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Enrique Grande, MD Anderson Cancer Center, Madrid, Health News, ET HealthWorld

Shahid Akhter, editor, ETHealthworld, spoke to Enrique GrandeHead, MD Anderson Cancer CenterMadrid, to know more about the incidence of bladder cancer and the challenges associated with it.

Bladder Cancer:Trends
Bladder cancer is one of the most common tumors that we have worldwide. This is between the 9th and 11th most frequent tumor in the world. The frequency heavily depends on the region, and this type of cancer is associated with the age and the smoking habits of an individual. Unfortunately, due to the change in lifestyle, there has been an increase in the trend of new cases of bladder cancer in recent years.

Thankfully, most of the bladder cancer cases are being diagnosed in the earlier stages. Our estimate is that around 70% of the patients with bladder cancer are diagnosed while the disease is still present in the bladder, so patients can be operated on and cured. On the other hand, for patients with metastatic failure carcinoma or bladder cancer, we now have a new standard of care to treat them systemically.

Bladder Cancer: Standard of Care
Traditionally, we offered cisplatin- or carboplatin-based chemotherapy for treatment, but this did not change the levels, and now we have a new reference standard of care that includes the option of four to six cycles of these platinum-based chemotherapy and provides the patient with the opportunity to leave with avelumab as a mandated strategy.

In the past, our strategy was completely different, where we would stop the chemotherapy and wait for the tumor to progress again, but now, with the use of immunotherapy as a mandated strategy, we have seen an improvement in the overall survival rates. Due to the good tolerability of immunotherapy, we have seen that these patients are living more comfortably.

Bladder Cancer: Challenges
However, we have to face a lot of challenges in our journey. One of the main challenges is the lack of reliable biomarkers to predict the efficacy of not only chemotherapy but also immunotherapy. The patients with metastatic urothelial carcinoma are changing the arsenal of drugs and the algorithms that we treat patients with when they have developed metastasized tumors.

But today, we know that these newer options are moving to earlier stages of the disease, in which the tumor is still in the bladder. There is a lot of research coming through the field on ways in which we can avoid the use of size technology and help in the removal of the bladder; this will dramatically change the quality of life of our patients. as we won’t have to operate the bladder and change the daily practices.

Urologists, oncologists, pathologists, and radiologists must work together to try and ensure that all those patients with primary tumors located in the bladder have the opportunity to preserve the bladder. In addition to this, most of the patients are diagnosed in the earlier stages, where they ensure that the cancer is not infiltrating the muscle.

Bladder Cancer: Research Outlook
We have new devices that settle inside the bladder and slowly release medications, including not only the classical BCG but also immunotherapy and chemotherapy, which contribute to controlling the local spread of non-muscle-invasive bladder cancer. We are hopeful that, in the future, a cystectomy will not be needed anymore because of the activity of the treatments.

Bladder Cancer: Future
For patients with metastatic urothelial carcinoma, we have a new horizon where a new set of drugs will be coming and adding to our armamentarium to treat these patients with novel antibody drug conjugates. These antibodies act like Trojan horses in the sense that they will be binding to the tumor cell and, on the other hand, they will bring chemotherapy treatment with them. The chemotherapy will inject itself inside the tumor cells, and we will soon be able to use it in the clinics, and it will soon be available in countries like India.

In addition to precision medicine entering the field of urothelial carcinoma, we know that patients with molecular alterations affecting the gene encoding for the fibroblast growth factor receptor are important to take into consideration because of the new development of FGFR inhibitors, which will target these patients with mutations affecting the FGFR-3 gene. On top of that, we have the combination of novel antibody drug conjugates, immunotherapy, FGFR inhibitors, blast immunotherapy, and all the new drugs that are coming into these fields shortly. Hopefully, in the future, we will not only have one or two lines of systemic treatment to offer, but at least three, four, or five different lines to offer in order to contribute to an improvement in the overall survival rate and increase the quality oflife.

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