Dr Bochner on Genetic Heterogeneity in Bladder Cancer

Bernard H. Bochner, MD, FACS, urologic surgeon, Sir Murray F. Brennan Chair in Surgery, Memorial Sloan Kettering Cancer Center, discusses the genomic complexity and heterogeneity of bladder cancer and what this heterogeneity has meant for the exploration of treatment options for this patient population.

Due to a substantial amount of research investigating the heterogeneity of bladder cancer, it has been established that patients with bladder cancer can present with tumors that harbor a wide variety of genetic abnormalities, Bochner begins, noting that these findings have created opportunities to explore different treatment strategies. He explains that bladder cancer is associated with a high tumor mutational burden (TMB), which has been linked with a more favorable responses to checkpoint inhibitors across different tumor types.

Clinical studies in the bladder cancer realm have explored the use of checkpoint inhibitors in combination with chemotherapy in the neoadjuvant setting for patients with platinum-eligible and -ineligible disease. The primary objective of exploring neoadjuvant checkpoint inhibition in combination with chemotherapy has been to increase the rate of patients who experience tumor downstaging or complete pathologic responses, and results from these studies have shown that checkpoint inhibitors have activity in the preoperative setting for patients with bladder cancer.

Bochner notes that this approach reflects a broader trend in oncology toward leveraging the unique genetic profiles of tumors to tailor and enhance treatment efficacy. By understanding the specific genetic characteristics of bladder cancer, including its high TMB, oncologists can better strategize therapies that are more likely to result in improved patient outcomes, he explains

Bochner's insights underscore the importance of genetic profiling in identifying suitable candidates for checkpoint inhibition and other targeted therapies in bladder cancer. This shift towards personalized medicine continues to shape the landscape of cancer treatment, promising a more nuanced and effective approach to managing a disease as complex and variable as bladder cancer.