Ronald Kool

Husband, father, MD, PhD candidate @mcgillu. Uro-oncologist at Erasto Gaertner Hospital - Curitiba, Brazil.

[Ashish M. Kamat, MD, MBBS @UroDocAsh]

People have been DM and asking me: with an HR of 0.68 for durvalumab + BCG in POTOMAC, why isn’t this for every high-risk NMIBC patient?

Here’s how hazard ratios work – and why they can mislead you if you stop there. 🧵 #ASCO26

@tompowles1 @WesKassouf @shilpaonc @DrFelixGuerrero

[Dr Rishabh Jain @DrRishabhOnco]

💥 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: https://t.co/xT82TdtaZ7

@ASCO @oncoalert @uro_today @theNCI
#BladderCancer #Oncology #UroOnc #Immunotherapy #CancerResearch

[Tom Powles @tompowles1]

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. https://t.co/NgHW54WzxT

[Marcelo Wroclawski @wroclawski_uro]

🥨 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

[Ronald Kool @dr_rkool]

@ThiagoHotaUro @quanta_system Very nice case my friend!

[Thiago Hota @ThiagoHotaUro]

#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

[European Urology Oncology @EurUrolOncol]

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: https://t.co/iVVBPpKm2V

#UroSoMe #MedTwitter

[Rod Breau @RodBreau]

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

[Wes Kassouf @WesKassouf]

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

[Gautier Marcq @gautiermarcq]

Just in 👉 @JCO_ASCO Benefit of Whole-Pelvis Radiation ☢️ for Patients With #MIBC
https://t.co/uY8XqgrCF8

👇👇👇TWEETORIAL 👇👇👇

[Nick James @Prof_Nick_James]

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

[Wes Kassouf @WesKassouf]

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
https://t.co/hShGhqaszh

[OncoAlert @OncoAlert]

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.

https://t.co/xEFTf5HqXR

@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

[Ronald Kool @dr_rkool]

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

[Andrew Armstrong @AarmstrongDuke]

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

[Markus Eckstein @Markuseckstein3]

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 https://t.co/x1zaqWR9c1

[Enrique Grande @drenriquegrande]

⚡️ 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

https://t.co/GOG4bb5y73

[Ronald Kool @dr_rkool]

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

[Ronald Kool @dr_rkool]

Happy to share our work on the Benefit of Neoadjuvant Cisplatin-based Chemotherapy followed by curative Radiation in muscle-invasive bladder cancer

https://t.co/V6KACIefpS

[Thomas Flaig @TomFlaigMD]

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
https://t.co/r5buyUY30b