Patrick Hensley: Thank you.
Ashish Kamat: We're going to talk now a little bit about the TURBT, the transurethral resection of bladder tumors, and why we're focusing this year at the IBCG26 and making that one of the focus topics. So you and I have shared thoughts that we all have on TURBT. I have thoughts for gosh now, 30 years. But tell me your insight into what it means, why you think we should focus on it, and why everybody should really focus on it.
Patrick Hensley: Yeah, I think as bladder-centric clinicians, we both appreciate the importance of a quality TURBT for purposes of first and foremost diagnosis, but also the therapeutic implications of a quality transurethral resection. I think it's long been understood or characterized as a low-priority operation and marginalized, especially in residency training programs. But we recognize the importance of a quality transurethral resection. In previous IBCG retreats, we focused on specific disease states, intermediate-risk or muscle-invasive bladder cancer, BCG-unresponsive disease, muscle-invasive disease. So this is the first time that we're focusing specifically on a procedure or a technique. And I think we're placing due emphasis, and I think that it could have a lot of impact on how we care for these patients. The recommendation statements that are going to be made during this session are going to be in the context of a multidisciplinary cancer team. And despite it being a surgically focused procedure, obviously, we're going to include our colleagues from radiation medicine, medical oncology, pathology, and translational medicine as well to give a holistic view of how to perform the procedure, how to document the procedure, how to document the pathology report from the procedure, and how and when to perform a quality and complete endoscopic TURBT in the context of systemic therapy and radiation therapy.
Ashish Kamat: Yeah. I think that's important because again, there are several pillars when it comes to TURBT. And I think everything that a bladder cancer patient goes through, other than if they unfortunately present with frank metastatic disease, starts with the resection. It's the resection that gives you the histology. It's the resection that gives you all the ability to do all the machine learning that people are doing, the genotyping, the profiling, the selection of appropriate therapy, muscle-invasive, non-invasive. So I think the TURBT is crucial really for us, our patients, and our colleagues. And we've created the teams for the IBCG already, and some of them are actually being led by rad-oncs. I just met with some of them here at GU ASCO and they're like, "Thank you for including us on a TURBT because now we can tell you what we want from you." And when I say you, I mean the urologic community from a good resection prior to starting chemoradiation, we want you to map the bladder. We want you to do this. Same thing with our medical oncology colleagues, sometimes they would like for us to do a repeat assessment in the middle of investigational cycles of therapy for tissue, but also maybe patient benefit. Sometimes it's not clear. So share briefly some of the teams that are in place.
Patrick Hensley: Yeah. So we're going to cover the role of a complete endoscopic transurethral resection with respect to tri-modality therapy. What is the role of a complete resection, maximally safe transurethral resection versus timely initiation of tri-modality therapy? What is the role of placement of fiducial markers for a boost to the primary tumor site? So that's the radiation or tri-modality therapy team. We're going to look at the role of a maximally safe transurethral resection when starting systemic therapy for both muscle-invasive disease in the neoadjuvant setting, but also in the systemic therapy setting for metastatic disease. Specifically with respect to technique, and this is where the urologists are really going to weigh in on intraoperatively, what is the role for advanced cystoscopic techniques? What are the methods by which and indications for bladder mapping? How do we evaluate the upper tracts appropriately? How do we use risk-stratified restaging transurethral resection, perioperative chemotherapy? And I think really importantly, how do we in a standardized fashion document our TURBT findings with respect to size and focality and endoscopic appearance of the tumor and the overall health and holistic view of the bladder? We'll have a team dedicated to mitigating periprocedural toxicity through preventative measures and implementation of ERAS protocols.
I think that's where the patient-reported outcomes, both in a clinical trial setting, but also in the real-world clinical practice setting, makes a lot of sense. And then I'm really looking forward to a session that's going to be led by our translational colleagues, as well as our pathologists on how do we adequately or appropriately report a TURBT finding from a pathology report perspective? What do our translational science colleagues need from an adequate tissue sampling perspective? What's the role of fresh tissue and biospecimen tumor banks, et cetera?
Ashish Kamat: Yeah. As I hear you talk about the different teams, I'm so happy I volunteered you to co-lead this effort. Thank you for doing that and thank you for taking the time.
Patrick Hensley: My pleasure. Thank you.