GU Cancers 2019 | The evolution of bladder cancer treatment and the immuno-oncology era

Right now, we’re not at a place where cancers that are curable with surgery are curable now with immunotherapy. That’s not where we’re at. But we’re at a place where the timing of interventions is changing. We have treatments that used to be reserved for only when patients fail surgery, for example, that are now being administered prior to surgery, so that the disease burden at surgery is less. As those treatments become better, we may be in a scenario, which would be a good scenario, to not need surgery, actually.

In bladder cancer, the main place where this will possibly have a role is in muscle invasive bladder cancer, I think. As the immunotherapies get better and we’re able to eradicate the tumors in the bladder without removing the bladder, we may be able to spare morbid operations for patients. But right now, we’re not there. We have single agent treatments that are being used for immunotherapies, or immunotherapies in combination with chemo. And still right now, the response rates are not high enough to avoid, unfortunately, organ removal or radiation to the organ.

In the non muscle invasive bladder cancer space, we also have a problem of recurrences. So it’s a different problem. In that disease state, we’re trying to prevent these tumors from coming back, and that’s the major issue for non-muscle invasive. It’s less to do with cancers progressing and killing people and it’s more to do with them recurring again and again and again and again. I think combinations of different modalities of treatments are what’s the innovation there. We’re starting to see systemic immunotherapies, which are right now still a little bit toxic. But I think they can be tailored, maybe given less frequently or lower doses, to achieve the effect we need, but with less toxicity. I think at this meeting, we saw some of that preliminary data, which is very interesting.