Recent Advancements Have Disrupted the Field of Bladder Cancer, Says Dr Alexander Kutikov

With new treatments and better risk stratification, there is increasingly more opportunity for bladder-sparing strategies in bladder cancer, said Alexander Kutikov, MD, FACS, chair, Department of Urology, Fox Chase Cancer Center.

Transcript

What did you discuss in your session about organ preservation in patients with bladder cancer?

The best bladder is one's own, and what are the strategies in 2024 in actually saving one's bladder even when there's aggressive disease? We reviewed the state-of-the-art that is currently available, which is neoadjuvant chemotherapy and risk stratification and really predicting whether there is residual disease after chemotherapy and its challenges. For instance, there's a prospective trial¹ that we did at the Fox Chase Cancer Center where we showed that that even though we would scrape the scar and do systematic biopsies and see nothing on endoscopic examination, about 25% of those patients harbored submucosal bladder cancer. And we talked about strategies of how to improve that prediction, but also discussed that if patients are appropriately stratified and appropriately counseled on the risks, there are opportunities to spare their bladders with or without delivering radiation to the bladder.

What advancements have we seen in bladder-sparing treatment?

The field has really been disrupted by enfortumab vedotin plus pembrolizumab data² showing how remarkably superior those systemic therapy strategies are over cisplatin-based chemotherapy. This is in the metastatic setting, but now there are trials being done in the neoadjuvant setting [and] in the localized muscle-invasive setting. I think there's a lot of hope there that we can offer patients bladder-sparing approaches following systemic therapy, but that chapter is not yet written. The data are still not there, but clinically we're seeing incredible responses.

References

1. Zibelman M, Asghar AM, Parker DC. et al. Cystoscopy and systematic bladder tissue sampling in predicting pT0 bladder cancer: a prospective trial. J Urol. 2021;205(6):1605-1611. doi:10.1097/JU.0000000000001602

2. McNulty R. FDA approves enfortumab vedotin plus pembrolizumab for locally advanced or metastatic bladder cancer. The American Journal of Managed Care. December 18, 2023. Accessed May 7, 2024. https://www.ajmc.com/view/fda-approves-enfortumab-vedotin-plus-pembrolizumab-for-locally-advanced-or-metastatic-bladder-cancer