High hopes for advances in bladder cancer treatment

At the upcoming 7th European Multidisciplinary Meeting on Urological Cancers (EMUC) in Barcelona, Spain from November 12 to 15, onco-urological experts from and outside Europe will again gather to tackle challenging treatment issues in urological malignancies and identify best practices in multi-disciplinary care.

Organised by three front-line professional organisations- the European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU)- the EMUC provides a platform for various cancer experts where they can share insights and exchange knowledge on how best to deliver optimal care.

Bladder cancer (BCa), which in recent years have shown high mortality rates in Europe and elsewhere, is one of the key topics in the four-day meeting, with diagnostics, medical and surgical therapies among the major points in the agenda. In Europe bladder cancer is considered the fifth most common cancer with more than 151,000 new cases diagnosed in 2012, compared to around 60,000 new cases of bladder cancer diagnosed annually in the United States, or approximately 13,000 deaths every year.

“I expect much more (developments) in the field of non-muscle invasive bladder cancer (NMIBC) compared to muscle invasive bladder cancer (MIBC). Actually NMIBC is our real challenge in daily practice in the western world,” said Prof. Morgan Roupret (Paris, FR) who will deliver an update lecture on BCa treatment strategies. “With the advent of new technologies combined with endoscopic access to the bladder for easier diagnosis, better treatment becomes a reality.”

Currently, the combined use of 5-ALA (Hexvix) and blue light cystoscopy is of great help to depict and detect more flat lesions in daily practice. However, he expects even more advances ahead mentioning technologies such as in-vivo non-contact and ultraviolet excited autofluorescence measurements that are converted into simple color-coded images-- diagnostics that improve or provide more efficient current detection methods. “It is already a reality. If this is converted from bench-to-beside, this will not only avoid bladder instillation but also depict flat lesion and provide direct endoscopic diagnosis,” he added.

But there are tough challenges ahead since bladder tumours have high recurrence rates that are often deadly, prompting doctors to resort to more radical treatment options.

“Some of the current challenges in bladder cancer management are to increase the detection of non- muscle invasive bladder cancer and especially flat lesions, to reduce residual tumors, reduce recurrence rate and to enhance the quality of the follow-up,” Roupret explained.

“The detection of carcinoma in-situ (i.e. flat lesion) can be improved due to technological advances and recent discoveries in molecular knowledge of carcinoma in-situ,” he added, noting that the challenge for specialists, such as urologists, is proper diagnostics and assessment of individual cases.

“After initial diagnosis of non-muscle invasive bladder cancer (NMIBC), up to 70% of these tumors are likely to recur. Urologists have to understand that the risk stratification is crucial and these tumours are often misclassified. Keep in mind that over 40% of NMIBC are multi-focal at initial diagnosis,” according to Roupret.

With treatment in the hands of many cancer experts such as medical oncologists, radiotherapists and urologists, Roupret acknowledged the crucial role that multi-disciplinary collaboration plays in delivering optimal treatment.

“If we want to provide symptom control whilst respecting patients’ co-morbidities, a ‘tailor-made’ treatment is mandatory,’ said Roupret. “This personalised medicine cannot be fulfiled without the help of other colleagues and clinicians in the field who are likely to bring their own perspective and strategy.”

He is convinced that collaborative links are key to achieve the most efficient way to improve patient care.

“Bottom line is I only see positive aspects in multidisciplinary team decisions,” he said while underscoring that effective treatment hinges on close coordination among experts. “It is necessary to establish a coherent strategy, follow the evidence and consider the experience of other experts which can only raise the level of medical care.”

Regarding the role of meetings like the EMUC, Roupret noted the vital role of organising meetings that are focused on specific areas of expert care.

“EMUC is, in fact, a "super multi-disciplinary team" and expert meeting that involve the best experts worldwide,” he said. “The meeting is an opportunity to gain experience, updates and key messages from the best of the best, and from a multidisciplinary perspective on how to deal with difficult cases. In fact, all the cases for which you cannot find a solution with currently available clinical EAU guidelines and which could only lead to a dead end.”

This year, and for the first time, the European School of Oncology (ESO) will also hold during the EMUC the ESO Interdisciplinary Conference to examine insights on personalised approaches to prostate cancer management. Also to be held on the EMUC’s opening day on November 12 is the 4th EAU Section of Urological Imaging (ESUI) meeting with “Imaging and Individualised Medicine” as theme.

Courses organised by the European School of Urology (ESU) will also complement the Scientific Programme’s focus on the medical treatment of metastatic kidney and castrate resistant metastatic prostate cancer, future prospects and the impact of the latest outcomes from research studies.

More information on the EMUC 2015 Scientific Programme >