EAU15: Trends in bladder cancer treatment
Bladder cancer is a common urological malignancy but is much more complex compared to others because of multiple mutations in cells. Moreover, treatment is expensive because of the high risk of recurrence and the cost of cystoscopies.
During Thematic Session 6dedicated to bladder cancer, novel findings in diagnostics and treatment with BCG were discussed. Prof. Torben Orntoft (DK) presented his work on searching for biomarkers in body fluids. Since bladder cancers consist of different populations, traditional biopsies are less reliable and liquid biopsies may be more useful. Orntoft suggested urine as a potential option for liquid biopsy.
The advantages are that collecting a urine sample is non-invasive and that it represents all, or close to all, tumour parts. The disadvantages are that it can be time consuming to collect urine samples and that they are non-homeostatic due to varying concentrations, pH value and content. In the future, urine samples can be used for identifying prognostic and surveillance biomarkers.
Related to this, Prof. Christopher Probert (GB) presented his work on sniffing cancer- or how dogs have demonstrated the ability to smell cancer and how, based on this principle, his team has developed a device which can identify the presence of cancerous tissue by analysing urine. By using gas chromatography–mass spectrometry (GCMS), the device distinguishes bladder cancer from controls in 95% of cases.
Prof. Dr. Maximilian Burger (DE) and Dr. Kay Thomas (GB) debatedwhether or not BCG is still the gold standard in bladder cancer treatment. Burger argued that it is the gold standard based on three arguments: the data supporting BCG may be old, but it is solid; to date there is no effective alternative, although some important study data are coming out soon. He added that BCG is a true and effective therapy for bladder cancer.
Thomas, in turn, noted that response rates of BCG are low when it is used as a single agent. Instead, she made a case for a combined regime with BCG and mitomycin C (MMC). She presented data which show that BCG works better in combination with MMC and results in a reduced recurrence rate, although there is no difference in disease progression.
After the debate, a show of hands revealed that Thomas had convinced majority of the audience to consider switching to combined therapy. Even Burger raised his hand and explained that he believes change is coming but added that “to date, the data of combined treatment are not convincing,” and thus BCG remains his treatment of choice.