Dr Bochner on Bladder-Sparing Regimens in MIBC

Bernard H. Bochner, MD, FACS, urologic surgeon, Memorial Sloan Kettering Cancer Center, discusses ongoing studies evaluating the feasibility and safety of potential bladder-sparing options for patients with muscle-invasive bladder cancer (MIBC).

In an interview with At the 17th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies, an event hosted by Physician’s Education Resource (PER®), Bochner highlighted the significance of ongoing investigations of MIBC management strategies, including the phase 2 Alliance A031701 trial (NCT03609216), which is being spearheaded by Gopa Iyer, MD, from Memorial Sloan Kettering Cancer Center. 

The trial was designed to evaluate the efficacy of chemotherapy alone in patients with MIBC with bladder preservation whose tumors harbor DNA damage repair (DDR) mutations. Prospective data have shown that many of these genes exhibit a strong correlation with platinum sensitivity, which is adeterminant of complete response (CR), Bochner expands. Through genetic sequencing of tumors, eligible mutations that could potentially guide the administration of platinum-based chemotherapy will be identified, he states. Eligible patients will be treated with investigator’s choice of standard dose or dose dense gemcitabine and cisplatin chemotherapy, with simultaneously genetic sequencing of pretreatment transurethral resection tumor specimens. Patients displaying 1 of 9 deleterious DDR alterations who exhibit a clinical CR following treatment with chemotherapy will be considered eligiblefor bladder preservation on a trial basis to identify the safety of this approach, he reports.

Scrutinizing molecular signatures could help identify subsets of patients for whom bladder preservation may be a viable option without compromising long-term outcomes, Bochner shares. Endeavors such as the Alliance A031701 trial epitomize the strides being made in personalized medicine, Bochner explains. The trial exemplifies a paradigm shift in the management of MIBC, potentially allowing for a more refined and patient-centric approach to treatment decision-making in this disease space, he concludes.

Clinicians referring a patient to MSK can do so by visiting msk.org/refer, emailing referapatient@mskcc.org, or by calling 833-315-2722.