Video Library

The following videos have been sponsored by CG Oncology.

Risk Stratification and staging of bladder cancer:

Gary Steinberg, MD, Professor Department of Urology, RUSH medical College explains how risk stratification has helped in the management of NMIBC.

Transcript:
The risk stratification for non-muscle invasive bladder cancer has really helped the patients as well as the clinicians. Non-muscle invasive bladder cancer has two major concerns. One is that the bladder cancer comes back, what we call recurrence, and that the bladder cancer can progress to potentially even muscle invasive or higher-grade cancers.

What are the different risk stratification levels in NMIBC?

Gary Steinberg, MD, Professor Department of Urology, RUSH medical College explains how risk stratification has helped in the management of NMIBC.

Transcript:
How do we define the different risk stratification levels in the American Urology Association, the Society of Urologic Oncology, low risk is a small, papillary, non-invasive, lowgrade bladder tumor. It’s a first-time event less than three centimeters in size. The intermediate risk is, typically, the low-risk patients, or the low-grade patients, papillary, non-invasive who have recurred, or they can have multiple low grade papillary tumors, or they can have a large, low grade papillary tumor. In general, they’re all mostly low grade. Now, in the American Urology Association risk stratification, we also include high grade papillary tumors, first time event, less than three centimeters. In general, it’s a solitary tumor, but we can have two to three tumors and still be in the intermediate risk category, especially if they’re small. Anytime a high-grade intermediate risk tumor recurs, they then automatically are in the high-risk category. The highrisk category is essentially anybody with high grade disease, T1, high grade carcinoma in situ, or Ta high grade greater than three centimeters, or recurrent Ta high grade.

Bladder Cancer Facts:

Sima P. Porten MD, MPH Associate Professor in Residence, UCSF, explains the incidence and risk factors for bladder cancer.

Transcript:
Bladder cancer is often under-recognized and underdiagnosed. However, it is a common cancer among patients in the United States. It affects men more than women, and approximately 80,000 cases in 2022 with about 18,000 deaths. Some known exposures such as cigarette smoking, carcinogens in the environment, carcinogens in drinking water such as arsenic have been described as being a contributor to development of bladder cancer. Most patients who present with bladder cancer present with non-muscle invasive disease about 70%, and about 20% present with muscle invasive disease and approximately five to 10% present with widespread disease or metastatic disease.

Patient Journey:

Siamek Daneshmand MD, Professor of Urology (Clinical Scholar), Director of Clinical Research, USC Keck School of Medicine of USC, explains the patient journey for patients with NMIBC and the intense follow-up patients face.

Transcript:
So patients with non-muscle invasive bladder cancer typically have a lot of treatments, intravesical treatment, typically BCG that’s been around for a long time, and they undergo surveillance cystoscopies afterwards looking for recurrence. The recurrence rates can be very high, 50 to 70% depending on the grade and the stage of the disease initially. But more importantly, we want to prevent the progression of disease which can happen in 20 to 30% of cases. So, there’s a lot of surveillance cystoscopies that happen after treatment, and these are every three to four months, typically in the office. A lot of biopsies, going back to the operating room to reassess the bladder, making sure that we don’t have recurrences or trying to catch those recurrences early on in the game.

BCAN – For and by bladder cancer patients:

Sima P. Porten MD, MPH, Associate Professor in Residence, UCSF discuss why the Bladder Cancer Advocacy Network (BCAN) is an important organization for patients, providers and researchers- an organization for and by bladder cancer patients that fosters collaboration.

Transcript:
BCAN or the Bladder Cancer Advocacy Network was founded in 2005 and is one of the only national advocacy networks, primarily driven by patients and driven for patients. It’s a really, really special organization because it really keeps the patient experience, priorities and journey through the treatment of bladder cancer at the center in everything that it does. And I’ve been very lucky to be a part of this organization. I primarily started out as a John Quale Travel fellow, and that means that I was given the opportunity to come and present my research at the scientific think tank, which is this wonderful, very special meeting where world renowned researchers from the United States and also abroad come to exchange scientific ideas in a very collaborative space with medical oncologist, urologist, basic scientist, environmental scientist, patient advocates, which is a really, really important part of the process as well as now our advanced practice providers and NPs and our community urologists as well, because they’re important partners in taking care of all of our patients.

BCAN patient resources:

Sima P. Porten MD, MPH, Associate Professor in Residence, UCSF talks about the resources BCAN provides to patients with bladder cancer.

Transcript:
BCAN has a wide variety of patient resources on their website. There are some really amazing documents that were created in collaboration from physicians and patients. And I think one of the best body of literature that they put out there is the bladder cancer basics for the newly diagnosed. It’s a really, really important informational tool. And I think the great part about it is that it’s accessible to anybody. It’s not hidden behind any institutional wall or anything like that. You can go to their website and access a multitude of information and tip sheets and tools as well as really good ways that patients and doctors can interface in making sure that the journey through this disease is hopefully as smooth as it can be.

Definition of BCG shortage:

Ashish M. Kamat, M.D. MBBS. Endowed Professor of Urologic Oncology (Surgery) and Cancer Research at University of Texas MD Anderson Cancer Center explains how the definition of BCG unresponsive disease came about and its impact clinical studies for patients with NMIBC.

Transcript:
The definition of BCG unresponsive disease has undergone changes over many years, and it actually started at an AUA meeting many years ago, and then was modified and ratified by the AUA group, the GU ASCO Group led by Seth Lerner, the International Bladder Cancer Group, which I happen to lead, and it was ultimately adopted by the FDA as an amalgamation of all these recommendations. And why was this important? Well, it was important because prior to the actual definition of BCG unresponsiveness being formalized, a lot of investigators, a lot of pharmaceutical companies invested a lot of time and effort. And of course, patients invested a lot of time and effort doing clinical studies after BCG had not worked. But we couldn’t really make head or tail out of the results of those studies because there was no uniformity in the inclusion criteria, the patient selected the endpoints. And that’s why when the definition of BCG unresponsive disease was adopted and formalized in the FDA guidance document 2018, there was an explosion of clinical studies. And these studies now follow that paradigm for regulatory and approval processes.

BCG shortage impact on patients:

Trinity J. Bivalacqua, MD, PhD, Professor of Urology and Oncology at the Perelman Center for Advanced Medicine, University of Pennsylvania discusses the impact of BCG shortages on bladder cancer patients and the goal of developing alternative options for BCG for those who do not have access to BCG or cannot tolerate it.

Transcript:
The definition of BCG unresponsive disease has undergone changes over many years, and it actually started at an AUA meeting many years ago, and then was modified and ratified by the AUA group, the GU ASCO Group led by Seth Lerner, the International Bladder Cancer Group, which I happen to lead, and it was ultimately adopted by the FDA as an amalgamation of all these recommendations. And why was this important? Well, it was important because prior to the actual definition of BCG unresponsiveness being formalized, a lot of investigators, a lot of pharmaceutical companies invested a lot of time and effort. And of course, patients invested a lot of time and effort doing clinical studies after BCG had not worked. But we couldn’t really make head or tail out of the results of those studies because there was no uniformity in the inclusion criteria, the patient selected the endpoints. And that’s why when the definition of BCG unresponsive disease was adopted and formalized in the FDA guidance document 2018, there was an explosion of clinical studies. And these studies now follow that paradigm for regulatory and approval processes.

Impact of the BCG shortage:

Ashish M. Kamat, M.D. MBBS. Endowed Professor of Urologic Oncology (Surgery) and Cancer Research at University of Texas MD Anderson Cancer Center discusses the history and impact of the BCG shortage in the US and life-altering impact on patients.

Transcript:
The BCG shortage has been going on for quite some time, and over the years we have had the fortune, or I guess the misfortune in many ways to find the impact of the BCG shortage on patients. Transcript: The BCG shortage has been going on for quite some time, and over the years we have had the fortune, or I guess the misfortune in many ways to find the impact of the BCG shortage on patients.

Future treatment options for patients with high-risk future treatment options:

Trinity J. Bivalacqua, MD, PhD, Professor of Urology and Oncology at the Perelman Center for Advanced Medicine, University of Pennsylvania discusses future treatment options for patients with high-risk non-muscle invasive bladder cancer that are BCG naive or BCG unresponsive.

Transcript:
The future treatment options for patients with high-risk non-muscle invasive bladder cancer that are BCG naive or BCG unresponsive, I think, is very exciting, and we have a lot of really great new therapeutics that are penetrating the market. And most importantly, this is going to help us treat our patients and provide them with more effective treatments. This may be intravesical treatments where you have novel adenoviral vectors and oncolytic adenoviruses, either alone or combined with checkpoint inhibitors. I think the future of BCG unresponsive disease and potentially BCG naive disease is the combination of intravesical agents combined with systemic checkpoint inhibitors.

Treatment gaps:

Siamek Daneshmand, Professor of Urology (Clinical Scholar) Director of Clinical Research USC Keck School of Medicine of USC discussed the treatment gaps and new developments to treat patients with NMIBC.

Transcript:
I think one of the biggest gaps in the treatment of bladder cancer today is the fact that we have had very limited options until now. We’ve been using the same drug, BCG, for decades now, and there really hasn’t been a lot of new developments until recently. A lot of exciting stuff going on in bladder cancer right now with newer novel therapies, both intravesical as well as IV and systemic therapies for both non-muscle invasive and muscle invasive bladder cancer.
So it’s an exciting time. We’re learning about combination therapies now and how we can mix and match various forms of therapy that have different mechanism of action to have better outcomes and decrease that high recurrence rates that we see in the bladder. And again, more importantly, that decrease the progression rates and non-muscle invasive cancer.
And the muscle invasive bladder cancer group, again, we’re trying to improve outcomes. Surgery oftentimes, or chemoradiation is not completely successful, and when patients metastasize, unfortunately, life is quite limited for them, so we’re constantly looking for better systemic therapies for those patients as well. And again, there’s some really nice developments in combination therapy in that space as well.

The BCG definition:

Trinity J. Bivalacqua, MD, PhD, Professor of Urology and Oncology at the Perelman Center for Advanced Medicine University of Pennsylvania discusses the development of the definition of BCG unresponsive disease and how this has helped in the development of clinical trials and drugs being approved for this disease.

Transcript:
In 2015, the FDA asked a number of urologists at GU ASCO to come up with a definition for patients who either, or had BCG relapsing refractory disease. There was no real terminology or standardized terminology to help design new clinical trials for the advent of new therapeutic drugs, either intravesical or systemic drugs that were coming into the market. So a group of urologists came together and came up with a definition, which has now been adapted, which is called BCG-unresponsive disease. This is very important because it helps us be able to standardize the groups of patients that are ultimately being enrolled in clinical trials and regulatory approval for things like KEYTRUDA, which has recently received FDA approval for nonmuscle invasive bladder cancer, which is BCG-unresponsive CIS.

How to treat patients during the BCG shortage:

Trinity J. Bivalacqua, MD, PhD, Professor of Urology and Oncology at the Perelman Center for Advanced Medicine University of Pennsylvania on the guidelines and use of BCG during the BCG shortage.

Transcript:
The AUA and the SUO have come out with a number of, what I would call, white papers to help advise urologists as to what to do with patients that they would normally give BCG to during the BCG shortage. So for example, we no longer give BCG to patients with intermediate risk non-muscle invasive bladder cancer, which is patients with low grade papillary disease. We now predominantly use intravesical chemotherapy and we reserve BCG for patients with high grade T1 disease and CIS.