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Ideas collide, big coffee gathers to talk about hot spots The Chinese edition of NCCN's "Bladder Cancer" was released

 Last Update: 2023-02-01
 Source: Internet
 Author: User

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Recently, the release of the Chinese version of the NCCN "Bladder Cancer" guidelines was successfully held
in the cloud.
Professor Guo Jun of Peking University Cancer Hospital and Professor He Zhisong of Peking University First Hospital led a number of experts in the field of bladder cancer to gather in the cloud to bring the interpretation of NCCN guidelines, as well as wonderful comments and discussions
.

At the beginning of Professor Guo Jun's meeting, Professor Guo Jun said in his speech that the NCCN guidelines are international authoritative guidelines, updated quickly, containing the latest progress and evidence-based medical evidence, and the evidence level requirements are strict, which has a certain guiding role
in China's clinical work.
The CSCO Guidelines are authoritative guidelines that combine China's national conditions and are superior to the NCCN Guidelines in some aspects, but the CSCO Guidelines have been published for a relatively short time, and it is still necessary to learn
from the NCCN Guidelines.
Professor Guo Jun said that young talents in the field of bladder cancer have worked hard in the compilation of the NCCN Chinese version of the guidelines for bladder cancer, and experts in the field of bladder cancer were invited to interpret the NCCN guidelines and discuss hot issues, and I believe that the NCCN Chinese guidelines will play a good guiding role
for Chinese clinicians and even grassroots clinicians.

First link

Leading the frontier, big coffee gathered to interpret the new progress of NCCN

Professor
Cui Chuanliang's first session was chaired
by Professor Cui Chuanliang from Peking University Cancer Hospital.

Xin Jiangtao, Vice President of Yimaitong

Mr.
Xin Jiangtao, Vice President of Yimaitong, shared the Chinese version of the NCCN guidelines for clinicians
.
Mr.
Xin said that in June 2022, Yimaitong and NCCN officially launched a strategic cooperation, which is the first cooperation between NCCN and China's Internet Doctor Platform, and the two parties will cooperate
in many aspects such as downloading, Chinese editions, interpretation of guidelines and lectures in China.
At present, Yimaitong has invited a number of Chinese expert teams in various fields of oncology to be responsible for the main translation of NCCN Chinese
editions.
In the future, the rich experience of CSCO guidelines will be applied to the tour and interpretation
of NCCN guidelines.
In addition, the NCCN Guidelines Zone also includes all the contents of the English and Chinese versions of the NCCN Guidelines (83 professional guides, 62 patient guides), all of which provide free download services, in order to better serve Chinese doctors, the clinical guidelines of Yimaitong continuously optimize the APP function
from structured search, multi-dimensional screening, translation and other aspects.
Mr.
Xin pointed out that Yimaitong has reached in-depth cooperation with NCCN, Chinese Medical Association Guide, Wanfang Medical Database and other platforms, and will continue to expand strategic partners in the future to provide more comprehensive genuine guidelines
for Chinese doctors.

Professor
Zhou Li of Peking University Cancer Hospital believes that the guidelines are constantly updated on the basis of high-level evidence-based medicine, and there are countless failed clinical studies behind it, and some drugs can be quickly marketed through single-arm research, but confirmatory studies
are still needed 。 Professor Zhou Li interpreted the NCCN
guidelines for bladder cancer from the treatment of muscle-invasive bladder cancer (MIBC), neoadjuvant/adjuvant therapy for urothelial carcinoma (UC), and the treatment of locally advanced or metastatic UC.
Professor Zhou Li pointed out that immune-based neoadjuvant strategies and bladder-preserving comprehensive treatment regimens are the current research hotspots, but high-level evidence-based medical evidence
is still needed before the inclusion guidelines.
For MIBC (cT2N0M0), the main treatment strategy is still cisplatin-based neoadjuvant chemotherapy + radical cystectomy (RC), surgery alone, and bladder-sparing concurrent chemoradiotherapy
.
In the field of neoadjuvant/adjuvant therapy, studies such as CheckMate274, IMvigor010, POUT, EV303, EV304 and other studies have shown the potential and advantages of novel therapies, and some studies may change clinical practice
.
For the treatment of advanced diseases, Professor Zhou Li reviewed the key research evidence corresponding to immune and targeted treatment regimens and pointed out that immunotherapy has entered various treatment lines, but more evidence and exploration
are still needed.

Interviews with famous people

Professor He Zhisong's first session was moderated by Professor He Zhisong, and Professor Wei Qiang from West China Hospital of Sichuan University and Professor
Zhang Aili from the Fourth Hospital of Hebei Medical University were invited as panelists
.

Discussion Topics:

1.
What are the current clinical studies in the field of MIBC that may change the guidelines?

2.
How do you view some drugs being marketed or recommended by guidelines through single-arm clinical studies?

Professor Wei Qiang, who interviewed

famous experts in the first session, pointed out that it is of great significance for NCCN guidelines to officially enter China, and it is also of great significance for Yimaitong to use the online platform to serve Chinese doctors Chinese version of
NCCN.
Second, in the future, it is hoped that China's research data will be more included in the NCCN guidelines
.
Third, when NCCN guidelines and CSCO guidelines coexist, how to make use of the advantages of each guideline is a question
worth exploring.
Professor Wei Qiang is cautious about "getting market through single-arm studies", pointing out that most single-arm studies have insufficient evidence to change clinical guidelines and need to be supported
by higher-level evidence.
Professor Zhang Aili pointed out that the NCCN guidelines are updated quickly, and there is also a lot of uncertainty
in the use of immunization regimens in neoadjuvant/adjuvant therapy.
The chemotherapy regimen with high evidence-based medical evidence is still the first choice at present, which is worthy of clinical reference
.
Immunotherapy and antibody drug conjugates (ADCs) are still the direction of continued exploration and development in the future, and we are looking forward to the clinical research data
of Chinese scholars.
Professor Ho Zhisong believes that many clinical studies may not be successful, and successful clinical research implementation has certain limitations
.
High-level research evidence is expected to support the use of clinical practice, but individual single-arm studies are not excluded as guiding clinical use
.

The second part

Compatible with medicine and surgery, big coffee discussed the future development of bladder cancer

Professor Du Peng's second session was chaired by Professor
Du Peng of Peking University Cancer Hospital
.
Professor Ni Xiaochen and Professor
Ni Xiaochen of the Fourth Hospital of Hebei Medical University shared the current status of immunotherapy for urinary tumors and the latest progress
of tislelizumab in urology-related fields.
Professor Ni Xiaochen pointed out that immunotherapy has brought epoch-making breakthroughs to patients with urine tumors and changed the treatment pattern of UC and renal cell carcinoma (RCC): it not only improves the response rate, but also benefits the long-term survival of patients
.
Tislelizumab leads the clinical practice of urologic tumor immunotherapy in China, and as the first PD-1 monoclonal antibody approved for UC indications in China, it has been included in the national medical insurance and has higher
patient accessibility.
Professor Ni Xiaochen interpreted the research evidence
related to the guideline recommendations.
RATIONALE 204 SHOWED THAT WHEN TISLELIZUMAB WAS USED IN SECOND-LINE TREATMENT OF ADVANCED UC, THE ORR REACHED 24%, AND COMPLETE REMISSION (CR)
WAS ACHIEVED IN 10% OF PATIENTS.
BGB-A317-2002 showed that tislelizumab combined with GC regimen for MIBC neoadjuvant therapy had a pathopathologically complete response (pCR) rate of 54.
2% and a stage reduction rate of up to 75%.

TRUCE-01 showed that tislelizumab combined with albumin paclitaxel was used for neoadjuvant therapy with a pCR rate of 53.
3%.

TRUCE-02 showed that tislelizumab in combination with albumin paclitaxel was used in high-risk non-muscle-invasive bladder cancer (NMIBC) with a CR rate of 55%.

Professor Ni Xiaochen pointed out that tislelizumab has deep remission and benefits across the board, and has taken the lead in exploring the whole process of UC disease and achieved positive results
.
Professor
Zhang Peng of West China Hospital of Sichuan University interpreted the exploration
of China's bladder protection strategy in the era of immunotherapy from four aspects: current situation, bladder preservation strategy, Chinese characteristic bladder preservation strategy, and comprehensive treatment.
Professor Zhang Peng pointed out that bladder-preserving comprehensive therapy is an optional treatment option for patients with locally advanced MIBC and high-risk NMIBC, and a number of studies have shown that the efficacy of bladder-preserving strategies is comparable to RC, and can bring patients a higher quality of life, and has been recommended
by a number of authoritative guidelines.
Immunotherapy has opened up a new situation for comprehensive bladder preservation treatment, and the bladder preservation strategy with Chinese characteristics has been innovative, and a number of research results have been announced in the international arena, among which the combination therapy regimen of tislelizumab has achieved encouraging results
in the exploration of MIBC and NMIBC patients in China.
Professor Zhang Peng believes that in the context of the MDT model, further optimization and standardization of comprehensive treatment strategies, including joint programs, population screening, efficient multidisciplinary cooperation, and better whole-process management, are all directions
worth exploring and discussing.

Interviews with famous people

Professor Sheng Xinan was hosted by Professor Sheng Xinan of Peking University Cancer Hospital, and Professor Cui Xin of Xuanwu Hospital of Capital Medical University, Professor Mu Dawei of the Air Force Characteristic Medical Center of the People's Liberation Army Chinese People's Liberation Army and Professor Zhang Cuijian
of Peking University First Hospital were invited as panelists
.

Discussion Topics:

1.
What are the advantages and prospects of immunotherapy for bladder protection?

2.
What is the experience and experience of tislelizumab in bladder-preserving treatment?

In the second session, Professor Cui Xin pointed
out that overall, the bladder preservation strategy is a very promising solution
.
The addition of immunotherapy to neoadjuvant therapy has achieved a good CR rate, which has created good biological conditions for bladder-preserving strategies, and triple therapy (TMT) is the preferred mode of bladder-preserving strategies, but the choice of bladder-preserving strategies and RC is still controversial
.
Studies conducted by Chinese scholars have found that neoadjuvant immunization combination strategies provide feasibility for better selection of bladder-sparing populations, and although there are many difficulties, bladder-preserving strategies still need a higher level of evidence-based evidence
.
Professor Mu Dawei pointed out that a study presented at the 2022 ASCO Conference showed that the 5-year survival data of bladder preservation strategy and RC were comparable and tended towards TMT strategy
.
From the research data, it can be seen that the bladder-preserving population needs to be screened: there are more patients in T2 stage, no hydronephrosis, no multiple carcinoma in situ, single lesions, etc.
, in addition to considering bladder function, capacity and other issues
.
In clinical work, we should change our thinking and effectively implement RC treatment
for high-risk patients.
Professor Zhang Cuijian pointed out that with the continuous emergence of new drugs and the improvement of patient demand, bladder-preserving treatment has become a trend, and the quality of life is better, but the population
needs to be screened.
Bladder-sparing treatment should strictly control the indications, including bilateral ureteral orifice and internal urethral orifice without tumor invasion, tumor cannot be widely distributed, staging ≤ T3a, etc
.
Professor Zhang Cuijian shared the clinical experience of bladder-preserving strategies and pointed out that bladder-preserving treatment is very promising and is a future development trend
.
Professor Sheng Xinan believes that the current problem of bladder-preserving treatment is the lack of high-level evidence-based medical evidence, and bladder-preserving treatment is still being explored, and more clinical research is needed to explore appropriate models
.

Summary of the conference

Professor He Zhisong concluded that we have CSCO guidelines, and NCCN is also a classic and authoritative guide, which can be easily downloaded from various guidelines (including NCCN guidelines) on the Yimaitong platform, which provides a good tool
for clinicians in the field of oncology in China.
The exploration of tislelizumab and other drugs in the field of bladder cancer also suggests that bladder cancer treatment has entered the era of immunotherapy and targeted chemotherapy or precision chemotherapy from the era of chemotherapy
.
At this stage, clinical practice cannot be separated from surgery, and internal medicine and surgery are closely integrated as a whole, and appropriate treatment should be given to suitable patients
.
Professor Ho Zhisong believes that the NCCN guidelines are updated quickly, several times in one year, keeping up with the latest progress, and from this point of view, the NCCN guidelines perform the best
.

Professor Guo Jun concluded that from the progress of systemic treatment and the continuous enrichment of powerful means, due to the superior efficacy, the scope of cystectomy "needs to be expanded" is also constantly improving and accurate, and under the same efficacy and benefit, we will choose to protect the bladder, which has a greater
impact on the quality of life of patients.
Based on the rapid development of ADC drugs and immunotherapy, in the future, bladder cancer surgery must be more delicate, accurate and reasonable
.
From the evidence from the included research of the guidelines, the CSCO guidelines are more grounded and can directly guide clinical practice
in China.
In general, the CSCO and NCCN guidelines have their own merits and learn from each other, and will provide guidance
for further improving the quality of clinical research for Chinese scholars in the future.

Editor: Yuna

Typesetting: Yuna

Execution: Rudolf

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