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Expert discusses progress made in understanding the development of bladder cancer

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“I think we're thinking about bladder cancer in a different mindset,” says Sunil H. Patel, MD, MA.

In this video, Sunil H. Patel, MD, MA, discusses progress that has been made in understanding the development of bladder cancer, touching on points that will be discussed during an upcoming session at the Bladder Cancer Advocacy Network (BCAN) Think Tank titled, “Carcinogenesis of Bladder Cancer: Exploring/Uncovering Environmental and Internal Risk Factors.” The BCAN Think Tank will be held from August 2–4, 2023 in Washington DC. Patel is an associate professor of urology and oncology at Johns Hopkins University School of Medicine in Baltimore, Maryland.

Video Transcript:

Bladder cancer has gone through numerous shifts. If you look back 15 years ago, we were behind the 8 ball, so to speak, in treating bladder cancer and understanding other causes. We've done a lot, and we've made a lot of headway in the advanced bladder cancer setting with immunotherapies and second-, third-line, fourth-line medications, and we're making a lot of progress on that. But now, we want to look at the pendulum shift in preventive medicine.

Dr. [Bishoy M.] Faltas at Cornell has done a lot of the work in germline testing, and he's teamed up with colleagues at the University of Washington as well. He's pioneered germline testing in bladder cancer. He published a paper in 2020 in Nature Communications, and they developed this computational framework that distinguished putative germline variants in a large number of urothelial carcinoma patients in the advanced setting. With his team, he's developed this model to isolate and look at that. That's going to be the next step in preventative medicine, in bladder cancer, and looking at these patients that are potentially higher risk from the get-go with a germline mutation.

These patients with germline mutations, they're essentially starting with almost 1 step behind. How can we prevent those patients from developing bladder cancer? The thought process is, and these are the conversations I've had with Dr. Faltas as well as Dr. [Petros] Grivas at University of Washington, almost as 2-hit combination theory where you have a patient with a germline mutation, and now they have this environmental stressor or intrinsic stressor that creates a second hit, and now cancer goes unchecked. I think we're thinking about bladder cancer in a different mindset. Like, "Okay, we've made big strides in the smoking aspect. We can still do better. I mean it's 11%, so we want to get that lower with smoking incidence. But are there other things that we can do to help prevent our patients from developing bladder cancer?"

And I think with this new mindset that Dr. Faltas has in providing this framework, we can collaborate and work together to figure out new mechanisms and carcinogenesis mechanisms for bladder cancer. That is going to be the next step in understanding how bladder cancer develops. In this session, we're going to get into these 3 mechanisms of action, whether it's intrinsic or extrinsic, which is environmental, and the genetic baseline, and those 3 aspects of what can cause bladder cancer.

This transcription has been edited for clarity.

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