Targeted and immunotherapies: Boosting bladder cancer research

04 August 2015 Joel Vega

Bladder cancer is a urological malignancy that remains a challenge to both clinicians and researchers. However, recent developments indicate that targeted and immunotherapies will increasingly take a front-line role in treating this deadly disease which is considered as the fifth most common cancer in Europe.

Top cancer experts will gather in Barcelona for the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC) which annually offers an effective platform for urological cancer experts to exchange best practices and share views on the latest developments in prostate, kidney and bladder cancers and other urological malignancies.

Prof. Maria De Santis (AT) and Dr. Thomas Powles (GB) will lecture on the second day which will feature an update session on systemic treatments in bladder cancer. They will join Prof. Cora Sternberg (IT) who will discuss the role of peri-operative chemotherapy. All three speakers are well-known medical oncology experts and they anticipate non-surgical systemic treatments to occupy a more crucial role in future optimal treatment strategies for bladder cancer.

“Immune therapy is a promising new treatment in transitional cell carcinoma (TCC) of the bladder,” said Powles. “We hope that immune therapy will identify a subset of patients who get long-term benefits from immune therapy.”

De Santis, who will discuss targeted therapies, highlighted the importance of sustaining key research efforts. She is also optimistic that given current trends in research, breakthroughs can be expected in bladder cancer studies.

“I expect new diagnostic pathways to be established to speed up diagnostic procedures and reduce time from diagnosis to definitive treatment. We also hope for targeted therapies to be approved for small subgroups of patients with driver mutations,” she said.

Similar to the expectations of Powles, De Santis said immunotherapy offers potentials and she hopes that it will also become aavailable for bladder cancer patients. She anticipates that new radio-sensitizing agents and the combination of radiation with immunotherapies will improve organ preservation or lead to systemic treatment benefits.

Surgery or radical cystectomy remains the so-called “gold” standard for patients with bladder cancer to reduce high mortality rates. But the procedure is replete with complications and negatively impacts the patient’s quality of life. For systemic or medical treatment, chemotherapy is a standard option or in combination with chemo-radiation.

“It is crucial for urologists and all other disciplines to use the existing tools in the best and most efficient way. This includes the use of cisplatin-baed combination chemotherapy whenever possible, and by taking every possible action to make the patient eligible for cisplatin,” she said.

To achieve optimal outcomes, De Santis added that in the perioperative setting, urologists should consider neoadjuvant chemotherapy rather than adjuvant as more patients will be able to receive perioperative chemotherapy before the cystectomy rather than later.

She recommended that doctors take the initiative to enroll patients in trials whenever possible. “If no trials are available or open in their own institution, collaborate with departments and centers that offer clinical trials for the sake of the patients,” she said.

With regards the EMUC, De Santis noted that as a meeting focused on urological cancers, the annual EMUC fulfills an important role in linking cancer experts for in-depth discussions.

“The meeting does not only allow for a high-quality educational meeting in a multidisciplinary setting but also the interaction of disciplines and the participants themselves. We see more interaction in this meeting and discussions may go beyond the systematic lectures. In this way we help identify educational gaps, enabling us to address them,” added De Santis.

Both Powles and De Santis also share the view that bladder cancer research needs to catch up with the rest of what is being done in other fields. “Bladder cancer research has been somehow left behind,” said Powles as he mentioned that more attention will certainly aid in boosting current research efforts.

De Santis: “Research in bladder cancer should be supported as well as European bladder cancer network studies. In addition, large-scale and novel trial designs- just as in prostate cancer- might help accelerate progress in the neglected field of bladder cancer research.”

Complementary programme

During the EMUC, the European School of Oncology (ESO) will also hold on November 12 the ESO Interdisciplinary Conference. The meeting aims to examine insights on personalised approaches to prostate cancer management.

Also to be held on the same day is the 4th EAU Section of Urological Imaging (ESUI) meeting with“Imaging and Individualised Medicine” as theme.

The European School of Urology (ESU) Courses will also complement the Scientific Programme by offering two courses on the medical treatment of metastatic kidney and castrate resistant metastatic prostate cancer.

Details on the EMUC’s Scientific Programme here