Ep. 67 Bladder Cancer Risk Stratification: Best Practices with Dr. Sunil Patel and Dr. Kristen Scarpato

Ep. 67 Bladder Cancer Risk Stratification: Best Practices with Dr. Sunil Patel and Dr. Kristen Scarpato

Why does up to 10% of bladder cancer pathology change on expert review, and what does that mean for your intermediate and high-risk patients? In this episode of BackTable, Dr. Bogdana Schmidt interviews urologists Dr. Kristen Scarpato and Dr. Sunil Patel to explore the complexities of diagnosis and risk assessment in non–muscle invasive bladder cancer (NMIBC). They discuss the real-world challenges of pathology interpretation, risk-group assignment, evolving diagnostic tools, and the impact these factors have on treatment decisions and patient outcomes. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Johnson & Johnson. --- Timestamps 00:00 - Introduction 01:02 - Risk Stratification 07:22 - Upstaging to High Risk 10:06 - Calculators and Patient Education 15:22 - Specific Tests Use Cases 18:50 - Conflicting Biomarker Results 21:36 - Adjunct Tests and Counseling 24:03 - Recurrence After Chemo Next Steps 27:01 - Escalation Deescalation Balance 32:48 - Future Research Priorities 35:43 - Biology Based Risk Stratification 38:03 - Clinical Pearls and Wrap Up --- More about this episode The conversation highlights the heterogeneity of intermediate-risk disease, the role and importance of expert pathology over-reads, and the need to accurately document the risk category for ongoing care. They discuss selective use of urinary and genomic assays and how these tests fit alongside cystoscopy and blue light endoscopy. Practical treatment approaches are reviewed, including when to use intravesical gemcitabine or BCG, managing care during BCG shortages, and balancing escalation versus de-escalation of therapy. Additional topics include strategies for long-term surveillance, upper tract imaging, rising rates of bladder cancer in younger patients, and why thorough TURBT and strong patient-provider communication remain central to optimal management. --- Resources The Memorial Study https://www.mskcc.org/cancer-care/clinical-trials/19-288 The BRIDGE Study https://www.nejm.org/doi/full/10.1056/NEJMoa1501035 --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 66 Managing Complications in Pancreatic Cancer with Dr. Zach Berman and Dr. Rebekah White

How do seasoned clinicians navigate the complex web of complications that accompany pancreatic cancer? In this episode of BackTable Tumor Board, Drs. Greg Botta, Rebekah White, and Zachary Berman discuss real-world strategies for managing pain, digestive complications, and the many challenges patients face. They explore multidisciplinary approaches, emphasizing the importance of tailored pain management, careful use of enzyme supplementation, and anticipating both surgical and medical risks, especially after procedures like the Whipple. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:36 - Interventional Radiology Approach to Pain Relief 05:37 - Nerve Blocks and Neurolysis for Treatment 09:05 - Expectations for Post-operative Recovery 10:46 - Whipple Anatomy and Side Effects 13:49 - Clot Prevention After Surgery 19:11 - Managing Nutritional Challenges and Gastric Outlet Obstruction 24:37 - Treating Malignant Ascites 29:54 - Mental Health Support for Pancreatic Cancer Patients 31:16 - Setting Expectations When Communicating with Patients 39:41 - Stent Choices and Sequencing --- More about this episode The conversation covers classifying and treating pain (visceral, neuropathic, somatic, and existential), multimodal and non-opiate therapies, and targeted nerve blocks for symptom relief. The doctors address nutrition and cachexia, strategies for managing post-surgical clotting risk, and the use of stents and interventional radiology to restore digestive flow. They also highlight the need for psychosocial support, exercise to combat fatigue, and streamlined team communication for standardized, patient-centered care. The episode wraps up with practical advice on setting patient expectations, troubleshooting persistent symptoms, and leveraging clinical trials and multidisciplinary expertise. --- Resources CASSINI Study https://pmc.ncbi.nlm.nih.gov/articles/PMC7476843/ --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 65 Navigating Shared Decision-Making in Bladder Cancer Treatment with Dr. Kelly Bree, Dr. Meredith Donahue, and Dr. Saum Ghodoussipour

What matters most to patients with non-muscle invasive bladder cancer (NMIBC)? In this episode of BackTable Urology, Dr. Kelly Bree, Dr. Saum Ghodoussipour, and Meredith Donahue, N.P., join host Dr. Vignesh Packiam to discuss the power of shared decision-making across the NMIBC spectrum. They explore risk-adapted treatment selection, when to escalate or de-escalate therapy, and how to navigate conversations about recurrence risk, treatment burden, quality of life, and the possibility of cystectomy. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Johnson & Johnson. --- Timestamps 00:00 - Introduction 01:55 - Second Opinions and Patient Counseling 06:08 - Intermediate Risk Stratification 12:13 - Treatment Options for Intermediate Risk NMIBC 16:20 - BCG and Alternative Treatments for High Risk NMIBC 26:49 - Options for BCG-Unresponsive NMIBC 31:42 - Sequencing and Cystectomy 37:03 - Financial and Time Toxicity 41:08 - Biomarkers and ctDNA 44:04 - Future Trials and NMIBC Innovations --- More about this episode They also review emerging therapies such as ZUSDURI, the evolving role of intravesical treatments, and the promise of biomarkers and ctDNA for personalized care. The discussion covers practical strategies for patient counseling, key updates to clinical guidelines, and a preview of innovations shaping the future of NMIBC management. --- Resources Active Surveillance Versus Intravesical Bacillus Calmette-Guérin for High-grade T1 Bladder Cancer with Negative Second Transurethral Resection: The Randomized Noninferiority Phase 3 JCOG1019 Trial: https://pubmed.ncbi.nlm.nih.gov/41571573/ Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non–Muscle-Invasive Bladder Cancer https://ascopubs.org/doi/10.1200/JCO-25-01324 CIRCULATING TUMOR DNA AS A BIOMARKER FOR UPSTAGING AND ADVERSE PATHOLOGY IN HIGH-RISK NON–MUSCLE-INVASIVE BLADDER CANCER: https://www.auajournals.org/doi/abs/10.1097/01.JU.0001191388.74345.c9.09 Preoperative Circulating Tumor DNA Predicts Upstaging and Recurrence in High-Risk Nonmuscle-Invasive Bladder Cancer Undergoing Radical Cystectomy https://pubmed.ncbi.nlm.nih.gov/41843048/ --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 64 Evolving Perioperative Management Strategies for Gastric & GE Junction Cancers with Dr. Michael Gibson

Is personalized, surgery-sparing treatment becoming a reality for patients with gastric adenocarcinoma? In this episode of BackTable Tumor Board, Dr. Eric Lander and Dr. Michael Gibson break down the rapidly changing landscape of treatment for resectable gastric and gastroesophageal junction adenocarcinoma. They trace the evolution from surgery as the standard, through difficult postoperative chemoradiation and perioperative chemotherapy (MAGIC, FLOT4), to the new strategies that are moving beyond traditional chemoradiation in the wake of the ESOPEC trial. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by AstraZeneca https://www.astrazeneca.com/our-therapy-areas/oncology/gastrointestinal-cancer.html --- Timestamps 00:00 - Introduction 09:41 - FLOT Becomes Standard 19:54 - Keynote 585 and Matterhorn 28:35 - Managing DFL Toxicity 35:10 - Path CR and Deescalation 38:46 - Future Directions and Organ Preservation --- More about this episode The conversation highlights the Matterhorn trial’s positive results with durvalumab added to perioperative FLOT, including manageable toxicity and benefits seen across PD-L1 expression levels. Lander and Gibson share practical management tips for patients who cannot tolerate FLOT, staging nuances like selective diagnostic laparoscopy, and future directions such as targeted therapy combinations, total neoadjuvant approaches, ctDNA-guided de-escalation, and organ preservation for MSI-high disease. --- Resources Matterhorn Trial https://www.nejm.org/doi/abs/10.1056/NEJMoa2503701 ESOPEC Study https://www.nejm.org/doi/abs/10.1056/NEJMoa2409408 CheckMate 577 https://www.nejm.org/doi/full/10.1056/NEJMoa2032125 --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 63 Launching Co-Managed APP/MD Clinics for Bladder Cancer with Dr. Amy Luckenbaugh and Meredith Donahue DNP

Are traditional bladder cancer care models falling behind as new therapies flood the field and reshape the landscape? In this episode of BackTable Urology, Dr. Bogdana Schmidt talks with Dr. Amy Luckenbaugh and DNP/APP Meredith Donahue about building a co-managed intravesical therapy clinic that rethinks care for patients with non–muscle invasive bladder cancer (NMIBC). With innovative agents increasing patient volume and complexity, the team discusses adapting care models to new realities. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Johnson & Johnson. --- Timestamps 00:00 - Why Clinic Models Need to Change Now 04:03 - Overcoming Financial and J-Code Hurdles 11:04 - High Volume Workflow 14:10 - Pharmacy Coordination And Timing 19:02 - Proactive Lower Urinary Tract SYmptom Management 22:25 - Handling Difficult Catheters 32:08 - Defining Clinic Success --- More about this episode The conversation covers prioritizing clinical trials, managing operational challenges such as prior authorizations and billing hurdles, and the importance of pharmacy coordination and predictable clinic workflows. Donahue describes a high-efficiency installation day model managing up to 50 patients a week with specialized staff, real-time decisions, and tailored logistics for therapies like Adstiladrin. They also discuss symptom prevention, patient triage, and clinic success measures including therapy availability, patient satisfaction, and opportunities to preserve bladder function. --- Resources Gemcitabine IDRS Drug Delivery Trial https://ascopubs.org/doi/10.1200/JCO.2026.44.7_suppl.635 BCG-IO Combination Trial https://www.astrazeneca.com/media-centre/press-releases/2026/imfinzi-approved-in-us-for-early-bladder-cancer.html --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app