Urothelial Carcinoma Flashcards
Midline cystic mass with calcifications near the bladder is consistent with what malignancy?
Urachal cancer
Plasmacytoid histology is associated with what mutation?
CDH1
Localized small cell bladder cancer treatment paradigm
Neoadjuvant small cell chemotherapy then surgery
What T stage becomes MIBC?
T2
What T stage is no longer considered resectable?
T4b = fixed to pelvic sidewall
What TNM stages are considered unresectable urothelial cancer? (3)
T4b
N+
M+
Treatment of cTa low grade
TURBT
Treatment of high grade cTa urothelial cacncer
TURBT, intravesical BCG maintenance
Treatment of cT1 low grade
TURBT, intravesical BCG maintenance
Treatment of cT1 high grade
TURBT, intravesical BCG maintenance
Treatment of Tis
TURBT, intravesical BCG maintenance
Treatment for NMIBC that is BCG unresponsive
Pembro
Who is a candidate for neoadjuvant chemotherapy?
cT2-T4a
N0
Treatment options (2) for neoadjuvant chemo
Gem + Cis (not carboplatin)
ddMVAC
2 instances to give adjuvant chemotherapy
No neoadjuvant given
pT3-4 or N+ disease
Minimal LN dissection to be removed during surgery
Minimum 13-15
Patient undergoes neoadjuvant GC and then cystectomy for T3N0 urothelial cancer. He has residual ypT2 disease. Anything to be done in adjuvant setting?
Nivo improves PFS, no OS
What are treatment options for localized bladder cancer for patients who don’t want a cystectomy?
ChemoRT with
5FU-Mitomycin
5FU-Cis
Cis-Taxol
1L mUC treatment
EV-Pembro
1L mUC in patients who can’t receive ICI?
Gem+Cis+ Avelumab maintenance if good response
1L mUC treatment in patients who are Cis eligible but can’t get EV-Pembro (2)
ddMVAC
Gem Cis Nivo
1L mUC treatment for patients who are cis ineligible and can’t get EV-Pembro (3)
Gem-Carbo
Atezo (PDL1 high)
Pembro
What 5 things makes a patient cisplatin ineligible?
GFR <60
Neuopathy >G2
Poor hearing
ECOG 2+
NYHA Class 3 CHF
Patient with mUC treated with Gem + Cis with a partial response on imaging at the end of chemo. What to do now?
Maintenance avelumab
2L treatment for mUC post-platinum? (3)
Pembro (preferred)
Nivo
Taxane
2L+ in mUC after ICI (3)
Erdafitinib (FGFR3 mut)
Sacituzumab
Enfortumab vedotin
Indication for Erdafitinib
Post chemo, post ICI mUC with FGFR3 alteration
Toxicity of EV (5)
Hyperglycemia
Neuropathy
Skin: bullous, peeling, SJS
Diarrhea
Hepatotoxic (use in caution with cirrhosis)
Indication for adjuvant Nivo
Residual disease at surgery (no pCR)
ypT2-ypT4 or ypN+
Treatment for T1N0 small cell bladder cancer
Neoadjuvant cis/etop then cystectomy
Treatment of T2N0 bladder adenoca
up front surgery
T3N0 UC is treated with neoadjuvant ddMVAC and then cystectomy. Develops metastatic disease 8 months later. Treatment?
EV+Pembro
Pembro (preferred)
Nivo
Characteristic toxicity of erdafitinb (3)
Retinopathy, retinal pigment detachment
Elevated Phosphate
Teratogen
