title: Definitive Management of Primary Bladder Tumors in the Context of Metastatic Disease: Who, How, When, and Why?
abstract: The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 70-year-old man with urothelial cancer of the bladder (UBC) metastatic to the pelvic and retroperitoneal lymph nodes was treated with gemcitabine plus cisplatin, but after two cycles neutropenic sepsis developed, which required a prolonged intensive care unit admission. Upon recovery, repeat imaging studies revealed progressive pelvic and retroperitoneal lymphadenopathy, and the patient enrolled in a clinical trial that evaluated treatment with an anti-PD-L1 antibody. The patient achieved a complete radiographic response to immune checkpoint blockade, which continued for 18 months after initiating therapy ( Fig 1 ). However, at that time, a cystoscopy of his primary tumor and a transurethral resection revealed residual muscle-invasive UBC. The patient asked whether there is any role for definitive local therapy of his primary bladder tumor with radical cystectomy or radiation.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Galsky
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Josep
authors.initials: J
authors.lastname: Domingo-Domenech
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: John P
authors.initials: JP
authors.lastname: Sfakianos
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Bart S
authors.initials: BS
authors.lastname: Ferket
mesh_terms: D000368:Aged; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D060890:B7-H1 Antigen / Q000037:antagonists & inhibitors; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D010388:Pelvis; D011878:Radiotherapy; D012187:Retroperitoneal Space; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D000093542:Gemcitabine
chemical_list: D060890:B7-H1 Antigen; C423236:CD274 protein, human; D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine