Husband, father, MD, PhD candidate @mcgillu. Uro-oncologist at Erasto Gaertner Hospital - Curitiba, Brazil.
Curitiba, Brazil
Joined October 2019
- Tweets93
- Following314
- Followers103
- Likes181
Ronald Kool retweeted
Congratulations @dr_rkool on passing your PhD defense yesterday. Great work with practice informing research in the field of organ preserving in #bladdercancer @McGillDeptSurg @mcgillu @kalasri3 @TholomierC
Ronald Kool retweeted
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
The approval answers one question, but leaves another unanswered: which patients truly derive enough benefit to justify escalation beyond optimized BCG?
The FDA approval of durvalumab plus BCG in high-risk NMIBC was driven by a meaningful improvement in disease-free survival (HR 0.68), mainly recurrence free survival. Checkpoint inhibitors are not benign therapies, carrying ~ 15% risk of serious treatment-related adverse events.
At the same time, this trial also demonstrated that patients with BCG-naïve high-risk NMIBC have low rates of progression and bladder cancer mortality, when treated with BCG appropriately.
For many patients, the balance between reducing recurrence and exposing them to potentially significant toxicity is not straightforward.
That raises a practical question: who should actually receive treatment intensification?
Ronald Kool retweeted
💥 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/10.120…
@ASCO @oncoalert @uro_today @theNCI
#BladderCancer #Oncology #UroOnc #Immunotherapy #CancerResearch
Ronald Kool retweeted
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…
Ronald Kool retweeted
🥨 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 retweeted
#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
Ronald Kool retweeted
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
Ronald Kool retweeted
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
In a multicenter randomized trial, tranexamic acid did not reduce blood transfusion during radical cystectomy. ja.ma/3XMBIMV
Ronald Kool retweeted
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/JCO…
👇👇👇TWEETORIAL 👇👇👇
Ronald Kool retweeted
Just in 👉 @JCO_ASCO Benefit of Whole-Pelvis Radiation ☢️ for Patients With #MIBC
ascopubs.org/doi/10.1200/JCO…
👇👇👇TWEETORIAL 👇👇👇
Ronald Kool retweeted
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
Effect of complete transurethral resection on oncologic outcomes after radiation therapy for muscle-invasive bladder cancer. redjournal.org/article/S0360…
Ronald Kool retweeted
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…
Ronald Kool retweeted
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/searchresult…
@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 retweeted
Great session discussing evolving mCRPC treatments here in Curitiba Brazil with @JnatasP82450795 and @dr_rkool! @DukeGUCancer
Ronald Kool retweeted
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 xitter.cf/markuseckstein3/status…
Ronald Kool retweeted
⚡️ 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/ar…
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/1iYsE…
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 retweeted
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
Ronald Kool retweeted
@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.europeanurolo…
