Urothelial Carcinoma

Question 1

Midline cystic mass with calcifications near the bladder is consistent with what malignancy?

Answer 1

Urachal cancer

Question 2

Plasmacytoid histology is associated with what mutation?

Answer 2

CDH1

Question 3

Localized small cell bladder cancer treatment paradigm

Answer 3

Neoadjuvant small cell chemotherapy then surgery

Question 4

What T stage becomes MIBC?

Answer 4

T2

Question 5

What T stage is no longer considered resectable?

Answer 5

T4b = fixed to pelvic sidewall

Question 6

What TNM stages are considered unresectable urothelial cancer? (3)

Answer 6

T4b
N+
M+

Question 7

Treatment of cTa low grade

Answer 7

TURBT

Question 8

Treatment of high grade cTa urothelial cacncer

Answer 8

TURBT, intravesical BCG maintenance

Question 9

Treatment of cT1 low grade

Answer 9

TURBT, intravesical BCG maintenance

Question 10

Treatment of cT1 high grade

Answer 10

TURBT, intravesical BCG maintenance

Question 11

Treatment of Tis

Answer 11

TURBT, intravesical BCG maintenance

Question 12

Treatment for NMIBC that is BCG unresponsive

Answer 12

Pembro

Question 13

Who is a candidate for neoadjuvant chemotherapy?

Answer 13

cT2-T4a
N0

Question 14

Treatment options (2) for neoadjuvant chemo

Answer 14

Gem + Cis (not carboplatin)
ddMVAC

Question 15

2 instances to give adjuvant chemotherapy

Answer 15

No neoadjuvant given
pT3-4 or N+ disease

Question 16

Minimal LN dissection to be removed during surgery

Answer 16

Minimum 13-15

Question 17

Patient undergoes neoadjuvant GC and then cystectomy for T3N0 urothelial cancer. He has residual ypT2 disease. Anything to be done in adjuvant setting?

Answer 17

Nivo improves PFS, no OS

Question 18

What are treatment options for localized bladder cancer for patients who don’t want a cystectomy?

Answer 18

ChemoRT with
5FU-Mitomycin
5FU-Cis
Cis-Taxol

Question 19

1L mUC treatment

Answer 19

EV-Pembro

Question 20

1L mUC in patients who can’t receive ICI?

Answer 20

Gem+Cis+ Avelumab maintenance if good response

Question 21

1L mUC treatment in patients who are Cis eligible but can’t get EV-Pembro (2)

Answer 21

ddMVAC
Gem Cis Nivo

Question 22

1L mUC treatment for patients who are cis ineligible and can’t get EV-Pembro (3)

Answer 22

Gem-Carbo
Atezo (PDL1 high)
Pembro

Question 23

What 5 things makes a patient cisplatin ineligible?

Answer 23

GFR <60
Neuopathy >G2
Poor hearing
ECOG 2+
NYHA Class 3 CHF

Question 24

Patient with mUC treated with Gem + Cis with a partial response on imaging at the end of chemo. What to do now?

Answer 24

Maintenance avelumab

Question 25

2L treatment for mUC post-platinum? (3)

Answer 25

Pembro (preferred)
Nivo
Taxane

Question 26

2L+ in mUC after ICI (3)

Answer 26

Erdafitinib (FGFR3 mut)
Sacituzumab
Enfortumab vedotin

Question 27

Indication for Erdafitinib

Answer 27

Post chemo, post ICI mUC with FGFR3 alteration

Question 28

Toxicity of EV (5)

Answer 28

Hyperglycemia
Neuropathy
Skin: bullous, peeling, SJS
Diarrhea
Hepatotoxic (use in caution with cirrhosis)

Question 29

Indication for adjuvant Nivo

Answer 29

Residual disease at surgery (no pCR)
ypT2-ypT4 or ypN+

Question 30

Treatment for T1N0 small cell bladder cancer

Answer 30

Neoadjuvant cis/etop then cystectomy

Question 31

Treatment of T2N0 bladder adenoca

Answer 31

up front surgery

Question 32

T3N0 UC is treated with neoadjuvant ddMVAC and then cystectomy. Develops metastatic disease 8 months later. Treatment?

Answer 32

EV+Pembro
Pembro (preferred)
Nivo

Question 33

Characteristic toxicity of erdafitinb (3)

Answer 33

Retinopathy, retinal pigment detachment
Elevated Phosphate
Teratogen