How Genitourinary Cancer Treatment Decisions Are Made: What Comes First

Dr. Shreyas Kalantri, an incoming medical oncologist at the University of Cincinnati, spoke with CURE about what he weighs first when figuring out a treatment plan for a genitourinary (GU) cancer, what precision medicine can target and the questions patients bring to those conversations.

What guides a treatment plan for genitourinary cancer?

"For a patient with the GU cancer, for me, I think the primary goal is to align myself with the patient's values," Kalantri said.

Those values differ from person to person, and treatment will affect daily life to some degree, which is why he starts by considering each patient’s individual needs and circumstances when determining the best approach to care.

"Every patient has different goals when it comes to their life and the way they want to lead it, and the quality of life they want," he explained.

The same approach holds across cancer types, not only GU cancers.

What can precision medicine target in genitourinary cancer?

"I think it's making strides," Kalantri said.

He gave FGFR in bladder cancer as one example of a change that can now be matched to a specific treatment. Other markers, including MSI-high, are what he described as pan-tumor, meaning they turn up across cancer types rather than in one alone. Between the two, he noted, oncologists have targets to work from when planning treatment for patients with GU cancers.

What should patients ask their oncologist?

Asking questions is the most useful thing a patient can do, according to Kalantri, who framed treatment planning as a shared decision.

"The more you ask, the more information you will get," he said, describing answers that tend to open further conversations and build a bond between a patient and their physician.

One question comes up more than any other: how long a person has left. It is often one an oncologist cannot answer, Kalantri said, because survival data describe large groups of people rather than any single person. Applying those numbers to one patient is difficult for the physician and the patient alike.

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