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Dr. Patel on the biggest unmet needs in the bladder cancer space


“The more and more people we can get excited about this and collaborate with, the better results we're going to get and the more we're going to learn,” says Sunil H. Patel, MD, MA.

In this video, Sunil H. Patel, MD, MA, highlights current unmet needs in understanding the carcinogenesis of bladder cancer, which was discussed during a session that took place at the Bladder Cancer Advocacy Network (BCAN) Think Tank titled, “Carcinogenesis of Bladder Cancer: Exploring/Uncovering Environmental and Internal Risk Factors.” Patel is an associate professor of urology and oncology at Johns Hopkins University School of Medicine in Baltimore, Maryland.

Video Transcript:

I think that's what the session is going to tie in. So, like I mentioned before, I think we've done really well in this bladder cancer setting, and [to] much of the credit of all the physicians, the medical oncologists, the urologists, and PhD scientists, who've done all that and all the patients who have enrolled in these clinical trials. I think we've made great strides. Where the unmet need is still, bladder cancer is a very laborous, time-consuming cancer to take care of. One of the most expensive cancers to take care of due to frequent cystoscopies and surveillance.

The vast majority of patients are non–muscle-invasive, so about 75% to 77%. Only 20% to 25% are muscle-invasive. The vast majority are non–muscle-invasive. If we can prevent patients from developing that, that will take away a lot of the burden that the healthcare industry has on bladder cancer surveillance and also from a patient standpoint too, frequent cystoscopies [and] intravesical therapy do have their [adverse] effects. We're learning more and more about that and we're doing clinical trials and studies about how to better the patient experience with transurethral resections of bladder tumors, cystoscopies, and intravesical therapies. I think the next step is if we can mitigate that and decrease that number, we will decrease the healthcare burden and increase patient satisfaction if we can prevent it from happening. That's where my thought process is and a lot of other physicians and other medical oncologists and even patients and other urologic oncologists like myself. What we want to do is figure out ways we can prevent it.

In these types of research, especially in environmental research, they are quite difficult to do. There are a lot of variables that we have to think about. The common question that I always get asked when I see patients in clinic is "Dr. Patel, how did this happen?" Or "Why did I develop this?" You go through, "Are you a smoker or secondhand smoked? Did your parents smoke, were exposed to a lot? What do you do for work? What medications have you taken?" We see a lot of patients who do not have any risk factors. So, you're left with "Okay, what do we do?"

Most recently, I saw some patients under the age of 40 developing bladder cancer, why are they developing bladder cancer? Do they have a germline mutation? What caused that? What stressors did they have? And I think what we can do better is some good multicenter collaborative work on this. This is not going to rely on just a medical oncologist and a urologist; this is going to require environmentalists, statisticians, public health care officials, patients. And luckily, I've been in good communications with firefighters across the United States, our veterans and [those in] active military duty because they're exposed to a lot of things. They're cancer incidence rates are relatively higher than the average population.

So, I think the next steps and the bigger needs is really working together as a big group, like how the Think Tank is, coming together from all different areas. You're going to see this session actually has a veterinarian who has done a lot of work in the canine model for bladder cancer and environmental exposures. Utilizing other people's expertise from that model, looking at genetic background, looking at the intrinsic urinary microbiome and looking at the external factors and working together as a multi-discipline collaborative group, that's going to make the best strides forward to really help us understand that. I think that's the biggest need in my opinion.

It's just going to take time. But I think we've come together over the last couple of years to think about this and be like, "Hey, this is something that's important." And I think that the more and more people we can get excited about this and collaborate with, the better results we're going to get and the more we're going to learn.

This transcription has been edited for clarity.

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