Update on bladder cancer advances in 2023

In this video, Joshua J. Meeks, MD, PhD, discusses notable bladder advances in 2023. Meeks is the Edward M. Schaeffer, MD, PhD, professor of biology and associate professor of urology and biochemistry and molecular genetics at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Transcription:

What are some notable bladder cancer advances in 2023?

We're just on the tail of ASCO; there are some really important things that have come out that we're excited about. First, is SWOG 1011 lymph node dissection trial, extended vs limited dissection. This is the second major randomized trial that's really not shown a benefit to extended pelvic lymph node dissection. That really moves bladder cancer from the sort of Halstedian approach of resecting more lymph nodes is better to, there may not be a benefit to that. There really doesn't look like there's a benefit, and in fact, it may be harmful to patients. So I really give Seth Lerner [, MD] and all the SWOG investigators a huge round of applause. I mean, [this was] a 600-patient randomized trial, really demonstrating that there's not a benefit for that. So for most patients, we can do a limited lymph node dissection, or a more regular pelvic node dissection and get the same benefit from that, which really appears at this point to just be a staging benefit, rather than a therapeutic benefit. That's on the surgical end. The big thing coming forward, obviously, as we wait for these randomized trials in early-stage bladder cancer, is looking at biomarkers going forward of minimal residual disease. I think we've all been interested in the urine as a source to identify who still has cancer. That's critical, because we should either be escalating for some people if they're not responding, or stopping therapy. We give, for example, 15 doses of BCG in the first year because we think people need that, but maybe not everybody does, and we don't really have a great way to monitor that. So I think we're all really excited about that, and there are a number of urine markers that are going to be on the forefront. In the metastatic setting, obviously, all of the ADCs are huge. Looking at the impressive results for cohort K, with enfortumab, it's amazing what that is going to provide our patients. I'll tell you I have people alive that a year ago would have expired from their really advanced disease that are having birthdays or having time with their family because of enfortumab and other ADCs that are moving forward. So it's a huge time for that. And then I think the last part is that for the first time, we have precision. We finally have evidence from THOR and from NORSE that FGF receptor 3 is a target. It's very active in certain patients. And so bringing that into the muscle-invasive setting, we're excited about how that could potentially be for those either luminal cancers or FGF receptor mutated tumors. That's a non chemotherapy targeted oncogene that we could potentially leverage to treat patients.

This transcript was edited for clarity.