Explorer | open up the road: "special" is not alone, the first CACA urothelial cancer integrated diagnosis and treatment guide national tour was successfully held!

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On August 26, 2022, the special edition of the academic interview column of "Secreta Seeker" initiated by Junshi Biotech, together with the big coffee in the field of urology, held the country's first lecture tour on the first "CACA Guidelines for the Integrated Diagnosis and Treatment of Urinary Urothelial Cancer", which discussed the clinical treatment progress and cutting-edge academic dynamics of urinary urothelial carcinoma (UC), and exchanged and shared clinical practical experience

At the beginning of the conference, Professor Yao Xin pointed out in his opening speech that in order to improve the level of clinical diagnosis and treatment as soon as possible and benefit the majority of patients, the Chinese Anti-Cancer Association organized a number of authoritative experts, which lasted more than 1 year, and collectively completed the first "China Cancer Integrated Diagnosis and Treatment Guidelines (CACA)"

Session 1 – Strive for Excellence

2022 EDITION OF THE CACA Guidelines for Urinary Urothelial Carcinoma Drug Treatment Guide

Professor Shen Yijun of the Affiliated Cancer Hospital of Fudan University shared that the second-line treatment of advanced UC is mainly based on immunotherapy drugs such as triprimumab, and targeted therapy, immunotherapy, antibody conjugated drugs (ADCs) have gradually risen strongly in the treatment, opening a new era of advanced UC therapy and contributing to improving the survival rate of

A master's perspective

Professor He Chaohong of Henan Provincial Cancer Hospital, Professor Liu Nan of the Affiliated Cancer Hospital of Chongqing University, and Professor Zhang Xinwei of the Cancer Hospital of Tianjin Medical University pointed out that with the publication of various immune checkpoint inhibitor (ICI) single-drug studies, immunotherapy has become the second-line standard treatment

2022 EDITION OF THE CACA Guidelines for Urothelial Carcinoma Surgical Treatment

Professor Chen Xusheng of Tianjin Medical University Cancer Hospital explained
how to achieve long-term survival of UC patients through standardized surgery, and how to preserve the bladder and improve the quality of life of patients through multidisciplinary integrated diagnosis and treatment.

A master's perspective

Professor Cui Zhe of Tianjin Medical University General Hospital, Professor Hu Bin of Liaoning Provincial Cancer Hospital, and Professor Zhang Qifu of Jilin Provincial Cancer Hospital discussed
the application of immunotherapy in the perioperative period.
Since it is difficult to achieve the ideal effect of bladder preservation by a single treatment method, the current treatment of bladder preservation mostly uses a triple therapy of surgery, chemotherapy and radiotherapy
.
Among them, immunotherapy has excelled in neoadjuvant therapy for muscle invasive bladder cancer (MIBC), improving tumor withdrawal rates, maximizing patient survival, and bringing hope
for more MIBC patients to preserve the bladder.

Session 2 – The bladder illuminates the future

Guidelines updated intensively read UTUC treatment strategies

Professor Chen Zhiwen of southwest hospital of the Army Military Medical University interpreted the standardized diagnosis and treatment of upper urinary tract urothelial carcinoma (UTUC), and gave a wonderful explanation
of UTUC kidney protection strategy, how perioperative tumors can improve the specific survival rate through integrated medical treatment.

A master's perspective

Professor Bian Jiasheng of Shandong Cancer Hospital, Professor Qiu Jianhong of the 980th Hospital of the Plast People's Liberation Army Joint Logistics Support Force, and Professor Zhang Chao of the Cancer Hospital of Tianjin Medical University believe that the development process of UTUC is complex, the degree of malignancy is higher, the prognosis is worse, and there are huge challenges
in clinical diagnosis and treatment.
There is no doubt that the treatment of UTUC is mainly surgical treatment, and the current neoadjuvant therapy such as chemotherapy and immunotherapy has been widely carried out in patients who are intolerant to gemcitabine + cisplatin (GC) regimen and renal insufficiency, bringing better survival benefits
to patients.
Therefore, through perioperative systemic therapy combined with local therapy, kidney preservation can gradually become possible
.

The guide updates the UC Research Direction Outlook for Intensive Reading

Professor Fan Jinhai of the First Affiliated Hospital of Xi'an Jiaotong University believes that with the advent of drugs such as ICI and ADC, the pattern
of advanced UC system treatment has been broken.
At the same time, integrated medicine will maximize the coordination of local treatment, systematic treatment, prevention and rehabilitation, so as to maximize the promotion of UC diagnosis and treatment to a new height
.

A master's perspective

Professor Hu Hailong of the Second Hospital of Tianjin Medical University, Professor Liu Qian of the First Central Hospital of Tianjin, and Professor Nie Qingsheng of Zibo Central Hospital mentioned that the clinical treatment of UC still faces many problems, such as many patients who are psychologically difficult to accept radical cystectomy (RC), and some patients are intolerant of platinum chemotherapy toxicity
.
A growing body of research suggests that immunotherapy offers new treatment options
for patients with advanced UC.
They also stressed that in the future, the UC treatment field can adopt the MDT to HIM model, carefully select a more accurate patient group, formulate an individualized integrated diagnosis and treatment plan, and ultimately achieve the optimal treatment effect
.

Session 3 – Unity of Knowledge and Action

MiBC perioperative case sharing under the guidance of the 2022 edition of the CACA guidelines

Professor Zhang Zhenting of Tianjin Medical University Cancer Hospital shared a perioperative case
of MIBC.
The patient was old, had thick visceral fat, poor kidney function, difficult surgery, and could not tolerate cisplatin-based chemotherapy, but the patient was extremely willing
to retain the bladder.
The patient was discussed with immune combination bladder preservation triple therapy (TMT
).
At present, the patient's condition and quality of life have been comprehensively improved
.
Professor Zhang introduced that the good efficacy
of immunotherapy on PATIENTS with MIBC can be seen from the treatment results of this case or the clinical study of immuno-neoadjuvant chemotherapy.
The results of the RJBLC-I2N003 study showed that the first 4 courses of terepliumab monotherapy achieved 40% complete pathological remission (pCR) and ORR was as high as 70%, and the tolerability and safety were good
.
At the same time, Professor Zhang pointed out that the "immunotherapy + surgery + radiotherapy + perfusion + immune maintenance" five-fold preservation bladder therapy provides a feasible solution
for patients who are not suitable/unwilling to undergo chemotherapy and total cystectomy.

Big coffee rounds

Professor Chen Fangmin of Tianjin Third Central Hospital, Professor Zhang Zhihong of the Second Hospital of Tianjin Medical University, and Professor Vasilijiang of the Cancer Hospital of the Chinese Academy of Medical Sciences said that for clinicians, it has always been a controversial topic
for MIBC patients to choose RC or TMT treatment.
Among MIBC's bladder-sparing treatments, TMT is the most evidence-based bladder-sparing treatment option at this stage
.
For patients who are not suitable or refuse to do RC, TMT balances tumor control with quality of life
to some extent.
It is worth noting that immunotherapy combined with TMT can bring considerable pT0 rates and denting rates to PATIENTS with MIBC
.
At the same time, they also pointed out that bladder protection therapy faces many challenges in clinical practice, such as the cost-to-effect ratio
.

Interpretation of advanced UC cases under the guidance of the 2022 edition of the CACA guidelines

Professor Yuan Fang of the Affiliated Cancer Hospital of Chongqing University conducted a case interpretation
of a patient with advanced UC.
The patient was initially diagnosed with left ureteral urothelial carcinoma with hepatic and lymph node metastases (cT4N1M1 stage IV), and his condition was more severe and generally poor
.
The patient went through 7 treatment stages, and systemic lesions were effective, but local progression continued
.
Professor Yuan said that after the last stage of local hypochondria radiotherapy, terreprimumab + GC therapy and chemotherapy for 2 cycles, some of the patient's lesions were reduced compared with before, and the disease situation was alleviated
.
He concluded that UTUC progresses rapidly, is highly concealed, clinical treatment is more difficult, and ICI has become an important treatment for
advanced UTUC.
At the same time, the choice of different ICI combination chemotherapy regimens and specific timing is more critical
.

Big coffee rounds

Professor Hu Gao of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology and Professor Xie Yu of Hunan Provincial Cancer Hospital said that from the existing evidence-based evidence, systemic chemotherapy (such as GC regimen) is still the choice of advanced UTUC first-line treatment, but ORR is only about 40%, and there are still 60% of patients with limited treatment benefits, so improving patient quality of life and prolonging survival has become the core of
clinical treatment.
The UTUC population is unique in terms of pathogenic factors and genes, and immunotherapy brings new opportunities
for patients with advanced UTUC.

Summary of the Conference

In the warm and cutting-edge collision of ideas, the meeting is gradually approaching the end, and everyone is still unfinished
.
At the end of the meeting, Professor Yao Xin, chairman of the conference, summarized that this meeting was the first session of the national tour of the "CACA Urothelial Cancer Integrated Diagnosis and Treatment Guidelines", and a number of experts published academic insights on UC diagnosis and treatment based on their clinical experience, and also provided many feasible suggestions for the CACA guidelines, and through the last 2 cases, urologists triggered deeper thinking
around the examples of clinical diagnosis and treatment in China.
Special thanks would be given to the Chairing Professor and the Professor who guided the meeting for their efforts
throughout the session.
At the same time, I am also very grateful to Junshi Bio for its full support
for this conference.
With a rock in mind, we continue to explore and optimize the treatment plan in a targeted manner, and use the "China Plan" to benefit the majority of UC people
.