Ep. 45 Urothelial Carcinoma: Understanding ctDNA & Precision Medicine with Dr. Amanda Nizam and Dr. Brad McGregor

Is the era of cisplatin over, or are we simply becoming more precise about who benefits from it? As perioperative strategies in bladder cancer continue to evolve, emerging tools like circulating tumor DNA (ctDNA) are playing a bigger role in how clinicians assess recurrence risk and tailor treatment. In this episode of BackTable Tumor Board, host Alan Tan, medical oncologist at Vanderbilt-Ingram Cancer Center, is joined by bladder cancer experts Dr. Amanda Nizam and Dr. Brad McGregor to discuss recent advances in the diagnosis and treatment of urothelial carcinoma.

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SYNPOSIS

The doctors examine the evolving management of muscle-invasive bladder cancer (MIBC), including the role of neoadjuvant and adjuvant therapies, the integration of immunotherapy, and the recent approval of enfortumab vedotin plus pembrolizumab. The discussion explores the rapidly changing perioperative landscape, the prognostic utility of ctDNA, and how biomarkers such as HER2 and FGFR are influencing treatment selection across disease states. They also address bladder preservation strategies, management of treatment-related toxicities, and the importance of multidisciplinary coordination. The episode concludes with a forward-looking discussion on emerging therapies and the potential to improve cure rates in bladder cancer.

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TIMESTAMPS

00:00 - Introduction
01:44 - Overview of Bladder Cancer Treatment
04:54 - Patient Staging and Treatment Goals
10:12 - Bladder Preservation vs. Radical Cystectomy
16:39 - Emerging Trials and Future Directions
22:40 - ctDNA and Precision Medicine
33:50 - Metastatic Disease and Biomarker Strategies
42:16 - Managing Neuropathy in Metastatic Treatment
48:44 - HER2 and FGFR in Bladder Cancer
54:15 - Future Directions in Bladder Cancer Treatment

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RESOURCES

EV-302/303 Trial
https://newsroom.astellas.com/2023-12-15-PADCEV-R-enfortumab-vedotin-ejfv-with-KEYTRUDA-R-pembrolizumab-Approved-by-FDA-as-the-First-and-Only-ADC-Plus-PD-1-to-Treat-Advanced-Bladder-Cancer

NIAGARA Regimen
https://www.nejm.org/doi/full/10.1056/NEJMoa2408154

KEYNOTE-905 Study
https://www.annalsofoncology.org/article/S0923-7534(25)04894-X/fulltext