Emerging Bladder Cancer Treatments Highlighted at ASCO GU 2022

The latest bladder cancer clinical trials pivot away from two current treatments: cisplatin-based chemotherapy and cecectomy (removal of the bladder). This means you may soon have alternatives to both. However, enrolling in these trials can at times prove difficult.

Following the 2022 Genitourinary Cancers Symposium hosted by the American Society of Clinical Oncology (ASCO GU), Patient Power spoke to Tracy Rose, MD, assistant professor of medical oncology at the University of North Carolina at Chapel Hill, about the landscape of emerging treatments for bladder cancer, especially those who are ineligible for chemotherapies.

Clinical Trial Response Rates Rival Cisplatin-Based Chemo

The median age of Americans diagnosed with bladder cancer is 73, according to the National Cancer Institute. This has long posed a challenge for physicians because mature patients may have underlying medical problems that make them too frail or unable to tolerate standard care for bladder cancer, such as chemotherapy.

Several ongoing clinical trials have been looking at ways to treat bladder cancer without cisplatin-based chemotherapies. Several presented at ASCO GU are in the mid to late stages, with a number of them showing potential for becoming possible first-line treatment options. "We're seeing pathologic response rates that rival cisplatin-based chemotherapy, which is really a good sign,” Dr. Rose said.

Certain Treatments Focus on Bladder Preservation

Another key takeaway on the landscape of recent bladder cancer trials has focused on bladder preservation. For patients who are diagnosed with bladder cancer, whether they are able to keep their bladders intact is a frequent question they have for their care teams. Certain treatments require a cecectomy, which is the partial or complete surgical removal of the bladder following initial treatment.

Researchers and physicians are still trying to figure out which patients are likely to respond to other forms of treatments that do not require a cecectomy after their initial treatment, Dr. Rose said. “If we can figure out who these people are who are going to have the great responses, and then eventually avoid surgery, that's really the home run,” she said.

That being said, clinical trials examining who may be a good fit for non-surgical treatments have so far been small in number. We may need to wait until larger randomized trials come out to shed more light on who these patients are.

“I think it's both clinically proving a benefit and then also doing the biomarker analysis from large cohorts of patients before and after treatment that, hopefully, we will get there."

Dr. Rose points to promising trials around the country that combine therapies, as well as others that address bladder preservation. At any given time, there's a lot of selection available for patients to enroll in, she said.

"I would hope all new patient consultations would have clinical trials discussed as options because I think that's really how we move the field forward. It also gives patients opportunities to get the most innovative treatments we have,” Dr. Rose said.

Keeping Side Effect Profiles in Mind

Each treatment and clinical trial option has a unique side effect profile. In some ways, we're lucky that a lot of the therapies have specific side effect profiles that don't overlap, Dr. Rose said. From a patient perspective, considering what medical problems you have may help influence which treatment is right for you, she added.

Still, it becomes challenging for patients with many medical problems who may not be eligible for clinical trials. "That’s a big area of unmet need that, as a field, we need to be more inclusive about what patients are able to enroll on trials,” Dr. Rose said. “But there is still a lot of opportunity.

This article was originally published March 28, 2022 and most recently updated March 29, 2022.
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