Dr. Kamran on current research into predictive factors of response to bladder-preserving treatment

In this video, Sophia C. Kamran, MD, discusses current research into pathologic/biomarker features for helping predict response to bladder-preserving therapy. Kamran is a radiation oncologist at the Massachusetts General Hospital Cancer Center and Assistant Professor of Radiation Oncology at Harvard Medical School, Boston, Massachusetts.

Transcription:

Are there any pathologic or biomarker features that can help predict response to therapy?

That’s an area of exciting research. There are a lot of data and exploration into potential biomarkers, not just looking at clinical factors, but more biological factors and pathologic factors to help us identify who may be a more optimal candidate for bladder sparing or radical cystectomy. And then within bladder sparing, there might be a more optimal candidate to add on immunotherapy or to add on a certain chemotherapy…. Our group here at Mass[achusetts] General [Hospital Cancer Center] has…done a lot of work into evaluating DNA-based biomarkers. We’ve recently been evaluating DNA damage response mutations, and something that came out that was…exciting was ERCC2, which is one of the DDR [DNA damage response] mutations that appears to correlate with improved outcomes to bladder-sparing therapy. That needs to be further validated, but that’s the type of work that we’re looking at. We’ve also evaluated RNA-based signatures. There was an analysis that was published in European Urology a few years ago, which found that there were RNA-based signatures that indicated T-cell activation and interferon gamma signaling were associated with improved disease-specific survival in patients who underwent bladder sparing, and that was in comparison with radical cystectomy.1So there do appear to be some features that are specific to patients that may indicate that they may be better candidate[s] for bladder-sparing therapy, or they may have an improved response…. [I]t may help us distinguish who should get a specific therapy, or even within bladder-sparing therapy it may help us identify who may not need full-dose radiation. That obviously [must] be further evaluated much more. But those are the kinds of questions that we’re asking; those are the hopes that we want to move forward with. There are a lot of exciting data that are coming out, and, of course, a lot of physicians and physician-scientists [who] are interested in these questions, and we’re working on that. So, I think that in the near future, we should have some exciting features that we can use going forward.

This transcript was edited for clarity.

Reference

1. Efstathiou JA, Mouw KW, Gibb EA, et al. Impact of immune and stromal infiltration on outcomes following bladder-sparing trimodality therapy for muscle-invasive bladder cancer. Eur Urol. 2019;76(1):59-68. doi:10.1016/j.eururo.2019.01.011