Accreditation/Credit Designation

Physicians' Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physicians' Education Resource®, LLC, designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Acknowledgment of Commercial Support

This activity is supported by educational grants from Astellas and Seattle Genetics, Genentech, and Merck Sharp & Dohme Corp.

Community Practice Connections™: Shifting Paradigms in Bladder Cancer: How Immunotherapeutic Strategies Are Changing Courses of Care


Release Date: April 30, 2019
Expiration Date: April 30, 2020
Media: Internet - based

Activity Overview

Until recently, there had been little progress to improve outcomes in the setting of advanced bladder cancer. However, the emergence of immunotherapy (IO) provides new therapeutic options for patients with bladder cancer. It is imperative that all members of the multidisciplinary care team understand both new data and best practices to integrate these newly available agents into patient care, including methods to proactively manage and mitigate immune-related adverse events. This online program is designed to address key questions related to the use of IO and provide you with cutting-edge, practical guidance that can be applied immediately to your clinical practices.

This case-based educational activity features video interviews with renowned experts in bladder cancer who share their perspectives on evidence-based, state-of-the-art use of IO strategies designed to meet the specific needs of urologists and oncologists who treat patients with genitourinary (GU) cancers. Throughout the activity, the faculty lead participants through an in-depth exploration of the latest data and their clinical implications.

Continuing Medical Education (CME) Activity Table of Contents

  • Pretest
  • Introduction
  • Current and Future Role of Immunotherapeutic (IO) Strategies for Nonmuscle-Invasive Bladder Cancers
  • Immunotherapeutic Strategies for Bladder Cancer Across Multiple Lines of Therapy: The Therapeutic Landscape in 2019
  • Clinical Applications of Established and Emerging Data From Bladder Cancer Clinical Trials
  • What’s Next for Nonresponders and Relapsed Patients? Promising Targeted Approaches
  • Key Takeaways
  • Posttest

Acknowledgement of Commercial Support

This activity is supported by educational grants from Astellas and Seattle Genetics, Genentech, and Merck Sharp & Dohme Corp.

Instructions for This Activity and Receiving Credit

  • You will need to log in to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review audio files/content until you finish the presentation.
  • At the end of the activity, educational content/audio files will be available for your reference.
  • In order to receive a CMEcertificate, you must complete the activity.
  • Complete the Posttest and pass with a score of 70% or higher, complete the Evaluation, and then click on “Request for Credit.” You may immediately download a CME certificate upon completion of these steps.


Target Audience

This educational program is directed toward oncologists, urologists, and researchers involved in the treatment of bladder cancers. Nurse practitioners, physician assistants, nurses, and other healthcare professionals interested in the treatment and management of patients with bladder cancers are also invited to participate.

Learning Objectives

Upon successful completion of this educational program, you should be better prepared to:

  • Explain the mechanistic rationale underlying the use of targeted and immunotherapeutic approaches to managing bladder cancer
  • Evaluate pivotal clinical trial results on immunotherapies and evidence concerning emerging biomarkers and combination strategies under evaluation for the treatment of bladder cancer
  • Consider practice-changing evidence in the context of multidisciplinary, team-based care approaches for patients with bladder cancer
  • Discuss strategies to monitor for, identify, and mitigate the impact of treatment-related toxicities that may occur in patients with bladder cancer

Faculty, Staff, and Planners’ Disclosures

Daniel P. Petrylak
Daniel P. Petrylak, MD
Professor of Medicine (Medical Oncology) and Urology
Director, Prostate and GU Medical Oncology
Director, Prostate Cancer Translational Research Group
Co-Director, Signal Transduction Research Program
Yale Cancer Center
New Haven, CT

Disclosures: Grant/Research Support: Ada Cap, Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Clovis, Eli Lilly, Endocyte, Genentech, Innocrin, MedImmune, Merck, Novartis, Pfizer, Progenics, Roche Laboratories, Sanofi-Aventis, Seattle Genetics; Consultant: Ada Cap, Amgen, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Clovis, Eli Lilly, Exelixis, Incyte, Janssen, Pfizer, Pharmacyclics, Roche Laboratories, Seattle Genetics, UroGen; Ownership interest/investment: Bellicum, Tyme.

Charles G. Drake
Charles G. Drake, MD, PhD
Professor of Oncology and Immunology
Director, Genitourinary Cancer Program
Co-Director, Immunotherapy Program
Herbert Irving Comprehensive Cancer Center
Columbia University Irving Medical Center
New York, NY

Disclosure: Consultant: AstraZeneca, MedImmune, Bristol-Myers Squibb, Compugen, Janssen, Merck, Pfizer, Pierre Fabre, Roche/Genentech; Other: Patents: Amplimmune, Bristol-Myers Squibb, Janssen; Other: Ownerships: Compugen, Kleo, Tizona.

Leonard G. Gomella
Leonard G. Gomella, MD, FACS
The Bernard W. Godwin, Jr. Professor of Prostate Cancer
Chairman, Department of Urology
Senior Director, Clinical Affairs, Sidney Kimmel Cancer Center
Clinical Director, Jefferson Sidney Kimmel Cancer Network
Thomas Jefferson University/Thomas Jefferson University Hospital
Editor-in-Chief, Canadian Journal of Urology International
Immediate Past-President, Society of Urologic Oncology
Philadelphia, PA

Disclosures: Consultant: Astellas/Pfizer, Clovis, Janssen, Merck, Strand Diagnostics; Other: Investigator: FKD-Oy.

Guru P. Sonpavde
Guru P. Sonpavde, MD
Director, Bladder Cancer
Dana-Farber Cancer Institute
Boston, MA

Disclosures: Grant/Research Support: AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Janssen, Merck, Pfizer, Sanofi; Consultant: Agensys/Astellas, Amgen, Argos, AstraZeneca, Bayer, Eisai, EMD Serono, Genentech, Janssen, Merck, Novartis, Pfizer, Sanofi; Other: steering committee for trials sponsored by AstraZeneca, Bavarian Nordic, Bristol-Myers Squibb, Astellas.

The staff of Physicians' Education Resource®, LLC (PER®), have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process

Off-Label Disclosure and Disclaimer

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic or treatment options for a specific patient’s medical condition.

The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.

PER Pulse™ Recaps

1 of 3
Insights from Leonard G. Gomella, MD, FACS—PER Pulse™ Recap:
Community Practice Connections®: Shifting Paradigms in Bladder Cancer: How Immunotherapeutic Strategies Are Changing Courses of Care

In the online continuing medical education–certified activity, Community Practice Connections®: Shifting Paradigms in Bladder Cancer: How Immunotherapeutic Strategies Are Changing Courses of Care, the expert faculty—Leonard G. Gomella, MD, FACS; Daniel Petrylak, MD; Charles Drake, MD, PhD; and Guru Sonpavde, MD—discuss recent clinical advances, ongoing clinical trials, and the outlook of immunotherapy for the treatment of both nonmuscle-invasive (NMIBC) and muscle invasive bladder cancer, including newly diagnosed, nonresponsive, and relapsed disease.

This first of 3 PER Pulse™ Recaps summarizing the online program focuses on the current and future roles of immunotherapeutic strategies for NMIBC. Below are some highlights of content covered in the activity by Dr Gomella:

  • Overview of how NMIBC is diagnosed and staged
  • The current standard of care, intravesical bacillus Calmette-Guérin (BCG), including its initial management and use in patients with nonresponsive or refractory disease
  • Insight on guideline-recommended treatment options for patients with NMIBC, including perioperative therapy, adjuvant therapy, and relapse and salvage therapies
  • Discussion of ongoing clinical trials of single-agent and combination immune checkpoint inhibitors for the treatment of NMIBC, including the phase II KEYNOTE-057 study of pembrolizumab for high-risk, BCG-refractory NMIBC and the phase III POTOMAC trial of durvalumab plus BCG for high-risk, BCG-naïve disease

“This area of immuno-oncology—taking PD-1 and PD-L1 inhibitors and administering them systemically—is a completely novel approach. We’ve seen some very strong, early responses in some of the trials, giving us hope that this may be another alternative for patients who don’t respond to BCG.”
— Leonard G. Gomella, MD, FACS


2 of 3
Insights from Charles Drake, MD, PhD, and Guru Sonpavde, MD—PER Pulse™ Recap:
Community Practice Connections®: Shifting Paradigms in Bladder Cancer: How Immunotherapeutic Strategies Are Changing Courses of Care

As a follow-up to the online continuing medical education–certified activity, Community Practice Connections®: Shifting Paradigms in Bladder Cancer: How Immunotherapeutic Strategies Are Changing Courses of Care, this second of 3 PER Pulse™ Recaps summarizing the program focuses on evidence-based, practical guidance regarding clinical applications of established and emerging data from clinical trials in muscle-invasive bladder cancer (MIBC). Below are some highlights from the activity featuring Drs Drake and Sonpavde:

  • Review of the 5 immune checkpoint inhibitors the FDA approved for treatment of advanced MIBC in the postchemotherapy setting (atezolizumab, avelumab, durvalumab, nivolumab, pembrolizumab), as well as the 2 agents approved for platinum-ineligible/PD-L1–positive disease (atezolizumab, pembrolizumab)
  • Ongoing phase III trials of immunotherapy in advanced urothelial carcinoma, such as the KEYNOTE-361 study of first-line pembrolizumab ± chemotherapy versus chemotherapy, the IMvigor130 study of first-line atezolizumab + platinum-based chemotherapy versus atezolizumab monotherapy, and the DANUBE trial of first-line durvalumab + tremelimumab versus standard-of-care chemotherapy
  • Discussion of ongoing clinical trials of immunotherapy in bladder cancer:
    • Early data from 2 phase II trials of pembrolizumab (ABACUS) and atezolizumab (PURE-01) in the neoadjuvant setting, demonstrating pathologic complete response rates of 29% and 40%, respectively
    • Results from phase III trials of adjuvant PD-1/PD-L1 inhibitors in MIBC, including the IMvigor010 trial of atezolizumab, the CheckMate 247 trial of nivolumab, and the AMBASSADOR trial of pembrolizumab
  • Insight on the most common immune-related adverse events (irAEs) associated with immune checkpoint inhibitor therapy, the importance of early identification and mitigation, and the current clinical practice guidelines for the management of irAEs

“The most common misconception…is the idea that if a patient is having an irAE, this means their immune system is activated and you should hold off on treating that irAE. But, frankly, nothing could be further from the truth. irAEs are much easier to treat early on before they become systemic, before they become challenging, and before they reach high grades.”
— Charles Drake, MD, PhD


3 of 3
Insights from Daniel Petrylak, MD—PER Pulse™ Recap:
Community Practice Connections®: Shifting Paradigms in Bladder Cancer: How Immunotherapeutic Strategies Are Changing Courses of Care

As a follow-up to the online continuing medical education–certified activity, Community Practice Connections®: Shifting Paradigms in Bladder Cancer: How Immunotherapeutic Strategies Are Changing Courses of Care, this third of 3 PER Pulse™ Recaps summarizing the program focuses on evidence-based, practical guidance regarding promising targeted treatment approaches for patients with bladder cancer that is refractory to or has relapsed after treatment with immunotherapy. Below are some highlights from the activity featuring Dr. Petrylak:

  • Overview of the recent accelerated approval of the FGFR inhibitor erdafitinib for the treatment of locally advanced or metastatic, FGFR2/FGFR3 alteration–positive bladder cancer based on results from the phase II BLC2001 study, in which erdafitinib demonstrated a 32.3% overall response rate among patients with cisplatin-refractory/-ineligible, metastatic/unresectable advanced urothelial carcinoma that harbors an FGFR3 or FGFR2 alteration.
  • Discussion of other FGFR inhibitors (eg, infigratinib and rogaratinib), mTOR inhibitors, immunotherapy-based combinations, angiogenesis inhibitors, and antibody-drug conjugates (eg, enfortumab vedotin, sacituzumab govitecan) currently being investigated for the treatment of bladder cancer
  • Insight on the key molecular pathways that might be targeted in patients with urothelial cancer in future clinical trials

“Cisplatin-based chemotherapy has been the standard of care for first-line treatment of urothelial carcinoma for a number of years. And we’re now starting to see whether these targeted agents have activity [in this setting]. We see that with FGFR3; we see that with anti-nectin and with anti-Trop2.”
— Daniel Petrylak, MD


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