Tag Archive for: non-muscle invasive bladder cancer

Exciting Developments in Bladder Cancer Treatment Advances: Muscle-Invasive and Non-Muscle-Invasive Care

Dr. Randy Vince from University Hospitals Cleveland Medical Center outlines the latest advancements in bladder cancer treatment, highlighting two key shifts in the standard of care: the increasing use of immunotherapy for muscle-invasive bladder cancer and the growing adoption of bladder preservation strategies through chemoradiation. Learn more about Dr. Randy Vince.  

[ACT]IVATION TIP

“Yes. So I’m a big believer in education, education, education. So, for patients specifically, I like to say, you know, again, know everything and please try to understand everything about cancer diagnosis. So, specifically, when we talk about cancer stage. And this goes back to the muscle-invasive versus non-muscle-invasive bladder cancer, because the treatment options vary drastically depending on whether or not you have non muscle-invasive bladder cancer versus muscle-invasive bladder cancer.”

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Transcript:

Lisa Hatfield:

Dr. Vince, could you share the latest advancements in bladder cancer treatment, and are there any emerging developments that have the potential to significantly change the standard of care?

Dr. Randy Vince:

Yeah. So, you know, typically what we think of when we talk about bladder cancer treatments is we divide bladder cancer into what we call muscle-invasive or non-muscle-invasive. And so, when it comes to the treatments, we base those treatments based off of what category you may fall in. But in recent years, there have been a number of advancements for bladder cancer treatment. One of the notable developments is the use of what we call immunotherapies. These are typically in patients who have muscle-invasive bladder cancer, but it provides an alternative to the chemotherapy regimens that we relied on in the past, which a lot of patients did not tolerate.

So, these immunotherapies give us the ability to fight off the cancer. While most patients are able to tolerate these medications with much more ease than they were with chemotherapy. The other thing that I think about is in the same realm as muscle-invasive bladder cancer is now we have bladder preservation options. Whereas before, when I was initially training, if someone had muscle-invasive bladder cancer, that meant that they would either get what we call neoadjuvant chemotherapy, which just means before treatment, their main treatment, get chemotherapy before that, followed by bladder removal and some type of diversion of the urine.

Dr. Randy Vince:

Whereas now we have the ability to give what we call chemo radiation, which is a combination of chemotherapy and radiation to the bladder. So, that way patients don’t have to lose their bladder. So, we allow bladder preservation while still being able to give treatment that is curative in nature. So, I think that has been two of the most recent advances when it comes down to shifting the paradigm of how we treat patients with bladder cancer.

Lisa Hatfield:

Okay, thank you. And one, follow-up to that. So, when you talk about bladder preservation, is that the standard of care now, or is that something that a patient would need to ask their oncologist about?

Dr. Randy Vince:

Yeah, so actually, you know, a lot of cancer guidelines that are published nationally by, you know, national institutions or national organizations like the NCCN, for instance. This is now in the guidelines where patients can have this therapy, and it’s recommended. Now, there are select patients who fall in the category that are eligible for chemo radiation. But this should be something that’s discussed in addition to, you know, more invasive treatments, like what we call a radical cystectomy, which is just removal of the bladder.

Lisa Hatfield:

Okay, thank you. And do you happen to have an [ACT]IVATION tip for this question?

Dr. Randy Vince:

Yes. So I’m a big believer in education, education, education. So, for patients specifically, I like to say, you know, again, know everything and please try to understand everything about your cancer diagnosis. So, specifically, when we talk about cancer stage. And this goes back to the muscle-invasive versus non-muscle-invasive bladder cancer, because the treatment options vary drastically depending on whether or not you have non muscle-invasive bladder cancer versus muscle-invasive bladder cancer.

So, for those with non muscle-invasive bladder cancer, we typically do intravascular therapies, which means instilling medication in the bladder versus the more aggressive treatments that we do for people with muscle-invasive bladder cancer. So, know your stage and try to know everything you can about your diagnosis.

Emerging Approaches in Bladder Cancer Treatment

Emerging Approaches in Bladder Cancer Treatment from Patient Empowerment Network on Vimeo.

Dr. Shilpa Gupta of the Cleveland Clinic shares a promising update in bladder cancer treatment and research, including the benefits of patient participation in clinical trials. 

Dr. Shilpa Gupta is the Director of the Genitourinary Medical Oncology at Taussig Cancer Institute and Co-Leader of the Genitourinary Oncology Program at Cleveland Clinic. Dr. Gupta’s research interests are novel drug development and understanding biomarkers of response and resistance to therapies in bladder cancer. Learn more about Dr. Gupta, here.

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Transcript:

Katherine:                  

So, Dr. Gupta, are there emerging approaches for treating bladder cancer that patients should know about?

Dr. Gupta:                  

Yes, absolutely. I would say that the field is so rife with so many different treatment approaches and ways to offer more personalized medicine. We know, for example chemotherapy followed by surgery has been the gold standard, but we have seen data that there are certain genes in some patients’ tumors which may predict how well they will respond and potentially we could avoid a life-changing surgery like cystectomy.

And we have trials with immunotherapy adding to chemotherapy in bladder preservation approaches along with radiation. So, these are some of the new work that’s been done. Approaches to intensify the effect of BCG in newly diagnosed non-muscle invasive bladder cancer patients are also ongoing. Then, in the metastatic setting, we have so many treatment options that have become approved in the last couple of years, now the goal is, well, how to sequence the therapies best for the patient and whether in the front-line therapy we can actually get rid of chemotherapy.

Some of these antibody drug conjugates and immunotherapy combinations are proving to be very effective and the hope is that one day patients may not need chemotherapy because we have chemo-sparing regimens. So, there’s a lot going on and I think the progress has been tremendous in the past few years.                                            

Katherine:                  

Some patients may be fearful when it comes to clinical trials. So, what would you say to someone who might be hesitant to consider participating in one? 

Dr. Gupta:                  

I would say there’s a lot of misconceptions out there that going on a trial is like being a guinea pig or you get a placebo. For the most part, patients are getting active drugs whenever possible. The only time where we have placebo-controlled trials is if, for that particular setting, there is no approved treatment. But I think patients should get all the information from their doctors and the study teams about the pros and cons.

Many times, it’s about – you could do the study because the patients meet the criteria and are fit to do it and if they wait for later, they may not be eligible anymore for whatever reasons.

I always put it this way, that standard of care therapies will still be available, but studies are sometimes with a tight window and tight criteria. So, I think patients should know that all these studies that are out there are very ethical and use the best possible control arm. So that even if they don’t get that experimental drug, they still get what is the standard of care unless it is something really being compared to nothing.