Immunotherapies in Treatment of Bladder Cancer - Episode 1

Incidence and Typical Characteristics of Newly Diagnosed Bladder Cancer

The current incidence of bladder cancer diagnoses and most common symptoms that newly diagnosed patients present with.

Leonard G. Gomella, MD: Well, welcome everybody to our immunotherapies and the treatment of bladder cancer today. This is part of the Urology Times Viewpoint series. I’ll be the moderator for this session. I’m Dr Leonard Gomella. I’m the chairman of the Department of Urology at Thomas Jefferson University. I’m also the senior director for clinical affairs for the Sidney Kimmel Cancer Center, as well as enterprise vice president for urology for the Jefferson Health System. I am very honored to be here today with 4 very esteemed panelists, all who have a tremendous amount of clinical and research expertise in the field of bladder cancer. Our panelists are going to be Dr Sam Chang, who’s a professor and the chief of urological oncology and the chief surgical officer at the Vanderbilt-Ingram Cancer Center [Nashville, Tennessee]; Dr Matt Galsky from the Icahn School of Medicine at Mount Sinai [New York, New York], where he is professor of medicine and the director of the GU medical oncology unit; Dr Karim Chamie, who’s the associate professor of urology at UCLA [Los Angeles, California]; and lastly, Dr Petros Grivas, who’s the director of the GU oncology program at the University of Washington School of Medicine and Fred Hutchinson Cancer in Seattle. So again, I’m very honored to be here today with these esteemed colleagues.

We’re going to be talking today about these areas in each section. We’re going to cover the overview of bladder cancer diagnosis and patient management. We’re going to talk about some of the first-line treatment options for non-muscle invasive bladder cancer, as well as for nonmetastatic muscle invasive bladder cancer. We’re going to move then to the treatment of advanced and metastatic bladder cancer and then we’re going to talk about the future developments and some of the unmet needs. Our focus today is going to be primarily on immunotherapy, but we will also take the time to cover other key areas that might come along.

In the first part here, what I’d just like to do is talk a little bit about where we are with bladder cancer in the United States for 2021. Overall, we have about 83,000 cases of bladder, cancer with a preponderance of males—about 64,000 cases—and about 20,000 cases of bladder cancer in females. When you look at the data, it gets a little bit fuzzy because we have renal pelvis cancers that are mixed in with kidney cancers and we have ureter and other genitourinary cancers that are mixed in with urothelial carcinomas. So the number that we’re dealing with is actually probably much higher than just the bladder cancer number. If you look among men, the 5 most common types of cancer in 2021 were of course prostate cancer, lung cancer, colorectal cancer, with bladder cancer accounting for a large number of that—7% of cases of men with bladder cancer. In ladies it’s a little bit lower on the list, but then again, in females we are seeing more and more cases of urothelial carcinoma, bladder cancer as time goes along.

I know we have a very learned audience here about the common clinical signs of bladder cancer but we’re all aware that these tend to be gross hematuria and frequently painless. Every once in a while, micro-hematuria is a reason that a patient is diagnosed with bladder cancer. Irritation, irritative warning symptoms, urinary frequency, a constant need to urinate is another common presenting cancer symptom very often associated with carcinoma and CY2. Lastly, we see incidental renal masses on imaging are also a reason that sometimes we’re referred for patient with disease. Of course, risk factors: smoking, chemical exposure, race—Caucasians more likely to get bladder cancer than African Americans. It’s a disease of older individuals, male-predominant disease, and also a history of pelvic radiation may increase the risk. We’re going to focus on immunotherapies and again of course bladder cancer and BCG [Bacillus Calmette-Guerin] are the arch typical examples of immunotherapy. We’re going to be talking a little bit about BCG, but again the exciting things that are going on with immunotherapy in bladder cancer are really going to be the focus of our discussion today.

Transcript edited for clarity.