Bladder Cancer Academy 2017: Genitourinary Oncology: A Peek Over the Horizon

Schaumburg, IL (UroToday.com) Dr. Theodorescu, gave a talk concluding the bladder cancer academy meeting, adding some important points that were not mentioned during the day. There are 3 different biomarker classes: predisposition, prognostic (assessing disease aggressiveness), and predictive (assessing therapy response).

Usage of the 3 classes of markers together with targeted drugs is the essence of precision oncology. Biomarkers can be DNA derived from normal tissue, RNA derived from tumor tissue, protein derived from blood, and metabolotome derived from urine for example.

The major clinical challenges in bladder cancer include:

Optimization of surveillance of non-muscle invasive bladder cancer (NMIBC) and try to predict natural history, including recurrence and progression.
Reduction of mortality of muscle invasive bladder cancer (MIBC) / metastatic disease. It is important to identify patients with occult nodal metastasis. It is also important to identify high risk patients that are also responders to systemic therapy. Lastly, it is crucial to recognize therapeutic targets and new drugs.

Most NMIBC have FGFR3 mutations, which are associated with improved prognosis. This can certainly be used as a surrogate to ascertain which NMIBC will not progress. When looking at MIBC, there is less than 20% adoption of neoadjuvant chemotherapy (NAC). It is important to try and see if we can increase NAC adoption by limiting treatment to high risk patients, and also see if we can identify the high risk patients that will respond to NAC. For this purpose, next generation sequencing (NGS) has accelerated biomarker discovery and targeted therapy trial developments in bladder cancer.

In summary, Dr. Theodorescu reiterated the importance of molecular profiling of patients at high risk for bladder cancer, enabling us to administer molecular guided therapy, and molecularly perform guided follow-up.

Presented By: Dan Theodorescu, MD, University of Colorado, Comprehensive Cancer Center, Aurora, CO

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
Twitter: @GoldbergHanan

at the 2017 Bladder Cancer Academy - June 9 - 10 - Schaumburg, Illinois, USA

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