Ronald Kool

💥 MIBC is no longer surgery-first—oncology is rewriting the rulebook. 🩺 Surgery & Chemo (traditional backbone) Radical cystectomy ± peri-op cisplatin chemo remains standard, but morbidity & patient fitness limit its universal application. 🧬 Immunotherapy integration Neo/adjuvant ICB now proven: • CheckMate-274 → Nivolumab improved DFS & OS • AMBASSADOR → Pembrolizumab improved DFS • NIAGARA → Durvalumab peri-op improved DFS & OS 🧪 ctDNA as MRD tool • Detectable ctDNA predicts relapse post-cystectomy • IMvigor010, TOMBOLA, MODERN exploring ctDNA-guided escalation/de-escalation 🚦 → Personalised systemic therapy decisions on horizon. 🎯 ADCs + ICB combos • EV+pembro (EV-302) revolutionised metastatic setting • Now moving peri-op in VOLGA, KEYNOTE-905, KEYNOTE-B15 → Potential to boost cure rates in cisplatin-eligible & ineligible pts. 🛡️ Bladder-sparing strategies • TURBT + systemic therapy → durable CR in select pts (HCRN GU16-257, RETAIN) • Emerging risk-adapted, biomarker-driven pathways • Goal: preserve organ without compromising cure. ➡️ The next decade = convergence of powerful therapeutics + precise biomarkers + risk-adapted strategies. Not just longer survival-cure + quality of life together. 📖 JCO 2025 Review: ascopubs.org/doi/full/10.12… @ASCO @oncoalert @uro_today @theNCI #BladderCancer #Oncology #UroOnc #Immunotherapy #CancerResearch

POTOMAC trial- Durvalumab + BCG shows positive results for DFS in high-risk NMIBC vs BCG alone. sasanlimab (CREST) also had an EFS advantage here: HR 0.68. Consistent results in early disease is compelling. IO tox is relevant in risk/benefit ratio. astrazeneca.com/media-centre/p…

🥨 SunRise 4 shows NeoAdj TAR 200 +/- cetrelimab is safe - ☣️Low G3 toxicity - ⛔️Low treatment discontinuation - 🔪No negative effect on cystectomy. 🦀Anxiously awaiting oncological outcomes! #EAU25

@ThiagoHotaUro @quanta_system Very nice case my friend!

#HoLEP as a safe option for deobstruction in the setting of advanced prostate adenocarcinoma, T4 lesion is not a restriction for the technique. Patient with invasive and metastatic lesion of the rectum in retention. Laser cyberHo (virtual basket mode): 2J40Hz @quanta_system @fgomsan @MSGONZALEZURO @PabloNContreras @scoffonecesare @drpalese @dr_rkool @carloswoidello @wroclawski_uro @lfredosanchez @Moser_DanielC @FCAFigueiredo @terralucas1 #UroSoMe

Benefit of Neoadjuvant Cisplatin-based Chemotherapy for Invasive Bladder Cancer Patients Treated with Radiation-based Therapy in a Real-world Setting: An Inverse Probability Treatment Weighted Analysis by @dr_rkool Full article: buff.ly/4gdkIY8 #UroSoMe #MedTwitter

A pleasure to finally share our findings of a large RCT of radical cystectomy patients from 10 Canadian institutions. To our shock, TXA did not reduce transfusion. Thank you to the patients, collaborators, and the many research staff. @WesKassouf @mcisaac_d @CIHR_IRSC

Congratulations @gautiermarcq @dr_rkool and all on moving this field forward. As patients’ profiles who opt for #chemoradiation #TMT is changing to include healthier patients with higher risk muscle-invasive #bladdercancer, pelvic nodal radiation becomes relevant and important

Just in 👉 @JCO_ASCO Benefit of Whole-Pelvis Radiation ☢️ for Patients With #MIBC ascopubs.org/doi/10.1200/JC… 👇👇👇TWEETORIAL 👇👇👇

Really important and been saying this for many years so good to see other sources supporting. Extent of debulking prognostic but not therapeutic nor practiced in other cancers. Pts in BC2001 with biopsy only did no differently to those with resections

Following IPTW, complete transurethral resection prior to radiation therapy for muscle-invasive bladder cancer was not associated with neither OS,CSS nor MFS. Is complete TUR, in large part, a surrogate for clinical stage?@ppavolio_MD redjournal.org/article/S0360-…

Effect of complete transurethral resection on oncologic outcomes after radiation therapy for muscle-invasive bladder cancer out on @ASTRO_org Red Journal Study compares the oncologic outcomes of patients with non-metastatic muscle-invasive #BladderCancer (MIBC) who underwent either complete or incomplete transurethral tumor resection (TURBT) before receiving radiation therapy☢️ The retrospective evaluation of 757 patients from ten Canadian🇨🇦institutions showed that, after adjusting for baseline characteristics, there were no significant differences in 5-year overall survival, cancer-specific survival, metastasis-free survival, or disease-free survival between the two groups While complete TURBT was more common in patients with organ-confined disease, the extent of TURBT did not independently impact oncologic outcomes in MIBC patients treated with radiation therapy. jamanetwork.com/searchresults?… @ppavolio_MD @ppavolio_MD @dr_rkool @BobbyShayegan @gautiermarcq @pcvblack @RodBreau @GaganFervaha @RSanchez_Salas @Nimira_A @GSK_UofT Ping GU & Rad Onc Faculty @apolo_andrea @PGrivasMDPhD #OncoAlertAF @nataliagandur @acampsmalea @BiagioRicciutMD @yekeduz_emre @HHorinouchi @FadiHaddad_MD @Dr_Ivanoncologo @Abdallah81MD @FernandoOnco @ElisaAgostinett @to_be_elizabeth @anmwongNZ @lungoncdoc @bavilima @realbowtiedoc @Erman_Akkus @DrFMartinelli @Lucarecco

@AarmstrongDuke @JnatasP82450795 @DukeGUCancer It was great to meet you! Rich discussion over germline and somatic mutations in mCRPC

Great session discussing evolving mCRPC treatments here in Curitiba Brazil with @JnatasP82450795 and @dr_rkool! @DukeGUCancer

FGFR3 mutations are frequent alterations in urothelial cancer, but 🚨: ➡️ NMIBC: ~50% are mutated ➡️ MIBC: ~10% are mutated ➡️ UTUC stage independent: ~ 30% are mutated ➡️ mUC (=bc + UTUC): ~15-20 % are mutated Fusions are very rare throughout all entities! Frequency is ~1%‼️ ➡️ to understand why FGFR3 mutations are more frequent in NMIBC 👉 read x.com/markuseckstein…

⚡️ Benefit of Neoadjuvant Cisplatin-based Chemotherapy for Invasive Bladder Cancer Patients Treated with Radiation-based Therapy in a Real-world Setting: An Inverse Probability Treatment Weighted Analysis #BladderCancer @dr_rkool sciencedirect.com/science/articl…

This is another paper based on our Canadian Collaborative retrospective database of patients with #MIBC treated bladder preservation. @GSK_UofT @gautiermarcq @RodBreau @BobbyShayegan @dr_cury @Nimira_A @siemensr @pcvblack @WesKassouf

Happy to share our work on the Benefit of Neoadjuvant Cisplatin-based Chemotherapy followed by curative Radiation in muscle-invasive bladder cancer authors.elsevier.com/c/1iYsE9Cfv--d…

The @NCCN Bladder Cancer Guidelines v1.2024 are now available. It has been a very active time in bladder cancer therapeutic development. Important updates on the treatment of locally advanced/metastatic disease and in many other areas. #BladderCancer nccn.org/home

@charleshesswani and Chelsea Jackson showing immunohistochemistry-based #MIBC molecular subtyping was not associated with response nor survival in patients treated with radiation. Great collaboration with @virchow and team. eu-openscience.europeanurology.com/article/S2666-…