Bernard H. Bochner, MD, FACS, Sir Murray F. Brennan Chair in Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), discusses the potential standardization of molecular profiling in bladder cancer.

The utility of molecular profiling is in its infancy, says Bochner. However, testing has the potential to impact treatment options for many patients.

For example, molecular profiling may provide insight on potentially targetable mutations in patients who do not respond to standard treatment like intravesical therapy or those with metastatic disease who progress through first- and second-line therapy.

At MSKCC, molecular profiling is commonly used to obtain data regarding how a patient’s genomicmakeup can enhance treatment, explains Bochner. Though standardization is not ready for primetime, molecular profiling may become commonplace in the future.

Videos

Bernard H. Bochner, MD, FACS, discusses the potential standardization of molecular profiling in bladder cancer.

Dr. Bochner on Standardizing Molecular Profiling in Bladder Cancer

Bernard H. Bochner, MD, FACS, Sir Murray F. Brennan Chair in Surgery, Memorial Sloan Kettering Cancer Center, discusses future treatment strategies in early-stage nonmuscle—invasive bladder cancer (NMIBC).

It is important to understand that there are a variety of risk groups to categorize patients with NMIBC, Bochner says. High-risk patients are unresponsive to Bacillus Calmette-Guérin intravesical immunotherapy. These patients should be referred to medical oncologists because checkpoint inhibitors are starting to make headway in that space.

Moreover, it is important to treat these patients aggressively because NMIBC tends to progress to muscle-invasive disease or present with local metastases if therapy is delayed. In the near future, urologists and medical oncologists are going to work closely to understand the biology of bladder cancer in order to integrate new systemic therapies like PD-1/PD-L1 inhibitors, Bochner predicts.

Bernard H. Bochner, MD, FACS, Sir Murray F. Brennan Chair in Surgery, Memorial Sloan Kettering Cancer Center, discusses future treatment strategies in early-stage non–muscle invasive bladder cancer.

Dr. Bochner on Future Treatment Strategies in Early-Stage NMIBC

Bernard H. Bochner, MD, FACS, Sir Murray F. Brennan Chair in Surgery, Memorial Sloan Kettering Cancer Center, discusses promising targets and pathways in bladder cancer.

Immunotherapy has shown a lot of promise in bladder cancer, Bochner says. This is likely related to the high tumor mutational burden (TMB) associated with bladder cancers. In other immunogenic tumors such as lung cancer and melanoma, TMB is also considerably high. With immunotherapy, physicians are able to exploit the DNA damage repair pathway. Currently, there are 7 FDA-approved checkpoint inhibitors in bladder cancer, 5 of which are approved as second-line treatment for platinum-refractory patients, and 2 of which are approved as frontline treatment for platinum-ineligible patients.

Next-generation sequencing tests have also identified cell growth and signaling pathways that may be useful in the future. From a molecular standpoint, it is important to remember that bladder cancer is not 1 disease but a multitude of different subtypes. It is a ripe field for investigation, in which there is plenty of room for progress, Bochner concludes.

Bernard H. Bochner, MD, FACS, Sir Murray F. Brennan Chair in Surgery, Memorial Sloan Kettering Cancer Center, discusses promising targets and pathways in the treatment of patients with bladder cancer.

Dr. Bochner on Promising Targets and Pathways in Bladder Cancer

Bernard H. Bochner, MD, FACS, Sir Murray F. Brennan Chair in Surgery, Memorial Sloan Kettering Cancer Center, discusses the importance of molecular profiling in the treatment of patients with bladder cancer.

We are learning a tremendous amount about the biology of bladder cancer, Bochner says, in large part due to the advanced technology and availability of genetic testing. Importantly, bladder cancer is not 1 disease but a number of heterogeneous subtypes that can be targeted with individualized therapy. As such, the field is ripe for genetic testing that will allow for the identification of additional pathways and alterations that had not previously been considered.

There is also the need for additional biomarkers to provide prognostic and predictive value. As new therapies are developed, it is important to understand which patients will benefit and which patients will become resistant. Moreover, it is critical to identify patients who are at high risk of developing advanced disease after local therapy so that they can receive combination treatment upfront. On the other hand, patients who have a good outcome with local therapy may be able to avoid the need for systemic therapy, Bochner says.

Bernard H. Bochner, MD, FACS, chair of surgery, Memorial Sloan Kettering Cancer Center, discusses the importance of molecular profiling in the treatment of patients with bladder cancer.

Bernard H. Bochner, MD, FACS

Articles

Dr. Bochner on Standardizing Molecular Profiling in Bladder Cancer

Dr. Bochner on Future Treatment Strategies in Early-Stage NMIBC

Dr. Bochner on Promising Targets and Pathways in Bladder Cancer

Dr. Bochner on Molecular Profiling in Bladder Cancer