How Individual Risk Factors May Guide Bladder Cancer Treatment

Non-muscle-invasive bladder cancer remains a disease which requires careful consideration of various factors when determining the best treatment approach including stage, prior therapy and patient goals, according to Dr. Patrick J. Hensley.

In a recent conversation with CURE, Hensley discussed the current treatment landscape of non-muscle-invasive bladder cancer, as well as how patient counseling is guided by individual risk factors. Hensley works at the Markey Cancer Center is an assistant professor of Urology at University of Kentucky, UK HealthCare, in Lexington.

Transcript

Can you walk us through how non-muscle-invasive bladder cancer is defined, and how you typically counsel patients on treatment options?

To kick things off, we'll set the stage of what defines non-muscle-invasive bladder cancer and how we triage our patient counseling and treatment options accordingly. Generally speaking, our recommended treatment options are based on the patient's tumor stage, grade and also the history of treatments that the patient may have previously undergone.

Certain disease states within bladder cancer are commonly treated with bladder removal, which is called radical cystectomy, due to a high risk of things like progression to metastatic disease or spread outside of the bladder. Patients treated with radical cystectomy are typically at higher-disease risk states, including what we call very high-risk non-muscle-invasive bladder cancer and treatment-refractory disease states like BCG-unresponsive non-muscle-invasive bladder cancer, including a whole spectrum of invasive disease called muscle-invasive bladder cancer, which is stage T2 or higher, and is commonly treated with radical cystectomy.

From a bladder-preserving option standpoint, we commonly treat, especially in the treatment-naïve setting, or a patient's first tumor occurrence, patients with bladder-preserving options. [This is] done through close surveillance, cystoscopically in their bladder, with scopes, or with treatments like intravesical instillations of medications and chemotherapy agents into the bladder to try to prevent recurrences and progression to higher-risk disease states. Specifically for non-muscle-invasive bladder cancer, these treatments are instilled through a catheter into the bladder, and there's a predefined dwell time for these medications.

I can just run through the overarching medication classes that we use for non-muscle-invasive bladder cancer. There's immunotherapy, like classic BCG, which is an attenuated mycobacterium that kind of "revs up" the body's immune system to attack and kill cancer cells. We can use chemotherapy agents, either as a single agent or as a combination of multiple agents. The goal there is to have cytotoxic effects, where the chemotherapy directly attacks and kills the cancer cells. Then there are some novel treatments that have recently been FDA-approved and others coming down the pike. ... That's where we're seeing a lot of these novel drugs kind of come into play.

Transcript has been edited for clarity and conciseness.

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