Plenary Session 7 “Combining immunotherapy with local treatment of GU cancer” covered topics on radioimmunotherapy for bladder preservation and the role of surgery in the time of immunotherapy. EAU Section of Oncological Urology (ESOU) Chair Prof. Morgan Rouprêt (FR) chaired the session together with oncologists Prof. Dr. Maria De Santis and Dr. Julia Murray (GB).
Oncologist Prof. Ananya Choudhury (GB) began her presentation on radioimmunotherapy for bladder preservation stating, “Surgery is not the only gold standard for treating localised muscle-invasive bladder cancer. There is plenty of data out there. Whether you look at match cohorts from a single institution, epidemiologically at population data or meta-analysis of the published studies, they show that bladder preservation has equivalent outcomes to radical cystectomy.”
During her lecture, Prof. Choudhury also cited high-level data from an individual patient data meta-analysis which shows that hypofractionation of giving radiotherapy over four weeks 55Gy/20f is superior to 64Gy/32f for invasive loco‐regional control (ILRC). She stated, “55Gy/20f should form the standard of care for any combination protocols going forward.”
She concluded her lecture with this statement: “I think we do not know what optimal radiotherapy dose and fractionation to combine with immunotherapy. I am hesitant about whether we should combine at all. We do not know what is the optimal radiosensitiser to combine alongside radiotherapy with immunotherapy. Are we suggesting that we should compromise on the radiotherapy schedule so that we can test immunotherapy safely? I am uncertain that it is something I am prepared to do. What we do know is there are numerous trials which are ongoing. There is going more data for us to discuss and on how best to treat our patients.”
In “The role of surgery in the era of immunotherapy” Prof. Arnulf Stenzl (DE) said, “We think about surgery as being cytoreductive; it can be informative or supportive for immunotherapy. The role of surgery is to obtain tissue information. It is a multimodal concept. The sequence that opens the window for opportunity is so important e.g. the combination strategies of surgery and immunotherapy wherein immunosuppressive effect is turned into a therapeutic opportunity.”
Watch their presentations in full, along with other highly-informative lectures of the session. Access the Resource Centre for more EMUC21 content.