SAN FRANCISCO, CA USA (UroToday.com) - In this presentation, Dr. Hikmat Al-Ahmadie discussed the potential for the use of molecular markers in the management of bladder cancer.
He opened his session by showing that a PubMed search for published studies on molecular markers in bladder cancer yielded 5 200 results while a search for validated molecular markers in bladder cancer yielded only 47, highlighting the difficulties of marker validation in bladder cancer research. He reviewed the current pathologic classification of bladder cancer, and the known clinicopathologic prognostic characteristics in both non-muscle invasive and muscle-invasive disease (e.g., grade, stage, tumor size, LVI, etc.).
He then focused on genetic changes that occur within bladder cancer. Low-grade disease demonstrates few changes other than deletions on chromosome 9 and mutation in FGFR3 and HRAS. In comparison, high-grade invasive disease is associated with a large number of genetic alterations. When compared to other cancers in the Cancer Genome Atlas project, bladder cancer demonstrated one of the highest rates of genetic alterations. Dr. Al-Ahmadie further elaborated on some of these alterations including those in the RB1/E2F3, PI3K/Akt and RTK/RAS/RAF pathways, as well as in genes involved in chromatin remodeling. He emphasized the significant heterogeneity present within bladder cancer, both intertumoral and even intratumoral. Identification of altered genes presents the possibility of utilization of new targeted therapies in bladder cancer. Dr. Al-Ahmadie concluded by reviewing some of these targeted therapies that are currently in trial including anti-Her2 therapies and BKM10, used in patients with alterations in the PI3K/Akt/mTOR pathway.
Highlights of a presentation by Hikmat Al-Ahmadie, MD at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
Memorial Sloan Kettering Cancer Center, New York, NY USA