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ALLO-316 showed significant activity and safety in patients with metastatic CD70-positive clear cell renal cell carcinoma.

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Russ Conroy is an Assistant Editor for CancerNetwork. He grew up in Hillsborough, New Jersey, and graduated from Rutgers University-New Brunswick in 2022.

On the weekends, he likes to unwind by playing video games with friends, tailgating at Rutgers football games with his family, or building his music collection with a visit to Princeton Record Exchange.

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Nick Barkemeyer, PA-C, MMS, is a physician assistant who specializes in bone marrow transplant at the Centennial Center for Blood Cancers Clinic in Nashville, Tennessee.

Bridget Hoyt is the assistant editor for Oncology Nursing News. She earned her BA in communication studies at Rider University with a minor in public relations. She can be reached at 

CAR T-cell therapy is starting to enter the treatment conversations sooner with patients with multiple myeloma, according to Nick Barkemeyer, PA-C, MMS.

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Oncology Nursing News connects oncology nurses and APPs with updates on therapy advances, side effect management, and patient-centered cancer care.

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, Lindsay Diamond, MSN, AGNP-C, AOCNP, spoke on updated data from the CheckMate 274 trial (NCT02632409), which were presented during the 2023 ASCO Genitourinary Cancers Symposium (ASCO GU), and commented on different trials paving the way in urothelial carcinoma.

According to Diamond, who is a nurse practitioner and clinical program manager of the GU Oncology Clinical Trials Department at the Icahn School of Medicine at Mount Sinai, the disease-free survival (DFS) outcomes from Checkmate 274 were very promising, as they signify that adjuvant treatment with nivolumab (Opdivo) may be able to help patients reach certain milestones. This trial showed that at a median follow-up of 36.1 months, the median DFS with adjuvant nivolumab was 52.5 months vs 8.4 months with placebo in the PD-L1 population (1% or greater). Moreover, in the intention-to-treat population, the median DFS were 22.0 vs 10.9 months, respectively.

Adjuvant nivolumab was approved for patients with urothelial carcinoma who are at high risk of recurrence after radical resection based on earlier data from CheckMate 274.

Moving forward, she hopes to continue to see positive readouts from this trial, as well as more research in bladder-sparing treatment approaches and better tumor markers to help patients track their diseases responses to treatment.

Interested in learning more from the meeting? Check out our coverage of 

We want to hear from you! Which ASCO GU data do you think will be practice-changing?

Email lfischer@mjhlifesciences.com with your feedback.

There is this mentality when patients have localized disease, of ‘well, it’s not metastatic and you had it removed so you’re fine,’ but those patients still live with cancer every day of their life after that surgery and it’s a waiting game. 

We, as providers, know that 30% of patients or so could have a serious immune-related adverse effect from immunotherapy, but the majority of patients are going to do fine on it. 

Generally, clinical trials looking at bladder sparing approaches [are important], whether it’s our study HCRN GU16-257 [NCT03558087]—that looks at chemotherapy and immunotherapy—or other trials that look at just chemotherapy. 

CheckMate 274 Follow-Up Supports the Use of Adjuvant Immunotherapy in Bladder Cancer

Pembrolizumab Shows Antitumor Activity at 45-Month Follow-Up in BCG-Unresponsive Papillary NMIBC

Real-World Data Supports Front-Line Maintenance With Avelumab For Locally Advanced, Metastatic Urothelial Carcinoma

Neoadjuvant Split-Dose Chemotherapy Represents Potential New Standard of Care for High-Risk UTUC

Maximizing Potential of Immunotherapy Requires Appropriate irAE Management

Laura Wood on the Integration of Avelumab, Erdafitinib, and Enfortumab Vedotin into Urothelial Cancer Care

Predicting Immunotherapy Response in Bladder Cancer

Chemo Cheat Sheets Help Nurses During Drug Delivery

A Look Back at 2022 FDA Approvals in Oncology

Galsky M, Witjes JA, Gschwend J, et al. Extended follow-up results from the CheckMate 274 trial. 

. 2023;41(suppl 6):LBA443. doi:10.1200/JCO.2023.41.6_suppl.LBA443

FDA approves nivolumab for adjuvant treatment of urothelial carcinoma. FDA. News release. August 19, 2021. Accessed April 3, 2023. 

Lindsay Diamond, MSN, AGNP-C, AOCNP, discusses findings from CheckMate 274 and other data presented during the 2023 ASCO Genitourinary Cancers Symposium.

Lindsay Diamond Discusses Ongoing Role of Immunotherapy in Bladder Cancer

Oncologic therapies approved in June included indications in genitourinary, lung, and hematologic, and head and neck cancers.

Oncology Drugs Approved by the FDA in June

UGN-102 has received FDA approval for use in patients with low-grade intermediate-risk non-muscle-invasive bladder cancer.

FDA Approves Mitomycin Intravesical Solution in Low-Grade NMIBC

Adding immunotherapy to chemo may boost pCR and downstaging rates in the neoadjuvant setting for muscle-invasive bladder cancer.

Chemoimmunotherapy May Increase pCR in Muscle-Invasive Bladder Cancer

Durvalumab added to BCG induction and maintenance improved disease-free survival vs BCG alone in high-risk non–muscle-invasive bladder cancer.

Durvalumab Plus BCG Boosts DFS in Non–Muscle-Invasive Bladder Cancer

Disitamab vedotin plus toripalimab improved PFS and OS over chemo in HER2+ metastatic urothelial cancer, per phase 3 RC48-C016 interim analysis.

First-Line Disitamab Vedotin Combo Ups Survival in Urothelial Cancer

In the genitourinary cancer space, there have been a lot of updates to follow in the past 5 years. At the 

, a nurse practitioner at Seattle Cancer Care Alliance, about why he thinks there have been so many updates recently.

I think that it's sort of a coalescence of a number of different things, timing, maybe a little bit of luck, and there's just a lot more interest in bladder cancer these days. It's a deadly disease when it's metastatic, and we're trying to find options that go beyond the first and second line that can really prove to have some survival benefit. For prostate cancer, it's such a common ubiquitous disease amongst men, and so, it just makes sense to continue the research in this realm and provide all the options that we can. 

The genitourinary cancer space has seen a lot of updates in the past 5-10 years, but where are they all coming from so suddenly? Oncology Nursing News spoke with Michael Lai, ARNP, a nurse practitioner at Seattle Cancer Care Alliance, about how the genitourinary cancer space has been able to have so many updates recently.

Where New Updates in Genitourinary Cancer Continue to Come From

Experts share insights on standard work-up and staging practices for a patient with newly diagnosed bladder cancer.

Unlocking Bladder Cancer: A Guide to Effective Diagnosis and Staging

 Talking about the diagnostic work-up, which again, is mostly done by an urologist, Nerina, if you can give us your thoughts. When we see these patients in the clinic, what testing do we do, assuming the cystoscopy and maybe a TURBT [transurethral resection of bladder tumor] was done? What other tests do we do in terms of imaging, maybe biomarkers? [Do you have] any comments on that?

: I think with biomarkers, the NCCN [National Comprehensive Cancer Network] guideline recommends germline testing and genetic counselor referrals, especially if patients are presenting at a younger age, or have a family history of colon or endometrial malignancy. You’re assessing for Lynch syndrome, DNA mismatch repair deficiency mutations, and other hereditary conditions. In terms of imaging, if there is evidence of muscle-invasive disease, we would get complete staging, including a CT of the chest, abdomen, and pelvis, to assess for other sites that could potentially be there.

: I totally agree, Nerina. I think that’s exactly the standard practice, imaging with a CT [of the] chest, abdomen, and pelvis, as you pointed out. And ideally, we use IV [intravenous] contrast for better-quality images. Sometimes, we have this challenge of patients having kidney failure, and IV contrast may be a challenge. Lisa, do you do an MRI in those cases with gadolinium, where you can use lower GFR [glomerular filtration rate] thresholds? How do you deal with that kidney impairment, or rarely, allergies to IV contrast?

: Often, if that is an issue, we will get a noncontrast CT [of the] chest, and then MRI imaging of the abdomen and pelvis to get a better sense of staging.

 Thank you. I think we do the same thing here. To add to this great discussion, we always think about, especially for metastatic disease, what else the patient may need. I totally agree, Nerina, germline testing is something we are learning about more and more because germline mutations are much more common than we thought. And we frequently send patients to genetic counseling, to your point, so I totally agree with that. A good family history assessment is key, and now we use nurse navigators more and more to try to ask the patients ahead of time about their broader family history and different degrees of relatives.

The other thing that comes to mind is genomic testing for tumor somatic mutations. We send tumor tissue to look for different genomic biomarkers. Traditionally PD-L1 has been something we looked at, but I think it’s not that useful anymore in urothelial cancer, mainly because we usually tend to start with chemotherapy in most patients. But we send genomic sequencing for all patients with metastatic disease because we look at different mutations, genomic alterations. We’ll talk a bit about erdafitinib in a second, and that’s for only select patients based on 

 mutations or fusions. It’s definitely an important message for the audience that if you have a patient with metastatic urothelial cancer, make sure to send at least tumor tissue for genomic testing. And in some cases, many of us may also send circulating tumor DNA to complement that and capture the heterogeneity of the disease. That’s a great discussion.

Emily, you are focusing on urinary cancer and have great experience. Can you tell us a bit more about the staging of bladder cancer? We do the multidisciplinary clinic together, and this comes up frequently. Can you drive us through, the diagnosis is [made with] usually cystoscopy, TURBT, sometimes urine cytology. Tell us a bit about the staging and the work-up of those people.

: T [tumor] stage is usually something we want to get pathologically, so we’re looking for muscularis propria to be present in the specimen from the TURBT so that we can assess whether this is muscle-invasive disease or not. So typically, we want to establish that this is muscle invasive on the TURBT specimen. Then we always look at the scans with our radiologist and our bladder cancer multidisciplinary clinic to also have them weigh in on whether they think there’s some suspicion of extravesicle, or extension beyond the bladder, on the CT scan. Obviously, MRI is much more sensitive for detecting T3 or T4 disease, but sometimes we can even see it on a CT scan. Then the nodal status is something that obviously we would just see on a baseline-staging scan. It’s also always helpful to be able to discuss those scans in real time with the radiologist and point out all of the more or less suspicious nodes, and get an expert interpretation of the degree of suspicion for lymph node involvement.

We often end up, by the time we see patients, they also have had multiple scans over the last several months. Usually by the time they get sent to our multidisciplinary clinic, this has been worked up with maybe an initial scan at the time of presentation, and then the CT IVP [intravenous pyelogram], or a CT [of the] abdomen and pelvis with contrast once we realize what is going on, maybe after the cystoscopy before the TUR [transurethral resection]. So it’s always helpful to have multiple time points where you can look for growth or stability in any indeterminate lymph nodes.

 Thank you, Emily. Great points, absolutely. Speaking about all those factors and the need for a multidisciplinary approach, obviously, as you mentioned, tissue is the issue. You need to have tissue confirmation and also adequate staging. And this can be nuanced sometimes, to your point, sometimes muscularis propria may not be represented in the tissue sampling of a TURBT, the transurethral bladder tumor resection. If it is a T1, we always repeat the TURBT to ensure muscularis propria presence, and even if it is present, there’s the risk of understaging. I think it’s an important point that the urologists do that, repeat the TURBT to minimize the chance of understaging.

And the clinical staging, to your point, Emily, takes into account the pathology information from the TURBT, but also the exam under anesthesia and imaging. Because I know you and I have done this before, you may have a case that looks like a clinical T3 with extravesical extension, as you mentioned, and hydronephrosis, but in tissue, you cannot prove the muscularis propria invasion. But if everything looks like T3, we treat this patient as a T3 stage. Right?

Experts share insights on standard work-up and staging practices for a patient with newly diagnosed bladder cancer. 

Expert panelists unpack a patient's bladder cancer presentation, evaluating the presence of typical signs and symptoms that could lead to a diagnosis.

Case Study: Recognizing the Typical Signs of Bladder Cancer

 presentation entitled, “Morning Rounds: The Bladder Cancer Treatment Paradigm.” I’m Dr Petros Grivas, your host for today. I’m a medical oncologist in Seattle, a professor in oncology, and the clinical director of the genitourinary [GU] cancers program at the Fred Hutchinson Cancer Center and the University of Washington [in Seattle]. I’m very excited and thrilled to be joined today by 3 amazing providers and members of our team. I will let each of them introduce themselves. Let’s start with Dr Emily Weg. Emily?

: Good morning, it’s a pleasure to be with you today. I’m Emily Weg, I’m an assistant professor in the department of radiation oncology at the University of Washington and the Fred Hutchinson Cancer Center, and I specialize in genitourinary malignancies.

 Great, Emily. And it’s great to work with you on our team. Then we have Lisa Adams, who’s a fantastic physician assistant in Colorado. Lisa?

: Hi, I am Lisa Adams. I’m a physician assistant in a medical oncology practice with the University of Colorado Health System [in Colorado Springs]. I’m very excited to be here this morning.

 Welcome, Lisa. [It’s] great to have you. Talking about fantastic physician assistants, I’m also thrilled to be joined by Nerina McDonald. She’s also a physician assistant, and she’s working with us here at the University of Washington and Fred Hutch. Nerina?

: Hi, I’m Nerina McDonald, I’ve been practicing in GU oncology at Fred Hutchinson Cancer Center for about 4 years now, and I have the pleasure of working with Dr Grivas on a regular basis in our clinic.

 Thanks, Nerina. It’s a pleasure to do this together today. We’re going to discuss the testing and treatment of patients with metastatic bladder cancer and urothelial cancer in general. Of course, the field is evolving so rapidly, and it’s really exciting to see the advances in the field. We’re going to look at some clinical scenarios and review best practices, and I want to hear and learn from my colleagues here today. Let’s begin, starting with a case, to put things in context. Again, as I mentioned before, it’s a great opportunity to do this program because so much has been changing in the field of urothelial cancer.

This particular case we have today is an 80-year-old gentleman who presents to the emergency department reporting severe lower abdominal pain in the suprapubic area, fatigue, tiredness, as well as increased urinary frequency and urgency. [He has] also noticed hematuria, blood in the urine, over the past few days. This gentleman has a history of smoking, he’s a former smoker with a 20 pack-year history. He quit about 10 years ago. His medical history is also significant for mild COPD [chronic obstructive pulmonary disease] and diabetes mellitus, which is controlled by medications. I know this is not the most common scenario of presentation of bladder cancer. Most of the patients come to us through urology, hematuria and other urinary tract symptoms, is the main entrance point for patients. Emily, I’ll start with you, you’re a very accomplished radiation oncologist. Do you get calls sometimes from the emergency department for newly diagnosed, newly presented patients? It’s probably less common, right?

: Yes, it’s pretty unusual that the emergency department would call the radiation oncologist. But I think a lot of this patient’s presentation is fairly typical. About 75% of patients with bladder cancer present with hematuria, and about a quarter of them present with lower urinary tract symptoms, like frequency, urgency, and discomfort with voiding. The suprapubic pain you described and the dramatic nature of this presentation is a bit unusual. The way radiation oncology is usually roped into the picture is, traditionally, once there’s already a proven tissue diagnosis.

 Thank you, Emily, I totally agree with you. And I think even in our practice, Nerina, you probably would agree that the vast majority of our patients come through the urology practice. It’s not that common to get this presentation, but it can happen. Sometimes we have a de novo metastatic urothelial cancer. Just for context for the audience, if you have 100 patients diagnosed with bladder cancer de novo, only about 4% or 5%, as Dr Weg mentioned, present de novo with metastatic disease. Usually, it’s already been diagnosed in early stage disease. I will ask you, Nerina, when we meet those patients in the clinic, could you comment a bit about the symptoms they have, especially with metastatic disease? What are they complaining about? What are their symptoms?

: I think patients may often present with urinary obstruction, irritated voiding, and pain. If they are in a metastatic setting, I have seen a handful of patients who are having bone pain due to bone metastases. Sometimes we can see constitutional symptoms, such as fatigue, weight loss, anorexia, failure to thrive, etc.

 [I] totally agree with you, and it depends on the [type of] disease and the extent of the disease. Lisa, I know sometimes there might be some differences between community practices and academic practices, mostly because the patients may start in a community practice, which may be closer to home for them. I talk frequently with my colleagues in community practices, and the patients we see sometimes in the tertiary academic center may be a bit filtered, selective populations who travel to see us. [Do you have] any comments on your end about the initial presentation of patients through the clinic, or the emergency department?

: Absolutely. Where we are in southern Colorado, we do serve a larger rural population, where maybe access to primary care, screening, and early referrals to specialists may be a bit less. So we do see maybe a bit more of this similar presentation of patients diagnosed in the advanced setting, or maybe going to the emergency department rather than through the traditional routes.

 [I] totally agree. Access to primary care, of course, and access to care in general I think is key and is not always given. That brings up an important point, Lisa, about disparities in health care, and how can we go work altogether, different stakeholders, to eliminate those disparities and provide access to care, diagnostic work-up. There are many initiatives, especially with the Bladder Cancer Advocacy Network, BCAN, that try to spread the word to people who have symptoms like blood in the urine, or other urinary tract symptoms, to seek medical attention early, and be referred to a urologist for work-up. It’s a very important need. And of course, as a medical oncologist or radiation oncologist in this group today, we usually see the patients after the diagnosis is made. The urologist is usually the first point of contact. Less commonly, in a situation like this when a patient goes to the emergency department, depending on the setting, maybe a biopsy of a metastatic site may be needed, or cystoscopy, and tumor tissue acquisition through a cystoscopy through a urologist.

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