ASCO GU 2017: Barriers in Progress in Muscle-Invasive and Non-muscle Invasive Bladder Cancer - Oncology Perspective - Session Highlights
Orlando, Florida USA (UroToday.com) Noah Hahn, John Hopkins University, presented the oncology perspective on trial design in non-muscle invasive bladder cancer. Myth #1- small tissue samples preclude genomic enriched trial designs. This is not true as shown by the HCRN 12-157 trial of dovitinib in BCG-unresponsive patients. Baseline, these patients required TURBT and had a median 14 slides cut and 4 additional slides left from this study for additional studies. Myth #2- systemic therapy does not effectively reach the urothelium. This is also not necessarily true. The same trial showed systemic chemotherapy did in fact enrich the epithelium with concentration well above the biologically active amount needed. Myth #3- phenotypic heterogeneity and infinite targets prevent novel efficient trials. This is not true as shown from TCGA studies and a multitude of other studies. The HCRN/SUO CTC 16-243 will assess durvalumab in intermediate/high risk non-muscle invasive bladder cancer patients in combination with other treatments to elucidate progression free survival. Myth #4- intravesical therapies are sufficient to improve outcomes. There are 7 trials actively accruing patients with non-muscle invasive bladder cancer to undergo systemic chemotherapy. Further efforts to improve our understanding of intravesical and systemic therapy in the management of these patients. Lastly, identifying patients according to genomics will elucidate in which patients treatments are more appropriate.
Presenter: Noah M. Hahn, MD, John Hopkins University
Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX