The Uromigos score (0-3) provides a rapid expert consensus on new treatments. It bridges the gap between slow, formal guidelines and long, unprioritized lists of approved therapies, offering a more immediate assessment of a drug's place in the standard of care.
An expert argues forcefully that the PD-L1 biomarker should be "ditched" in bladder cancer. Citing its repeated failure to predict overall survival benefit across multiple major trials, it is deemed an oversimplified and unreliable tool that leads to both over- and under-treatment of patients.
Experts are divided on the optimal strategy for CT-DNA negative patients post-surgery. One side advocates for monitoring to spare patients from unnecessary treatment toxicity, while the other questions if this delay is non-inferior to immediate adjuvant therapy, a critical question not yet answered by trials.
Expert consensus shows a major paradigm shift: perioperative systemic therapy (like EV-Pembro, scoring 2.9) is the undisputed standard for muscle-invasive bladder cancer. Approaches starting with cystectomy alone now score below 1.8, formally branding them as inferior options.
Despite strong data favoring pre-surgical systemic therapy, a surgeon argues that many patients will continue to undergo surgery first. This is due to real-world factors like surgeons being the point of diagnosis, urgent symptoms requiring rapid intervention, and patient preferences to have the tumor removed immediately.
Experts warn against over-interpreting a single negative ctDNA test after surgery, clarifying that these patients still face a significant 25-30% risk of recurrence. The biomarker's true prognostic power comes from serial testing that shows a patient remains persistently negative over time.
Despite strong efficacy data, the drug DV-Toripalimab scored lower than a competitor (2.5 vs 3.0). Experts attribute this confidence gap to its Phase 3 trial being conducted only in China, which raises generalizability concerns and reflects a lack of hands-on experience for Western physicians.