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Adaptive planning and other advances in bladder-preserving treatments


In this video, Sophia C. Kamran, MD, discusses the most promising future treatments in bladder-preserving therapy. Kamran is a radiation oncologist at the Massachusetts General Hospital Cancer Center and Assistant Professor of Radiation Oncology at Harvard Medical School, Boston, Massachusetts.


What are the most promising future treatments in this area?

I think for bladder-sparing therapy, the radiation [treatment will] continue to improve. One thing that’s exciting is something called adaptive planning. This uses our radiation technology, but we adapt a patient’s radiation plan [daily] based on their anatomy, and we incorporate the use of AI [artificial intelligence] in that technology. We always get scans for patients [who] are undergoing radiation therapy, and then we use that scan that is day-of anatomy to adapt their plan, and then that helps to improve their overall treatment plan for that day. Because on a day-to-day basis, you can imagine that there could be subtle differences in gas patterns, bladder filling patterns, and slight movements. They’re very subtle, but that can make a big difference going forward, especially when we’re becoming so much more targeted, and we want to be much more accurate. So, because of that, that’s being incorporated more…. And we’re evaluating that very closely with regard to bladder-sparing treatment. This may allow us to actually dose-escalate the radiation treatment in conjunction with immunotherapy….[W]hen we tried to give a higher dose per day, in conjunction with immunotherapy, we had to stop that because it was found in several early phase 1 trials that there was a lot of toxicity and it really wasn’t safe. The toxicity was mostly gastrointestinal related. That’s not too surprising—the bowel is there; the rectum is there. There are a lot of critical organs in that area. So if we use adaptive planning, and we really try to reduce the dose that’s going to the rectum or to the bowel, because we can see it on a day-to-day basis, we may be able to give that higher dose per day in conjunction with something like an immunotherapy if that’s what we plan to do. And that may be safe; that may be the way to get around the toxicity that was seen in the early phase 1 trials when you try to give a higher dose of radiation per day with immunotherapy. So, I think…that’s going to continue to grow. And I think we’re going to see a lot more of that in the future. And then I think that we’re going to continue to try to incorporate unique therapies to improve upon outcomes with bladder-sparing therapy….[T]he ongoing NRG/SWOG 1806 trial is looking at the incorporation of immunotherapy. I think that there’s going to be some excitement with trying to move antibody-drug conjugates into earlier treatments…in the muscle-invasive space, perhaps, in conjunction with the radiation therapy. So, I think that we’re going to see more of both of those things to really improve upon bladder-sparing therapy for patients going forward.

This transcript was edited for clarity.

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