From Sledgehammer to Selective: Transforming Cytotoxic Potency Through Targeted Treatments for Advanced or Metastatic Urothelial Cancer Monograph


This activity is supported by educational grants from Astellas, Merck Sharpe & Dohme, and Seattle Genetics.





This monograph recounts recent successes and failures in the decades-long medical crusade against advanced and metastatic urothelial cancer (mUC). Advances in first- and second-line approaches are selectively captured, and the role played by immunotherapy and targeted treatments is explored.

Fortunately, >80% of the almost 82,000 cases of urothelial cancer (UC) that occur in the United States each year are diagnosed at early or localized stages, when it is highly curable. But approximately 12% of cases are detected at regionally advanced or metastatic stages. These patients typically have poor outcomes with low 5-year survival rates.

In recent years, however, survival rates have been gradually climbing as newer targeted agents work in tandem with systemic chemotherapy, replacing a heavily cytotoxic “sledgehammer” approach that had traditionally been used.

This activity will help advanced practitioners who treat patients with UC to better understand how to select and sequence treatments as well as how to identify and manage potential treatment-related adverse events (trAEs).


Elizabeth R Plimack, MD, MS
Chief, Division of Genitourinary Medical Oncology
Director, Genitourinary Clinical Research
Professor, Hematology/Oncology
Fox Chase Cancer Center, Temple Health
Philadelphia, Pennsylvania


Susan K Roethke, NP
Certified Registered Nurse Practitioner
Genitourinary Medical Oncology
Dept of Hematology/Oncology
Fox Chase Cancer Center
Temple University Health System
Philadelphia, Pennsylvania


Release date: March 29, 2021
Expiration date: March 29, 2022
Estimated time to complete activity: 1 hour



This educational initiative has been designed for community oncologists; advanced practitioners in oncology including APNs, BCOPs, CNSs, NPs, OCNSs, and PAs; as well as oncology care coordinators and other clinicians who provide care for patients with urothelial cancer.


Upon completion of this educational activity, participants should be able to:

  • Articulate the mechanisms of action of targeted biopharmacologics and immune checkpoint inhibitors (ICIs) used in the treatment of urothelial cancer (UC)
  • Outline efficacy and safety findings from key clinical trials of approved ICIs, antibody-drug conjugates (ADCs), and fibroblast growth factor receptor inhibitors (FGFRs) developed for the treatment of advanced or metastatic UC
  • Implement a patient-focused strategy for identifying, monitoring, and mitigating adverse events that can be caused by novel UC treatments

There are no fees for participating and receiving CME/CE credit for this activity. During the period of March 29, 2021 through March 29, 2022, participants must:

  • Read the learning objectives and faculty disclosures
  • Complete the pretest
  • Study the educational activity
  • Complete the posttest and the evaluation form

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.




Accreditation Statement
Integrity Continuing Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation
Integrity Continuing Education designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.


This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global Education Group and Integrity Continuing Education. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is approved for 1.0 contact hour (which includes 0.9 hours of pharmacology).


Global Education Group is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This educational activity for 1.0 contact hour is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.


For information about ACCME accreditation of this activity, please contact Integrity Continuing Education at (855) 835-4004 or

For information about CNE or AANP accreditation of this activity, please contact Global Education Group at (303) 395-1782 or


Integrity Continuing Education and Global Education Group requires instructors, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The following faculty/planners reported the financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of these CME activities:

Elizabeth R Plimack, MD, MS
Consulting/Scientific Advisory/Data Safety Monitoring: AstraZeneca, Genentech, Infinity Therapeutics, Merck, Pfizer, Seattle Genetics
Grants for research including clinical trials: Astellas, Bristol Myers Squibb, Genentech, Merck

Susan K Roethke, NP
Speakers Bureau: Astellas, Pfizer

The planners and managers, Michelle R. Rizzo, ELS, and Donna Fausak, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months. The Global Education Group planners and managers, Ashley Marostica, RN, MSN, Kristin Delisi, NP, Lindsay Borvansky, Andrea Funk, Liddy Knight, and Ashley Cann, also have nothing to disclose.


This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Integrity Continuing Education and Global Education Group do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


When you participate in an online educational activity sponsored by Integrity Continuing Education, Inc., you will be asked for your name, degree(s), affiliation(s), street address, telephone number, fax number, and…(continued)


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The information provided at this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.


This CME activity is provided by Integrity Continuing Education.

This CNE/AANP activity is jointly provided by Global Education Group and Integrity Continuing Education.


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