Armine K. Smith, MD, recaps BCAN session on oligometastatic bladder cancer

In this interview, Armine K. Smith, MD, recaps a 2024 Bladder Cancer Think Tank session on oligometastatic bladder cancer. Smith is an assistant professor of urology at Johns Hopkins University as well as the co-director of the Women’s Bladder Cancer Program at Sibley Memorial Hospital.

Video Transcript:

Thanks for having me. My name is Armine Smith. I am an assistant professor of urology at Johns Hopkins University. I'm also a co-director of Bladder Cancer Program for Women at Sibley Memorial Hospital, which is also part of the program with the Greenberg Bladder Cancer Institute [at Johns Hopkins Medicine]. I wanted to tell you about our breakout session that happened at the Bladder Cancer Advocacy Network Think Tank in 2024, just recently. Our breakout session was dedicated to [the] oligometastatic state in bladder cancer. We had a really nice faculty. Along with Dr. Randy Sweis [from] University of Chicago, and presenters Dr. [Sean P.] Pitroda from University of Chicago and Dr. [Phouc T.] Tran from University of Maryland, we collectively decided to focus on the current state of treatments in this stage of disease and to analyze the experience in the treatment of oligometastatic cancers from other cancer states. The reason we wanted to think about this and talk about this is because traditionally, metastatic bladder cancer was a lethal disease, and hence consolidative treatments are [not really] offered to patients unless it's for very severe palliation of symptoms.
However, we are living in a new era of treatments. We have new treatment combinations for metastatic disease. Earlier this year we had data presented at the oncology meeting that looked at a few different combinations. One was enfortumab [vedotin] and pembrolizumab, and that had a great response rate in patients––about a 70% response rate in patients. Another combination was nivolumab with cisplatin and gemcitabine, and that produced about a 60% response rate. Now, compare [that] to prior chemotherapy regimens that only produced about 44% overall response in metastatic bladder cancer patients. With this exciting development, we rethought a lot of the paradigms in this cancer.

Additionally, we have experience with the clinical trials in prostate, colorectal, breast, and lung cancers in the oligometastatic state. We also have treatment in oligometastatic kidney cancers. Building on our experience from these other disease states, we have also experienced a paradigm change in metastatic cancers.
In the past, again, any sort of metastatic cancer [was] felt to be incurable, so there was not a huge reason to target those metastatic spots. However, we have now realized that in some patients with a low number of metastatic sites, providing systemic treatment and providing some site-targeted treatment will provide lasting benefit or at least a temporary benefit that will help ameliorate the need for the systemic treatments or very intense systemic treatments.

So, the question is, is oligometastatic disease curable? It depends on the number of metastatic sites [and] the sites of metastatic deposits in the human body. We know that indolent clinical metastatic disease is the one that has [a] low number of lesions, about 1 to 5––again, extrapolating from other disease states––metachronous presentation, meaning that these arise in sequential fashion, and usually there is no involvement of lymph nodes, there's a slow rate of progression, and there are limited organ sites. We also have to look at the biology of the cancer. Favorable histological presentations can also give us a hint whether this disease may be amenable to cure. Some other things that we have to consider are what is the purpose of treatment for these patients? Is it the cure? Is it improvement of quality of life? And what is the optimal treatment type? Is it radiation therapy vs surgery? We had a very interesting discussion from all the presenters and all the attendees, and we all felt that the time is right for trials in the bladder cancer space just because I think we have really nice systemic treatments now. They're not 100% effective, but they're not really lacking in efficacy. It would be very nice to have a more organized plan to try to treat this disease both systemically and with targeted therapy, which may be provided by multiple disciplines. We know that bladder cancer is a multidisciplinary disease, especially in the advanced state.

This transcription has been edited for clarity.