Philippe Spiess

Moffitt Cancer Center · Genitourinary Oncology

Objectives: Perioperative blood transfusion (PBT) has been associated with worse survival after radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC). Here, we evaluated the association between PBT and survival after RC that was preceded by neoadjuvant chemotherapy (NAC). Methods: A retrospective analysis was performed on 9...

Purpose of Review In contemporary urological practice, managing rare genitourinary (GU) malignancies presents significant challenges, necessitating a comprehensive understanding of their unique characteristics and tailored treatment approaches. Recent Findings Rare GU malignancies, whether per se, variants of common histologies, or common tumors i...

Background Penile squamous cell carcinoma (PSCC) carries significant morbidity and mortality. Literature is limited regarding prognostic factors, especially prognostic factors for development of metastasis. Objectives To identify independent prognostic factors associated with poor outcomes, defined as local recurrence (LR), metastasis and disease‐...

Purpose of review This review sought to define the emerging roles of urinary tumor DNA (utDNA) for diagnosis, monitoring, and treatment of bladder cancer. Building from early landmark studies the focus is on recent studies, highlighting how utDNA could aid personalized care. Recent findings Recent research underscores the potential for utDNA to be...

Though penile cancer is an uncommon disease, it can cause significant disfiguration, adverse impact on quality of life, and an inherent high rate of morbidity and mortality. Management of the inguinal lymph nodes is of tantamount importance from a diagnostic, prognostic, and therapeutic perspective. However, traditional open lymph node dissection c...

Bladder cancer, the sixth most common cancer in the United States, is most commonly of the urothelial carcinoma histologic subtype. The clinical spectrum of bladder cancer is divided into 3 categories that differ in prognosis, management, and therapeutic aims: (1) non–muscle-invasive bladder cancer (NMIBC); (2) muscle invasive, nonmetastatic diseas...

Introduction The objective of this study was to stratify preoperative immune cell counts by cancer specific outcomes in patients with renal cell carcinoma (RCC) and a tumor thrombus after radical nephrectomy with tumor thrombectomy. Methods Patients with a diagnosis of RCC with tumor thrombus that underwent radical nephrectomy with thrombectomy ac...

Objective To determine the effectiveness and adverse effects of urethrectomy alone or as part of multimodal therapy (MMT). Methods A comprehensive search was conducted across MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) databases, from their inception to the present date. The study cohort comprise...

Human epidermal growth factor-2 (HER2) overexpression is an oncogenic driver in many solid tumors, including urothelial bladder cancer (UBC). In addition, activating mutations in the ERBB2 gene have been shown to play an oncogenic role similar to ERBB2 amplification. To describe and compare the frequency and nature of genomic alterations (GA) of ER...

Introduction: Penile squamous cell carcinoma (PSCC), a rare genitourinary cancer, is associated with poor outcomes due to limited treatment effectiveness, especially in advanced stages. Areas covered: While chemotherapy and/or surgery remain the standard of care, emerging therapies like immunotherapy, targeted therapy, and human papillomavirus (...

Objective To investigate the optimal number of induction chemotherapy cycles needed to achieve a pathological response in patients with clinically lymph node‐positive (cN+) bladder cancer (BCa) who received three or four cycles of induction chemotherapy followed by consolidative radical cystectomy (RC) with pelvic lymph node dissection. Patients a...

Urological cancers are one of the leading causes of morbidity and mortality in the world, representing more than 10% of the total number of new cancer cases worldwide. Being a complex disease, several problems are currently related to its diagnosis, management, monitoring, and treatment. These problems require multidisciplinary solutions that encom...

Introduction This study investigated the efficacy and safety of neoadjuvant chemotherapy (NAC) for locally advance penile squamous cell carcinoma (PSCC), for which current evidence is lacking. Methods Included patients had locally advanced PSCC with clinical lymph node metastasis treated with at least one dose of NAC prior to planned consolidative...

10 Background: Penile carcinoma is a rare malignancy. However, in developing countries the incidence rate is higher with approximately 6 cases per thousand men. mPC has a very poor prognosis and effective systemic treatments are an unmet need. Understanding the molecular alterations is essential for evaluating possible targets for more effective sy...

181 Background: Primary sarcoma of prostate is exceedingly rare and not well-studied. We sought to describe the genomic landscape of this rare entity and identify potential therapy targets. Methods: From 19,057 cases of prostate cancers, only 11 (<.01%) cases of primary sarcomas were identified and underwent comprehensive genomic profiling (CGP) us...

540 Background: Activating DNA sequence genomic alterations (GA) in the FGFR3 gene including short variant (SV) mutations and kinase domain activating gene rearrangements/fusions (RE-FUS) are known drivers and relevant precision treatment targets for pts with UC. THOR trial showed a significant overall survival benefit with erdafitinib (FGFR inhibi...

413 Background: Renal Cell Carcinoma (RCC) is a global public health burden with over 400,000 new cases and over 175,000 deaths annually. Immune checkpoint inhibitors (ICI) in combination with vascular endothelial growth factor tyrosine kinase inhibitors (VEGF-TKI) has become an integral part of the management of patients with advanced RCC which re...

370 Background: Multiple new therapies for metastatic clear cell renal cell carcinoma (mccRCC) have been approved in the past decade. Real-world (RW) data on access to novel therapies and the impact on health-related disparities are limited. This study assessed RW access to novel therapies along with racial and social disparities for mccRCC patient...

451 Background: While renal AML is generally a benign tumor, malignant eAML is a rare form of renal malignancy of uncertain histogenesis featuring variable prognosis. Consequently, most series are limited in small sample sizes and lack comprehensive genomic analysis. We sought to survey the genomic landscape in malignant renal eAML and identify pot...

535 Background: Although both U and NU bladder adenoCA share several histological similarities, they differ in site of origin and optimal treatment paradigms. They are both relatively resistant to conventional cisplatin-based chemotherapy and surgical resection is the only curative option for organ-confined stages. The purpose of this study is to i...

9 Background: Penile squamous cell carcinoma (PSCC) is a rare and aggressive malignancy with limited treatment options in the advanced or recurrent settings. Immunotherapy can yield clinical responses in PSCC, but less than 20% of patients benefit. Herein, using multiplex immunofluorescence (MIF), we analyzed the composition of the tumor immune mic...

7 Background: Nodal metastases from SCC are a clinical challenge in urologic and gynecologic oncology. Strategies employing CGP to identify targeted therapies for CUPs have shown potential; however, the molecular landscape of SCCUP remains poorly defined. We report the results of CGP testing in patients with SCCUPs identified in the Foundation Medi...

450 Background: Inactivating genomic alterations (GA) of FANCC gene are associated with genomic instability, DNA cross-linking, and homologous DNA repair deficiency (HRD). FANCC GA are most frequently associated with colon, lung, breast, and prostate cancers (0.5% frequency) with germline FANCC mutations linked to familial breast cancer. FANCC GA h...

TPS13 Background: Penile squamous cell carcinoma (PSCC) is a rare and deadly cancer, with limited therapy options in patients with disease progressive on platinum chemotherapy. Patients are encouraged to enroll in clinical trials since the overall survival is less than 5 months with standard therapy. Development of efficacious treatment options for...

The number of people living with HIV infection has been increasing globally. Administration of antiretroviral therapy is effective in controlling the infection for most patients and, as a consequence, people living with HIV (PLWH) now often have a long life expectancy. However, their risk of developing cancer - most notably virus-related cancers -...

There is a critical unmet need for safe and efficacious neoadjuvant treatment for cisplatin-ineligible patients with muscle invasive bladder cancer. We launched a Phase 1b study using the combination of intravesical cretostimogene grenadenorepvec (oncolytic serotype 5 adenovirus encoding granulocyte-macrophage colony stimulating factor) with system...

Introduction The European Association of Urology (EAU) and the American Society of Clinical Oncology (ASCO) recently issued updated guidelines on penile cancer, emphasising dynamic sentinel node biopsy (DSNB) as the preferred method for surgical staging among patients with invasive penile tumours and no palpable inguinal lymphadenopathy. This paper...

Simple Summary Penile cancer is a rare and aggressive disease. Current treatment options when the cancer is locally advanced are suboptimal and potentially mutilating. Insight into the immune dysregulation necessary for the emergence of penile cancer could suggest innovative ways to manipulate the immune system which have already demonstrated effic...

Background Standardized, high-quality PRO data reporting is crucial for patient centered care in the field of oncology, especially in clinical trials that establish standard of care. This study evaluated PRO endpoint design, conduct and reporting methods in FDA approved drugs for GU malignancies. Methods A systematic review of the FDA archives ide...

Purpose: Multifocal partial nephrectomy (MPN) is a critical management strategy for extirpation of multiple distinct renal masses; however, its short- and long-term impact on renal function remains poorly described. Herein we compared absolute glomerular filtration rate (GFR) and change from baseline at multiple time points after MPN and standard...

Importance Tumor mutational burden (TMB) is a putative biomarker of efficacy for immune checkpoint inhibitor (ICI) therapies of solid tumors, but not specifically for penile squamous cell carcinoma (PSCC). Objective To characterize biomarker features and ICI therapy outcomes associated with high TMB in PSCC in the routine clinical practice setting...

Background Social media platforms (SMP) are an emerging resource that allows physicians, patients, and families to converse on cancer prevention, diagnosis, and treatment. We aimed to characterize penile cancer (PC) content shared on SMP. Methods We searched PC posts on Twitter, Facebook, and Instagram from July 1st, 2021, through June 30th, 2022....

Objectives To examine the global disease burden and country‐specific trends of penile cancer incidence by age group and investigate its associations with several factors. Materials and Methods The Global Cancer Observatory database was interrogated for penile cancer incidence. The 10‐year cancer incidence rates were collected from the Cancer Incid...

Objective To determine the oncological impact of extended pelvic lymph node dissection (ePLND) vs standard PLND (sPLND) during radical cystectomy (RC) in clinically lymph node‐positive (cN+) bladder cancer (BCa). Patients and Methods In this retrospective, multicentre study we included 969 patients who underwent RC with sPLND (internal/external il...

Purpose: Penile cancer is rare, with significant morbidity and limited literature assessing utility of peripheral and deep en face margin assessment (PDEMA) vs traditional margin assessment (vertical sections) on treatment outcomes. Materials and methods: This was a 32-year retrospective multicenter cohort study at 3 academic tertiary care cente...

INTRODUCTION: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Cisplatin, however, can induce renal toxicity. Furthermore, RC is an independent risk factor for renal injury, with decreases in estimated glomerular filtration rate (eGFR)...

Penile cancer presents as a lesion that can be papillary, nodular, ulcerative, flat or fungating. It is often asymptomatic though pain, discharge and bleeding are associated with advanced disease. There are several risk factors for penile cancer and a detailed clinical history should be taken. A careful clinical examination and biopsy are required...

Objective: To evaluate factors associated with perioperative outcomes in a multi-institutional cohort of patients treated with CN. Methods: Data was analyzed for metastatic renal cell carcinoma (mRCC) patients treated with CN at 6 tertiary academic centers from 2005-2019. Outcomes included: Clavien-Dindo complications, mortality, length of hospi...

Objectives To evaluate clinical characteristics associated with survival in patients with metastases to the penis. Methods After approval by the IRB, records of collaborating centres in Leuven, London, Rostock, Amsterdam and Tampa were screened for men presenting with metastatic disease to penis. Multivariate logistic regression analyses were used...

BACKGROUND The onset of the coronavirus disease 2019 (COVID-19) pandemic changed the landscape of oncology practice and placed tele-oncology at the center of cancer care delivery. As tele-oncology will likely remain a key part of cancer care delivery, healthcare organizations need to determine how to implement tele-oncology programs. OBJECTIVE We...

Background: Treatment options for penile squamous cell carcinoma (PeCa) are limited. We sought to investigate clinical outcomes and safety profiles of patients with PeCa receiving immune checkpoint inhibitors (ICIs). Methods: This retrospective study included patients with locally advanced or metastatic PeCa receiving ICIs during 2015-2022 acros...

Importance: A true revolution in the management of advanced genitourinary cancers has occurred with the discovery and adoption of immunotherapy (IO). The therapeutic benefits of IO were recently observed not to be solely confined to patients with disseminated disease but also in select patients with localized and locally advanced genitourinary neo...

Purpose: Immune checkpoint blockade holds promise for treating BCG-unresponsive non-muscle invasive bladder cancer. In this phase II study, we investigated the safety and efficacy of durvalumab, a human IgG1 monoclonal antibody, against BCG-unresponsive CIS. Patients and methods: Patients with BCG-unresponsive CIS containing non-muscle invasive...

Simple Summary Penile squamous cell carcinoma (PSCC) is a rare and aggressive cancer. About half of all PSCC cases are thought to be related to human papillomavirus (HPV) or have increased expression of p16 by immunohistochemistry (IHC), a surrogate marker for HPV infection. HPV/p16 positivity is generally a marker of better outcomes in more common...

Simple Summary Penile cancer is considered a rare disease in most developed countries, yet it represents a significant global oncology challenge. Many patients are faced with substantial psychosocial morbidity from diagnosis and treatment, which is further compounded by a lack of access to novel treatment approaches when the disease becomes resista...

Objective To assess the ability of cell-free urinary and plasma tumor DNA (cfDNA) to predict pathologic stage at radical cystectomy for patients with clinical muscle-invasive bladder cancer. MethodsA total of 25 patients with clinical muscle-invasive bladder cancer were enrolled before undergoing radical cystectomy. Blood and urine were collected b...

Background: Careful patient selection is critical when considering cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) but few studies have investigated the prognostic value of radiologic features that measure tumor burden. Objective: To develop a prognostic model to improve CN selection with integration of common radiologi...

Objective: Patients with advanced penile squamous cell cancer (pSCC) have a poor prognosis and can benefit from early palliative care consultation. We built a model to identify those patients most likely to benefit. Methods: Patients with pSCC undergoing inguinal lymph node dissection (ILND) were identified from the National Cancer Database (NCD...

Purpose: Modified and superficial inguinal lymph node dissection (MILD and SILD) are the 2 widely used templates for surgical staging of clinically node negative (cN0) penile cancer (PeCa); however, no previous reports have compared their outcomes. We compared these 2 surgical templates for oncological outcomes and complications. Materials and me...

Background: Recently, the Tetrafecta score has been published as the first instrument for assessing the quality of primary surgical treatment for penile cancer (PECa). An external scientific discussion about the defining criteria is still pending and forms the study objective. Material and methods: An international working group consisting of 12...

Von Hippel‐Lindau disease is a rare inherited cancer‐predisposition syndrome. The authors report the updated recommendations for the multiorgan surveillance protocols.

Background: Penile cancer accounts for less than 1% of male cancers in the United States. Localized disease, particularly T1 tumors are potentially curable with local therapy. We present the racial differences in survival outcomes for T1, penile cancer from the SEER database. Methods: From 2004 to 2016 all men with T1, N0, M0 penile cancer in th...

Introduction: Although the COVID-19 pandemic spurred telehealth adoption for many specialties and care team roles, the patient and caregiver experience for telepharmacy visits has been relatively understudied. To our knowledge, there is a paucity of studies that have attempted to qualitatively evaluate this. This study aimed to qualitatively asses...

Background: The aim of this study is to investigate the differential stage-dependent outcomes of patients undergoing radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC). Methods: We performed a retrospective analysis of 1422 patients with cT2-4N0 MIBC treated with RC, with/without cisplatin-based NAC, from our multicenter coop...