Dr Shore on the Importance of a Multidisciplinary Team in Urologic Oncology

Neal Shore, MD, FACS, US Chief Medical Officer of Surgery and Oncology, GenesisCare USA, and director, CPI, Carolina Urologic Research Center, Atlantic Urology Clinics, discusses the importance of a multidisciplinary team in light of recent developments in urologic oncology.

Shore begins by noting that since the January 2020 FDA approval of pembrolizumab (Keytruda) in Bacillus Calmette–Guerin-unresponsive, high-risk, non–muscle-invasive bladder cancer (NMIBC) with carcinoma in situ with or without papillary tumors ineligible for cystectomy, more and more urologic oncologists are becoming comfortable with using PD-1 inhibitors and other immunotherapies. However, for clinicians who are not comfortable with these agents, collaboration with a medical oncologist is a great solution, Shore says.

Shore also highlights the 2023 FDA approvals of nivolumab (Opdivo) plus cisplatin and gemcitabine in frontline unresectable or metastatic urothelial carcinoma and enfortumab vedotin-ejfv (Padcev) with pembrolizumab for locally advanced or metastatic urothelial cancer. The approvals were based on findings from the phase 3 CheckMate-901 (NCT03036098) and EV-302/KEYNOTE-A39 (NCT04223856) studies, respectively. Findings from both studies demonstrated improved progression-free survival compared with their control arms while also extending overall survival, Shore says.

When using systemic therapies such as those in CheckMate-901 or EV-302, urologists should collaborate with their tumor boards and their medical oncologist to plot the best course of action, Shore notes. Moreover, findings from promising trials are expected to read out in the near future, which include studies examining trimodal bladder sparing, Shore says. Studies such as these emphasize the importance of a multidisciplinary team because they incorporate complete resection of the bladder lesion, chemoradiation, chemoimmunotherapy, and potentially other modalities, Shore explains. Thus, urologic oncology, medical oncology, radiation oncology, and pathology, among other specialties will need to be increasingly combined in advanced bladder cancer centers, Shore concludes.