Bladder cancer

Question 1

Erdafitinib SE’s

Answer 1

• hyperphosphatemia
• stomatitis
  *hyponatremia
• retinal detachment

Question 2

sacituzumab mechanism

Answer 2

TROP2

Question 3

sacituzumab SE’s

Answer 3

• neutropenia
• diarrhea (including neutropenic colitis)

Question 4

Urothelial carcinoma in situ management

Answer 4

• surgical resection (eg distal urethrectomy) (won’t have good penetration with intravesicular treatments)

Question 5

squamous cell bladder cancer RF’s

Answer 5

• chronic indwelling catheters
• schisto

Question 6

Gene mutation associated with plasmacytoid bladder cancer

Answer 6

CDH1

Question 7

First line for metastatic urachal adenocarcinoma

Answer 7

FOLFOX

Question 8

other RF’s for urothelial bladder cancer

Answer 8

• rubber
• aluminum
• die manufacturing

Question 9

Ta is

Answer 9

noninvasive papillary lesion

Question 10

T3 in bladder

Answer 10

perivesicle soft tissue invasion

Question 11

T4 in bladder

Answer 11

Extravesical tumor directly invades any of the following: Prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall

Question 12

Galsky criteria for cisplatin eligibility

Answer 12

1) ECOG performance status 0-1
2) Impaired renal function with creatinine clearance (CrCl) >60 mg per minute per 1.73 m2
3) No significant hearing loss (measured at audiometry of 25 dB at two contiguous frequencies) (basically not requiring hearing aids)
4) Grade <2 peripheral neuropathy (ie, sensory alteration or paresthesia, including tingling, but not interfering with activities of daily living)
5) No clinical evidence of New York Heart Association class III or greater heart failure

Question 13

Demonstrated clinical benefit of adjuvant immunotherapy for MIBC

Answer 13

DFS benefit, OS still not reported

Question 14

Criteria for TMT eligibility

Answer 14

1) urothelial histology (studied in urothelial
2) variants chemoresistant)
3) no tumor-associated bilateral hydronephrosis (lower odds of CR - bilateral per DFCI) AND T2-T3a (increased T stage = decreased response)
4) tumor <6 cm (or 5?)
4.5) no extensive/multifocal CIS (chemo/radioresistant)
5) no multifocal disease (ideally but still offered)
6) not close to bladder neck (XRT ineligible)
7) good bladder function (worth preserving)
8) node-negative (Ideally but rad onc provider dependent, can boost FDG avid nodes)
9) no prior regional extensive radiation

Question 15

General management of variant histologies for localized disease

Answer 15

cystectomy

Question 16

Plasmacytoid bladder 1) radiology description 2) site of metastasis to know 3) mutation

Answer 16

1) “vague infiltrative process”
2) peritoneal mets
3) CDH1

Question 17

Ta bladder cancer management

Answer 17

TURBT w/ single injection of intravesicular chemo (gemcitabine or mitomycin)

Question 18

Tis or T1 management

Answer 18

TURBT w/ induction BCG,
IF in CR, then maintenance BCG for up to 3 years
IF no CR, alternative intravesicular agent (chemo - valrubicin or pembro)
*IF T1 with high RF’s, cystectomy (LVI, extensive bladder involvement, CIS involving prostatic ducts/acini, pure squamous or adenocarcnoma histology, or other variant histologies)

Question 19

Distinction between muscularis mucosa and propria

Answer 19

propria refers to muscle invasvie disease

Question 20

components of MVAC

Answer 20

Methotrexate
Vinblastine
Adriamycin (doxorubicin)
Cisplatin

Question 21

FIrst step in management of T1 NMIBC

Answer 21

Restaging TURBT in 4-6 weeks (1/2 to 1/3 with T1 are upstaged to T2 or higher)

Question 22

Indications for adjuvant nivo in MIBC

Answer 22

ypT2-ypT4a or ypN+