcinoma in situ, the persistence of CIS or recurrence of CIS after adequate BCG therapy.

Transcript edited for clarity.