Suzanne B. Merrill, M.D., F.A.C.S. - PowerPoint Presentation

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2. Suzanne B. Merrill, M.D., F.A.C.S.Urologic OncologistColorado UrologyBladder Cancer Support Group Inaugural Meeting

3. Why a Support Group?Brings people with similar experience togetherCreates a sense of belongingReduces feelings of isolationCan empower individuals—regain back controlImproves coping and adjustmentEnhances understanding of what to expectGain practical advice + medical informationCreates a Community:Together we are Stronger

4. OutlineCurrent bladder cancer statisticsThe numbers and who is at riskNew FDA approved therapeutics & diagnosticsNon-muscle invasive + Muscle invasive diseaseNew frontier—clinical trialsNon-muscle invasive + Muscle invasive disease

5. Bladder Cancer StatisticsIn 2023…Over 82,200 people in the U.S. were diagnosed with bladder cancer~225 people per day heard the words “You have bladder cancer”16,700 deaths attributed to bladder cancerOver 600,000 cases diagnosed worldwide

6. Bladder Cancer StatisticsCurrently…Over 700,000 people in the U.S. are living with bladder cancerMore people than the population of Wyoming

7. Bladder Cancer StatisticsIn Colorado….1,220 new cases in 2023

8. Bladder cancer cases are rising…Estimated increase of %1.35 over 2022With the aging U.S. population  Projected 68% increase by 2030Why…Bladder Cancer?

9. Bladder Cancer = 6th Most Common CancerSEER Cancer Statistics 20234th most common cancer in men

10. Most Common at Ages: 65-74 yrsOver 90% of cases in age >55yrs

11. Bladder cancer disproportionately affects older adultsAmong age >80 years179 new cases per 100,000High rates of multimorbidityMedian 8 chronic conditionsBladder cancer deaths are highest amongst age 85+> 60% of deaths occur over 75 yrs32% of deaths are in 85+ Nielsen ME, et al. Cancer 2014; 120(1); Smith BD, et al. JCO 2009; 27(17); Garg T et al. J Urol 2018; 199(2); SEER cancer statistics 2021.

12. Gender Predilection

13. New Cases of Bladder Cancer by Gender/Race

14. Bladder Cancer Risk FactorsAccounts for 47% all cases

15. New FDA Approved Therapeutics & DiagnosticsNon-Muscle Invasive & Muscle Invasive Bladder Cancer

16. Stages of Bladder Cancer

17. Superficial Bladder Cancer(Non-Muscle Invasive Bladder Cancer)> 60% patients are diagnosed at this stageRisk of recurrence Up to 61% at 1 year and 78% at 5 yearsRisk of progressionUp to 17% at 1 year and 45% at 5 years10%70%20%

18. Traditional Agents Treatment of Superficial Bladder CancerIntravesical Agents—mainstay of therapyBacillus Calmette-Guerin (BCG)Supply shortage continuingCR up to 80%, but not durableGemcitabineGemcitabine/Docetaxel46% RFS at 2 yearsMitomycinBCG Unresponsive diseaseOccurs in 50% of high risk patients

19. New FDA ApprovedTreatment of BCG Unresponsive NMBICNadofaragene firadenovec (Adstiladrin)—adenovirus vector gene based therapy (IF2b)53% CR at 3 months—durability ~10 monthsIntravesical--given every 3 months x 4 yearsN-803 (Anktiva) +BCG –IL 15 superagonist (May/June approval)55% CR at 3 months—durability ~27 monthsIntravesical--given like BCG (1x week/6 weeks)Pembrolizumab—PD-1 inhibitor41% CR at 3 months—durability ~24 monthsIV therapy--every 3-6 weeks x 2 years

20. New Technology for Superficial Bladder CancerBlue light cystoscopy with Cysview (intravesical agent)

21. Advantages of Enhanced CystoscopyNarrow Band Imaging (NBI)Improves detection of tumors (~25%)At diagnosisDuring follow-upDecreases rate of recurrence (~11%)May decrease rate of progression

22. Invasive Bladder CancerTumor grows into muscle layer or beyond33% patients are diagnosed at this stage

23. Treatment of Invasive Bladder Cancer(Muscle Invasive Bladder Cancer)Multidisciplinary careUrologic OncologistMedical OncologistRadiation Oncologist Options:Chemo + SurgerySurvival advantageChemo + Radiation Clinical trials (bladder sparing)Immunotherapy + Intravesical therapy

24. Surgical TreatmentInvasive Bladder Cancer

25. Surgical TreatmentInvasive Bladder CancerQuality of life improvements:Men  nerve sparing to preserve erectile functionFemales  Vaginal sparing and ovary sparing (premenopausal)

26. Surgical TreatmentInvasive Bladder Cancer

27. Surgical TreatmentInvasive Bladder Cancer

28. For patients after cystectomy with:pT2 or worse disease (with neoadjuvant chemo)ORpT3 or worse disease (without neoadjuvant chemo) Nivolumab (Opdivo)—PD-1 inhibitor30% risk reduction of BC recurrence/death (HZ 0.7, 95% CI 0.57-0.86)IV therapy--every 2-4 weeks x 1 yearNew FDA ApprovedTreatment of Persistent Invasive Disease After Surgery

29. New Frontier: Clinical TrialsCritical component when standard of care treatments are not viableSunRISe 1 –BCG unresponsive high risk CIS +/- pTa diseaseTAR-200 (intravesical slow release Gemcitabine) + CetrelimabSunRISe 3 –BCG naïve high risk diseaseTAR-200/Cetrelimab vs. BCG aloneKeynote 676 –BCG naïve or persistent diseaseBCG +/- PembrolizumabNon-Muscle Invasive Bladder Cancer

30. New Frontier: Clinical TrialsCritical component when standard of care treatments are not viableSunRISe 2 –unfit or unwilling for cystectomyTAR-200 + Cetrelimab vs. Chemotherapy/RadiationSunRISe 4 –ineligible for Cisplatin based chemotherapyCetrelimab +/- TAR-200 prior to cystectomyMuscle Invasive Bladder Cancer

31. www.coloradouro.comThank you!

32. Bladder Cancer Support GroupColorado UrologySemi-annual to quarterly meetingsShare your emailContinue the community support throughout the year!Meeting topicsWhat do you want to learn about?Upcoming clinical trials and therapeuticsOstomy tips/tricksPelvic floor physical therapyWays to mitigate side effects of intravesical therapyNovel treatments for metastatic bladder cancer

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