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Advanced urothelial carcinoma: Expert guidance to navigate an evolving therapeutic landscape

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This activity is jointly funded by an independent medical education grant from Astellas Pharma Inc. and Seagen Inc. This activity is jointly provided by USF Health and touchIME.

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    Faculty & Disclosures
    Prof. Thomas Powles

    Barts Cancer Centre, London, UK

    Prof. Thomas Powles is Director of the Barts Cancer Centre, one of the UK’s largest cancer centres, and a professor of genitourinary oncology at the Queen Mary University of London, UK. read more



    Prof. Powles has led a number of clinical trials and translational oncology projects that have appeared in the major journals. He has had a key role in the development of biomarkers and new drug strategies in genitourinary cancer, including multiple EMA and FDA approvals. In 2023, Prof. Powles was named in ‘Nature’s 10’, a list of the most influential global scientists. 

    Prof. Powles has over 300 peer-reviewed publications. He has presented data at plenary sessions at the major meetings and was awarded the bladder cancer award at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium in 2018. Prof. Powles hosts multiple podcasts and has an active role on social media, with over 10,000 followers on X. 

    Prof. Powles leads the European Society for Medical Oncology (ESMO) guidelines for renal and bladder cancer, and was the track chair for non-prostate genitourinary cancer in 2021. He has previously participated in the steering committee for the educational and scientific tracks for ESMO meetings, including co-chairing the ESMO Immuno-Oncology Congress from 2019 to 2021.



    Disclosures

    Prof. Thomas Powles discloses: Advisory Board or panel fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Consultancy fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Gilead, Incyte, Ipsen, Johnson & Johnson, Mashup, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Grants/research support fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics.
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    Bladder Cancer, Genitourinary Cancer, Immunotherapy CE/CME accredited

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    Advanced urothelial carcinoma: Expert guidance to navigate an evolving therapeutic landscape

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    Prof. Thomas Powles is Director of the Barts Cancer Centre, one of the UK’s largest cancer centres, and a professor of genitourinary oncology at the Queen Mary University of London, UK. read more

    Prof. Powles has led a number of clinical trials and translational oncology projects that have appeared in the major journals. He has had a key role in the development of biomarkers and new drug strategies in genitourinary cancer, including multiple EMA and FDA approvals. In 2023, Prof. Powles was named in ‘Nature’s 10’, a list of the most influential global scientists.

    Prof. Powles has over 300 peer-reviewed publications. He has presented data at plenary sessions at the major meetings and was awarded the bladder cancer award at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium in 2018. Prof. Powles hosts multiple podcasts and has an active role on social media, with over 10,000 followers on X.

    Prof. Powles leads the European Society for Medical Oncology (ESMO) guidelines for renal and bladder cancer, and was the track chair for non-prostate genitourinary cancer in 2021. He has previously participated in the steering committee for the educational and scientific tracks for ESMO meetings, including co-chairing the ESMO Immuno-Oncology Congress from 2019 to 2021.

    Disclosures

    Prof. Thomas Powles discloses: Advisory Board or panel fees fromAstellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Consultancy fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Gilead, Incyte, Ipsen, Johnson & Johnson, Mashup, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Grants/research support fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics.

    Take CE/CME Test

    Prof. Thomas Powles is Director of the Barts Cancer Centre, one of the UK’s largest cancer centres, and a professor of genitourinary oncology at the Queen Mary University of London, UK. read more

    Prof. Powles has led a number of clinical trials and translational oncology projects that have appeared in the major journals. He has had a key role in the development of biomarkers and new drug strategies in genitourinary cancer, including multiple EMA and FDA approvals. In 2023, Prof. Powles was named in ‘Nature’s 10’, a list of the most influential global scientists.

    Prof. Powles has over 300 peer-reviewed publications. He has presented data at plenary sessions at the major meetings and was awarded the bladder cancer award at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium in 2018. Prof. Powles hosts multiple podcasts and has an active role on social media, with over 10,000 followers on X.

    Prof. Powles leads the European Society for Medical Oncology (ESMO) guidelines for renal and bladder cancer, and was the track chair for non-prostate genitourinary cancer in 2021. He has previously participated in the steering committee for the educational and scientific tracks for ESMO meetings, including co-chairing the ESMO Immuno-Oncology Congress from 2019 to 2021.

    Disclosures

    Prof. Thomas Powles discloses: Advisory Board or panel fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Consultancy fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Gilead, Incyte, Ipsen, Johnson & Johnson, Mashup, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Grants/research support fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics.

    Take CE/CME Test

    Prof. Thomas Powles is Director of the Barts Cancer Centre, one of the UK’s largest cancer centres, and a professor of genitourinary oncology at the Queen Mary University of London, UK. read more

    Prof. Powles has led a number of clinical trials and translational oncology projects that have appeared in the major journals. He has had a key role in the development of biomarkers and new drug strategies in genitourinary cancer, including multiple EMA and FDA approvals. In 2023, Prof. Powles was named in ‘Nature’s 10’, a list of the most influential global scientists.

    Prof. Powles has over 300 peer-reviewed publications. He has presented data at plenary sessions at the major meetings and was awarded the bladder cancer award at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium in 2018. Prof. Powles hosts multiple podcasts and has an active role on social media, with over 10,000 followers on X.

    Prof. Powles leads the European Society for Medical Oncology (ESMO) guidelines for renal and bladder cancer, and was the track chair for non-prostate genitourinary cancer in 2021. He has previously participated in the steering committee for the educational and scientific tracks for ESMO meetings, including co-chairing the ESMO Immuno-Oncology Congress from 2019 to 2021.

    Disclosures

    Prof. Thomas Powles discloses: Advisory Board or panel fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Consultancy fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Gilead, Incyte, Ipsen, Johnson & Johnson, Mashup, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Grants/research support fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics.

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    Learning Objectives

    After watching this activity, participants should be better able to:

    • Choose appropriate treatments for patients with advanced urothelial carcinoma who are ineligible for or whose disease does not respond to first-line platinum-based chemotherapy
    • Outline how new and emerging therapies can be integrated in the treatment algorithm for advanced urothelial carcinoma
    • Manage adverse events of newly approved agents and combination therapies
    Overview

    In this activity, Prof. Thomas Powles, an oncologist specializing in bladder cancer, provides an update on the latest developments in the treatment of advanced urothelial carcinoma, including the latest guideline recommendations, supporting clinical data and factors to support decision making in clinical practice. Prof. Powles also highlights the key safety considerations and side-effect management strategies for antibody–drug conjugates, immune checkpoint inhibitors and FGFR inhibitors.

    This activity is jointly provided by USF Health and touchIME. read more

    Target Audience

    This activity has been designed to meet the educational needs of oncologists, urologists, oncology nurses and pharmacists involved in the management of patients with urothelial carcinoma.

    USF Accreditation

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Prof. Thomas Powles discloses: Advisory Board or panel fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Consultancy fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Gilead, Incyte, Ipsen, Johnson & Johnson, Mashup, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics. Grants/research support fees from Astellas, AstraZeneca, Bristol Myers Squibb, Eisai, Exelixis, Ipsen, Johnson & Johnson, Merck/Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche and Seattle Genetics.

    Content reviewer

    Rachelle Amanda Rodriguez MS, APRN, AOCNP has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributors

    Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu 

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditsTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 17 June 2024. Date credits expire: 17 June 2025.

    If you have any questions regarding credit, please contact cpdsupport@usf.edu

     

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Topics covered in this activity

    Bladder Cancer / Genitourinary Cancer / Immunotherapy
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    This activity is jointly funded by:

    An independent medical education grant from
    Astellas Pharma Inc. and Seagen Inc.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals outside of the USA and UK only.

    Date of original release: 17 June 2024.
    Date credits expire: 17 June 2025.

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    touchEXPERT OPINIONS
    Advanced urothelial carcinoma: Expert guidance to navigate an evolving therapeutic landscape
    0.75 CE/CME credit
    Question 1/5
    Your 65-year-old patient has been diagnosed with unresectable stage IV urothelial carcinoma. Assuming the patient is eligible for all available treatment options, which first-line treatment would you choose based on the current ESMO and NCCN guidelines?

    ESMO, European Society for Medical Oncology; NCCN, National Comprehensive Cancer Network.

    ESMO and NCCN guidelines recommend pembrolizumab plus enfortumab vedotin as the preferred first-line treatment for patients with locally advanced or metastatic urothelial carcinoma.1,2

    Abbreviations

    ESMO, European Society for Medical Oncology; NCCN, National Comprehensive Cancer Network.

    References

    1. NCCN. Bladder Cancer V4.2024. Available at: www.nccn.org/professionals/physician_gls/pdf/bladder.pdf (accessed 19 May 2024).
    2. Powles T, et al. Ann Oncol. 2024:S0923-7534(24)00075-9 (online ahead of print).
    Question 2/5
    You initiate treatment with pembrolizumab plus enfortumab vedotin for your patient with unresectable stage IV urothelial carcinoma. After eight cycles of treatment, the patient reports paraesthesia affecting their hands and feet. You diagnose grade 2 peripheral neuropathy. What is the most appropriate management option for this side effect?

    Peripheral neuropathy is a possible adverse event associated with enfortumab vedotin.1 Grade 2 peripheral neuropathy should be managed by withholding treatment until grade ≤1, while higher grade peripheral neuropathy justifies permanently discontinuing treatment.2 Corticosteroids are not recommended for the management of peripheral neuropathy in this context.2

     References

    1. Powles TB, et al. N Engl J Med. 2024;390:875–88.
    2. EMA. Enfortumab vedotin SmPC. Available at: www.ema.europa.eu/en (accessed 19 May 2024).
    Question 3/5
    What was the hazard ratio for overall survival with nivolumab plus gemcitabine and cisplatin vs gemcitabine and cisplatin for the first-line treatment of locally advanced or metastatic urothelial carcinoma in the phase III Checkmate-901 trial?

    In the phase III Checkmate-901 trial comparing nivolumab plus gemcitabine and cisplatin (n=304) to gemcitabine and cisplatin (n=304) for the first-line treatment of patients with locally advanced or metastatic urothelial carcinoma, the hazard ratio for overall survival was 0.78 (21.7 months vs 18.9 months; p=0.02).

    Reference

    van der Heijden MS, et al. N Engl J Med. 2023;389:1778─89.

    Question 4/5
    A patient with metastatic urothelial carcinoma shows disease progression following first-line gemcitabine plus cisplatin and avelumab maintenance treatment. They have a susceptible genetic alteration of the FGFR3 gene. Which of the following is the most appropriate treatment option for this patient according to ESMO and NCCN guidelines?

    ESMO, European Society for Medical Oncology; FGFR, fibroblast growth factor receptor; NCCN, National Comprehensive Cancer Network.

    ESMO and NCCN guidelines include erdafitinib as a recommended treatment option for patients with a susceptible FGFR genetic alteration whose disease progresses following first-line treatment on chemotherapy and ICI.1,2 An ICI should only be considered if this has not been received in the first-line setting,1,2 and trastuzumab deruxtecan is recommended by the NCCN guidelines for HER2-positive disease only.2

    Abbreviations

    ESMO, European Society for Medical Oncology; FGFR, fibroblast growth factor receptor; HER2, human epidermal growth factor receptor 2; ICI, immune checkpoint inhibitor; NCCN, National Comprehensive Cancer Network.

    References

    1. NCCN. Bladder Cancer V4.2024. Available at: www.nccn.org/professionals/physician_gls/pdf/bladder.pdf (accessed 20 May 2024)
    2. Powles T, et al. Ann Oncol. 2024:S0923-7534(24)00075-9 (online ahead of print).
    Question 5/5
    You initiate second-line treatment with erdafitinib for your patient with metastatic urothelial carcinoma. Which of the following monitoring strategies do you implement to detect possible side effects of erdafitinib treatment as early as possible?

    Erdafitinib has been associated with a risk of ocular adverse events, including CSR and RPED.1 It is recommended that routine ophthalmological examinations are performed during treatment to identify these conditions.1 ICI therapy is associated with a risk of hyper- and hypothyroidism,2–5 while peripheral neuropathy associated with enfortumab vedotin therapy warrants musculoskeletal and neurological assessments.6  

    Abbreviations

    CSR, central serous retinopathy; ICI, immune checkpoint inhibitor; RPED, retinal pigment epithelial detachment. 

    References

    1. FDA. Erdafitinib PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2024/212018s007s008s009lbl.pdf  (accessed 23 April 2024).
    2. EMA. Atezolizumab SmPC.
    3. EMA. Pembrolizumab SmPC.
    4. EMA. Avelumab SmPC.
    5. EMA. Nivolumab SmPC.
    6. EMA. Enfortumab vedotin SmPC.

    All SmPC available at: www.ema.europa.eu/en(accessed 20 May 2024).

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    This activity is jointly funded by:

    An independent medical education grant from
    Astellas Pharma Inc. and Seagen Inc.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals outside of the USA and UK only.

    Date of original release: 17 June 2024.
    Date credits expire: 17 June 2025.

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