Brock O’Neil, MD, assistant professor, Division of Urology, University of Utah School of Medicine, Huntsman Cancer Institute, discusses the current standard of care in muscle-invasive bladder cancer (MIBC).

Currently, patients with MIBC who are undergoing a cystectomy receive neoadjuvant treatment with cisplatin-based chemotherapy. Unlike many other related tumor types, MIBC hasn’t seen an update in treatment options in around 20 years. O’Neil says urologists generally haven’t administered neoadjuvant chemotherapy as much as they should, but it’s been getting better in recent years. Another limitation is that not every patient can tolerate neoadjuvant chemotherapy. A lot of patients with bladder cancer develop renal insufficiency, rendering them ineligible to receive cisplatin.

O’Neil stresses that it’s a much inferior approach to give patients carboplatin-based chemotherapy if they cannot receive cisplatin. He is hopeful that new biomarkers will soon emerge that will depict what patients will benefit from neoadjuvant chemotherapy.

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Brock O’Neil, MD, assistant professor, Division of Urology, University of Utah School of Medicine, Huntsman Cancer Institute, discusses the current standard of care in muscle-invasive bladder cancer.

Dr. O'Neil on Standard of Care in Muscle-Invasive Bladder Cancer

Brock O’Neil, MD, assistant professor, Division of Urology, University of Utah School of Medicine, Huntsman Cancer Institute, discusses emerging therapeutic techniques in bladder cancer.

There is a lot of interest in exploring robotic cystectomy, says O’Neil. The field is likely to move in that direction, especially by way of intracorporeal urinary diversions. The procedure is getting more established through ongoing clinical trials. Results from the RAZOR trial were recently presented that are promising and encouraging, states O’Neil.

However, the trial failed to show any significant benefits over complications. They seem to show equivalence in terms of oncologic outcomes, explains O’Neil. The biggest benefits come in blood loss and potentially length of hospital stay.

Another shift in the field is the push for early recovery after surgery protocols. Most centers that do cystectomies have those protocols in place and have shown shorter hospital lengths of stay. O’Neil notes that they may also have some impact on complications.

Wearable sensors, though fairly new, is another technique that has garnered a lot of attention. The ideology behind the sensors is early identification of postsurgical complications for early intervention.

Dr. O'Neil on Emerging Therapeutic Techniques in Bladder Cancer

Brock O’Neil, MD, assistant professor, Division of Urology, University of Utah School of Medicine, Huntsman Cancer Institute, discusses adjuvant therapy for patients with bladder cancer.

There were several trials that were attempted but subsequently closed due to poor enrollment, says O’Neil. The problem, he says, is that cystectomy is a very morbid procedure. All the trials have a window in which patients need to be enrolled into adjuvant therapy if they are going to do it. However, there are a lot of challenges with enrollment following post-surgical complications.

Urologists believe that physicians can identify those patients who are the most likely to benefit from neoadjuvant therapy and surgery, and then select those who are not likely to benefit from neoadjuvant chemotherapy. If physicians are still worried about those patients who did not receive neoadjuvant chemotherapy, they can receive adjuvant chemotherapy after surgery. That is the direction the field will move in, says O’Neil.

Dr. O'Neil on Adjuvant Therapy in Bladder Cancer

Brock O'Neil, MD, physician, instructor in urologic surgery, Vanderbilt University, discusses a study that demonstrated evidence of superior quality of life after robotic assisted radical prostatectomy.

Though robotic prostatectomy has been around for quite some time, O'Neil explains, there is lack of evidence to prove its efficacy. In O'Neil's study, researchers compared data from two large cohort studies. One set of data was analyzed from the 1990s, which focused on open radical prostatectomy, and another from 2011 and 2012, which focused on robotic surgery. This allowed researchers to compare outcomes from studies that were dominated by a single type of surgery.

The comparison found that there was a significant benefit, especially for sexual function, for patients undergoing robotic surgery. There was also a significantly statistical benefit in urinary function, but O'Neil says this may not be clinically meaningful.

View more from the 2015 AUA Annual Meeting

Brock O'Neil, MD, physician, instructor in urologic surgery, Vanderbilt University, discusses a study that demonstrated evidence of superior quality of life after robotic assisted radical prostatectomy. 

Brock O'Neil, MD

Articles

Dr. O'Neil on Standard of Care in Muscle-Invasive Bladder Cancer

Dr. O'Neil on Emerging Therapeutic Techniques in Bladder Cancer

Dr. O'Neil on Adjuvant Therapy in Bladder Cancer

Dr. O'Neil on Superior Quality of Life After Robotic Prostatectomy