ASCO GU 2017: Options for the Patient Who Does Not Respond to Bacillus Calmette-Guérin When Radical Cystectomy Is Not an Option - Session Highlights
Orlando, Florida USA (UroToday.com) James McKiernan, Columbia University, discussed options for the patient who does not respond to Bacillus Calmette-Guerin when radical cystectomy is not an option. Barriers to drug development for BCG unresponsive non-muscle invasive bladder cancer including an effective standard of care exists, novel intravesical environment, systemic therapies not generally accepted with side effects and an effective surgical pathway exists with high cure rate (AUA guidelines). There are failure definitions that have varied in the past, heterogeneous disease state, urologist unresponsiveness and poor quality of diagnosis, treatment and surveillance of this disease. There are also variable endpoints which survival is not necessarily applicable to non-muscle invasive bladder cancer. The FDA is currently considering single arm trials for drug development which will pave the way for future approval of drugs in this disease. Currently not a barrier are interest at the investigator level as well as pathways, targets and ambition to discover novel agents. Unfortunately, there is a list of past failure which include valrubicin, mitomycin C and several others. However, there are several clinical trials underway including use of targeted immunotherapy agents for the treatment of non-muscle invasive bladder cancer which will hopefully lead to improved treatment of these patients.
Presenter: James M. McKiernan, MD, Columbia University Medical Center
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