Dr. Amanda Nizam

I am Amanda Nizam.

I'm a GU medical oncologist at Cleveland Clinic, where we have much more snow and frigid temperatures than Boston, surprisingly.

In the muscle invasive setting?

Yeah, so T2N0, you know, we explain it.

I show them a diagram of the bladder and the layers of the, you know, superficial layers and the detrusor muscle layer, the perivascular fat.

So I explain it that way.

And then I also kind of, when I talk to them about perioperative therapy, I talk to them and kind of use the analogy of a weed killer because we're not just treating only to shrink the tumor.

We're also treating micrometastatic disease.

We know that bladder cancer is a systemic disease.

But when it is confined to the bladder, then we do discuss that the goal is to cure and that we use not only imaging as surveillance to assess our treatment outcomes, but also ctDNA as a prognostic marker, which we've seen from the early Niagara data, ctDNA that was presented earlier this year.

And then also Invigor also showed us that those patients with ctDNA-positive disease

benefited from adjuvant therapy, whereas those who remained negative after cystectomy, almost all of the patients remained without disease recurrence even at two years.

So that's how I discuss it.

The ctDNA data, we're still ironing out quite a bit, especially we're awaiting that from the EV community.

and PEMBRO perioperative trial to see if that data aligns with what we saw with the Niagara data.

But even in the Niagara data, we did see that patients with negative ctDNA did still benefit from the perioperative approach, whether that was from the neoadjuvant component or the adjuvant component, that's to be determined.

These are the questions that are going to plague our field right now.

And when we talk about precision medicine and bladder cancer, especially in the perioperative setting, the focus really, I think all of us could probably agree that people benefit from neoadjuvant systemic chemoimmunotherapy.

But who really needs adjuvant therapy?

We need to really refine how we give adjuvant therapy to patients.