Immunotherapy in Renal Cell Carcinoma.

There have been tremendous advancements in immunotherapy approaches for patients with renal cell carcinoma (RCC) from the initial interleukin-2 era to the current immune checkpoint inhibitor (ICI) combinations. Several ICI-based therapies have greatly improved outcomes for patients with RCC with the potential for durable responses for a subset of patients. In this chapter, we review the data of key frontline ICI-based combinations for RCC in the metastatic setting and recent data on adjuvant immunotherapy.

Clinical and Pathological Predictors for Occult Lymph Node Involvement in Patients With Clinical Node-Negative Bladder Cancer Undergoing Radical Cystectomy.

Background: Occult pathological lymph node involvement in patients with clinical node-negative (cN0) bladder cancer (BC) remains a diagnostic challenge. We evaluate predictors of lymph node positivity (pN+) in patients with cT1-4N0M0 BC undergoing radical cystectomy and pelvic lymph node dissection (RC-PLND).

Methods: We included patients with cT1-4N0M0 BC undergoing RC-PLND from February 2004 through October 2020.

Urothelial carcinoma: Perioperative considerations from top to bottom.

Urothelial carcinoma is an aggressive entity that is associated with significant morbidity, but there have been major advances in both our understanding of and treatment options for patients with this disease. In this review, the authors focus on novel therapeutic and diagnostic approaches in the perioperative setting, with an emphasis on patient-centered and individualized care. For urothelial carcinoma of the bladder (UCB), advances in nonplatinum-based therapies, specifically immunotherapy and antibody-drug conjugates, have expanded the therapeutic arsenal for patients with muscle-invasive UCB in both the neoadjuvant and adjuvant settings to improve survival outcomes.

Beyond Citations: Exploring Gender and Racial Gaps in Urology Publications Through Citation and Altmetric Analysis.

Objective: To examine the effects of author gender and race on citation metrics, including Altmetric Attention Scores (AAS), in urology publications.

Methods: We analyzed 91,100 urology publications published between 2009 and 2023, retrieved from the Altmetric database via Drexel University. Author gender was identified using GenderGuesser, and race was estimated using a published name-based algorithm.

Trends in Surgical Overtreatment of Prostate Cancer.

Importance: Overtreatment of prostate cancer is a public health concern that undermines prostate cancer screening efforts.

Objective: To assess trends in pathologic grade on prostatectomy during the past 2 decades as a surrogate for overtreatment.

Design, Setting, And Participants: This retrospective cohort study examined the grade of prostate cancer on final pathology reports among patients undergoing prostatectomy between January 1, 2010, and September 1, 2024, in 2 parallel cohorts: Surveillance, Epidemiology, and End Results (SEER), a nationwide cancer registry, and Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide clinical registry.

Perioperative outcomes using template mapping after radical cystectomy and extended lymph node dissection.

Background: To evaluate oncologic and perioperative outcomes of extended pelvic lymph node dissection (PLND) during robot-assisted radical cystectomy (RARC) based on the location of lymph node positivity (LN).

Methods: We reviewed a tertiary center database of patients with bladder cancer who underwent extended PLND during RARC from 2004 to 2020. Patients were assigned to a standard (sPLN) or extended (ePLN) cohort based on LN location.

Comparative Genomic Characterization of Small Cell Carcinoma of the Bladder Compared With Urothelial Carcinoma and Small Cell Lung Carcinoma.

Purpose: Small cell bladder cancer (SCBC) is a rare histologic variant of bladder cancer with an aggressive disease course and poor outcomes. Given its uncommon nature, there is a paucity of high-quality data characterizing genomic drivers of this disease, and most patients are treated with approaches mirroring small cell lung cancer (SCLC). Leveraging the Tempus Lens deidentified clinically annotated genomic data set, we sought to evaluate the mutational landscape of SCBC relative to urothelial carcinoma (UC) and SCLC.

Treatment and Attrition Trends for Metastatic Clear Cell Renal Cell Carcinoma in the US.

Importance: The treatment landscape of metastatic clear cell renal cell carcinoma (ccRCC) has rapidly evolved with the approval of multiple immune checkpoint inhibitor (ICI)-based combinations. However, clinical data on changes in treatment patterns and attrition before and after ICI-based combinations approval are lacking.

Objective: To assess treatment patterns and attrition rates in patients with metastatic ccRCC before and after the approval of ICI-based combinations.

Clinical Implications of the Molecular and Genomic Landscape of Upper Tract Urothelial Carcinoma.

Purpose Of Review: Upper tract urothelial carcinoma (UTUC) is an aggressive entity with treatment strategies mirroring bladder cancer. Genomic and molecular profiling allows for a better characterization of this disease and allows for patient-tailored approaches. We aim to describe the genomic and molecular implications of this disease.

The gut microbiome and dietary metabolites in the treatment of renal cell carcinoma.

The gut microbiome is interlinked with renal cell carcinoma (RCC) and its response to systemic treatment. Mounting data suggests that certain elements of the gut microbiome may correlate with improved outcomes. New generation sequencing techniques and advanced bioinformatic data curation are accelerating the investigation of specific markers and metabolites that could predict treatment response.

Antibody-drug conjugates in solid tumors: a new frontier.

Purpose Of Review: Antibody-drug conjugates (ADCs) are designed to carry cytotoxic payloads and deliver them to specific molecular targets within tumor cells. Several ADCs are already approved with many more in development across several disease types. In this review, we will provide an overview of the ADCs currently approved and those under investigation in solid tumors.

Cabozantinib and nivolumab with or without live bacterial supplementation in metastatic renal cell carcinoma: a randomized phase 1 trial.

Supplementation with CBM588, a bifidogenic live bacterial product, has been associated with improved clinical outcomes in persons with metastatic renal cell carcinoma (mRCC) receiving nivolumab and ipilimumab. However, its effect on those receiving tyrosine kinase inhibitor-based combinations is unknown. In this open-label, randomized, investigator-initiated, phase 1 study, 30 participants with locally advanced or mRCC with histological confirmation of clear cell, papillary or sarcomatoid component were randomized in a 2:1 fashion to receive cabozantinib (an inhibitor of vascular endothelial growth factor receptor, MET and AXL) and nivolumab (anti-programmed cell death protein 1) with or without CBM588 as first-line treatment.

De-escalating treatment indications for patients who achieve metabolic goals.

Introduction: Robust evidence exists regarding initiation, intensification or modification of treatments. Recommendations to de-escalate therapy are lacking, specifically in diabetes. A successful treatment de-intensification reduces overtreatment, polypharmacy, and risk of adverse effects.