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The Future of Bladder Cancer Research

Panelists: Daniel P. Petrylak, MD, Yale University Cancer Center; Dean F. Bajorin, MD, Memorial Sloan Kettering Cancer Center; Robert Dreicer, MD, MS, Virginia Cancer Center; Arjun V. Balar, MD, Laura and Isaac Perlmutter Cancer Center; Elizabeth R. Plimack, MD, MS, Fox Chase Cancer Center; David I. Quinn, MBBS, PhD, USC Norris Cancer Hospital
Published Online: Thursday, May 04, 2017



Transcript:

Daniel P. Petrylak, MD:
There’s certainly a lot of hope for the future for bladder cancer, particularly with new agents. This has really been a great discussion. I’ve really enjoyed this and learned a lot. I’d like to talk to each of our panelists about just simply summarizing what their thoughts are on bladder cancer. We’ll start with Dr. Quinn first.

David I. Quinn, MBBS, PhD: I think in the last 3 years, we’ve gone from pessimism and hope to starting to deliver for our patients and our community oncologists. The challenge we have is that we’ve thrown up a lot of questions. You hear us talk today about all these things and about how uncertain we are, and I think we’ve got our major challenges. And I hope that today will help the community oncologists work through some of these things.

Daniel P. Petrylak, MD: Arjun?

Arjun V. Balar, MD: I would agree with Dr. Quinn. I think what we observed over the last 2.5 to 3 years is, frankly, more progress than we’ve done previously in the last 30 years. And me being young in this field, I feel pretty lucky to be part of this wave rather than not so much the earlier wave. And to see patients coming in to our clinics that we can offer therapies that we previously could not before—patients in their elderly high 80s, young 90s, and these are patients who previously would never have received any form of therapy who are now coming in for therapy and living vibrant lives—I think that part is the most promising aspect. Obviously, there’s much more work to be done. The challenges that lay ahead are obviously how to define the next set of combinations and, obviously, how to manage toxicities and safety, make sure we’re doing these things safely.

Daniel P. Petrylak, MD: Betsy?

Elizabeth R. Plimack, MD, MS: I agree with both those things. I think one of the most encouraging things to come out of all the data that we’ve talked about is that we’ve accrued an amazing number of trials answering important questions in a very short period of time. And I think if you had told all of us 3 years ago that you could accrue 300 patients to a bladder cancer trial in less than a year, no way. And it’s happening. It’s happening because we have drugs that really hold promise. And I think, hopefully, we can keep that going. We’ve outlined a number of important questions in the field as part of this discussion. Those require well thought out, well designed clinical trials. There are, fortunately, a limited number of patients with bladder cancer, and I think we really need, as a field, to prioritize the important questions and continue to enroll patients to trials as we have.

Daniel P. Petrylak, MD: I think those are great points. Dean?

Dean F. Bajorin, MD: I think the greatest thing for a medical oncologist, in sitting with a patient, is that you’re both on the same page. And there’s enthusiasm on behalf of patients for therapy that’s nontoxic, and there’s enthusiasm for us. It’s in concert. That is actually a pleasure now compared to sometimes confronting patients with toxic chemotherapy. And so, what we know, for example, is it’s less toxic and it’s not going to encumber the patient to the same degree as before. We can treat elderly patients who really have concern about toxicity. It’s for the family members who bring in older patients who know that they have to deal with the toxicities at home. And then, the last thing is that you can actually offer a therapy that is less toxic but has the opportunity for durable long-term complete response, something that we just didn’t see in these settings before. And that is an absolute sea change, and it’s great to be part of it.

Daniel P. Petrylak, MD: Rob?

Robert Dreicer, MD, MS: As an older GU medical oncologist, one of the things—with all that has been said is true, of course—is to the next generation of urologic oncologists, several sitting on this panel, who are incredible thought leaders who are going to take advantage of the rapid development in science. I’m going to try to hang around long enough to continue to help folks. So, that’s my take on this.

Daniel P. Petrylak, MD: Absolutely. I think Betsy’s point about the explosion and growth in bladder cancer, certainly, in looking at the other 2 GU tumors—prostate cancer and kidney cancer—this has been really quite remarkable quite fast. And some of us at this table run around, go to, and remember some of the wonderful comments we had over the years. And I think back to comments at the plenary session at ASCO. It was 1988 or 1989 about just simply cisplatinum versus MVAC. We’ve come a long way since that time, and I think we’re all really, really proud that we’re able to say that we have new treatments for our patients. And we’re really grateful that we can participate in their care and participate in new trials that can improve their treatment. We thank you all for your contributions to this discussion. On behalf of our panel, we thank you for joining us. We hope that you found this Peer Exchange® discussion to be useful and informative.

Transcript Edited for Clarity

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Transcript:

Daniel P. Petrylak, MD:
There’s certainly a lot of hope for the future for bladder cancer, particularly with new agents. This has really been a great discussion. I’ve really enjoyed this and learned a lot. I’d like to talk to each of our panelists about just simply summarizing what their thoughts are on bladder cancer. We’ll start with Dr. Quinn first.

David I. Quinn, MBBS, PhD: I think in the last 3 years, we’ve gone from pessimism and hope to starting to deliver for our patients and our community oncologists. The challenge we have is that we’ve thrown up a lot of questions. You hear us talk today about all these things and about how uncertain we are, and I think we’ve got our major challenges. And I hope that today will help the community oncologists work through some of these things.

Daniel P. Petrylak, MD: Arjun?

Arjun V. Balar, MD: I would agree with Dr. Quinn. I think what we observed over the last 2.5 to 3 years is, frankly, more progress than we’ve done previously in the last 30 years. And me being young in this field, I feel pretty lucky to be part of this wave rather than not so much the earlier wave. And to see patients coming in to our clinics that we can offer therapies that we previously could not before—patients in their elderly high 80s, young 90s, and these are patients who previously would never have received any form of therapy who are now coming in for therapy and living vibrant lives—I think that part is the most promising aspect. Obviously, there’s much more work to be done. The challenges that lay ahead are obviously how to define the next set of combinations and, obviously, how to manage toxicities and safety, make sure we’re doing these things safely.

Daniel P. Petrylak, MD: Betsy?

Elizabeth R. Plimack, MD, MS: I agree with both those things. I think one of the most encouraging things to come out of all the data that we’ve talked about is that we’ve accrued an amazing number of trials answering important questions in a very short period of time. And I think if you had told all of us 3 years ago that you could accrue 300 patients to a bladder cancer trial in less than a year, no way. And it’s happening. It’s happening because we have drugs that really hold promise. And I think, hopefully, we can keep that going. We’ve outlined a number of important questions in the field as part of this discussion. Those require well thought out, well designed clinical trials. There are, fortunately, a limited number of patients with bladder cancer, and I think we really need, as a field, to prioritize the important questions and continue to enroll patients to trials as we have.

Daniel P. Petrylak, MD: I think those are great points. Dean?

Dean F. Bajorin, MD: I think the greatest thing for a medical oncologist, in sitting with a patient, is that you’re both on the same page. And there’s enthusiasm on behalf of patients for therapy that’s nontoxic, and there’s enthusiasm for us. It’s in concert. That is actually a pleasure now compared to sometimes confronting patients with toxic chemotherapy. And so, what we know, for example, is it’s less toxic and it’s not going to encumber the patient to the same degree as before. We can treat elderly patients who really have concern about toxicity. It’s for the family members who bring in older patients who know that they have to deal with the toxicities at home. And then, the last thing is that you can actually offer a therapy that is less toxic but has the opportunity for durable long-term complete response, something that we just didn’t see in these settings before. And that is an absolute sea change, and it’s great to be part of it.

Daniel P. Petrylak, MD: Rob?

Robert Dreicer, MD, MS: As an older GU medical oncologist, one of the things—with all that has been said is true, of course—is to the next generation of urologic oncologists, several sitting on this panel, who are incredible thought leaders who are going to take advantage of the rapid development in science. I’m going to try to hang around long enough to continue to help folks. So, that’s my take on this.

Daniel P. Petrylak, MD: Absolutely. I think Betsy’s point about the explosion and growth in bladder cancer, certainly, in looking at the other 2 GU tumors—prostate cancer and kidney cancer—this has been really quite remarkable quite fast. And some of us at this table run around, go to, and remember some of the wonderful comments we had over the years. And I think back to comments at the plenary session at ASCO. It was 1988 or 1989 about just simply cisplatinum versus MVAC. We’ve come a long way since that time, and I think we’re all really, really proud that we’re able to say that we have new treatments for our patients. And we’re really grateful that we can participate in their care and participate in new trials that can improve their treatment. We thank you all for your contributions to this discussion. On behalf of our panel, we thank you for joining us. We hope that you found this Peer Exchange® discussion to be useful and informative.

Transcript Edited for Clarity
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