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Dr. Wang on personalized treatment selection in relapsed/refractory urothelial carcinoma

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In the setting of refractory urothelial carcinoma, Jue Wang, MD, says it is essential to thoroughly understand a patient's molecular profile, comorbidities, and residual side effects from prior lines of therapy.

In this video, Jue Wang, MD, discusses the “highly personalized” treatment selection process for patients with relapsed/refractory urothelial carcinoma. Wang is a professor in the Department of Internal Medicine and a member of the Division of Hematology and Oncology at UT Southwestern Medical Center, UT Southwestern Harold C. Simmons Comprehensive Cancer Center, in Dallas.

Transcript

Based on our understanding of refractory urothelial carcinoma, we know that the traditional sequencing method—counting [and numerically labeling] lines of therapy and using trial and error—doesn’t work in this setting. So, [in the absence of that traditional sequencing method], I think that several factors can guide our treatment selection in this era in which we have multiple active agents but must account for how each patient is different; treatment selection in this era has become highly personalized and highly challenging. So, there are several practical considerations for community [physicians] to consider. Number 1, we need to know our patient, and number 2, we need to know our disease. The disease is a dynamic process. [The treatment of] refractory cancer [in urothelial carcinoma] is not something we can read in a textbook. We have to know the disease and know the patient; we have to know that patient’s vulnerabilities because we are not only dealing with the cancer, we are also dealing [with the fact that] the patient is aging and has multiple comorbidities. There are prior existing residual side effects from earlier treatments and every new treatment used has a different side effect profile. In addition, compared with the frontline therapy, you may have an overlapping side effect. So, with sequencing in this setting, we need to move away from counting the lines of therapy and assigning each treatment to a specific line, and rather, we need to consider the disease biology from the beginning. We need to understand the patient’s molecular profile and hopefully, in the future, the molecular signature. And most importantly, the key currently available factor is still the art of medicine—basically, you need to understand the patients sitting in front of you; what are their commodities? What are their residual side effects from their previous lines of therapy?…I think the goal is to consider everything—the disease burden, the pace of the disease progression, the comorbidities, and the side effects—and then, hopefully, personalize the choice of therapy for each patient. The takeaway is that not every clinical trial can answer every real-world clinical question. There’s no clinical algorithm that addresses every clinical scenario. For real-world patients, itis much more complex.

This transcript has been edited for clarity.

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