Experts discuss review of the microbiome and bladder cancer

In this video, Ilaha Isali, MD, MSc, and Laura Bukavina, MD, MPH, MSc, discuss how they hope findings from their recent Urologic Oncology paper “State-of-the-Art review: The Microbiome in Bladder Cancer” could help influence the development of microbiome-based inventions for bladder cancer. Isali is a urology resident at Weill Cornell Medicine in New York, New York, and Bukavina is an assistant professor of urologic oncology at Cleveland Clinic Glickman Urologic Institute and the translational science lead in GU oncology at Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio.

Transcription:

How do you see the findings from your review influencing the development of microbiome-based interventions or contributing to personalized medicine approaches for patients with bladder cancer in the future?

Isali: I think our review mainly highlighted the potential for microbiome-based interventions to revolutionize bladder cancer care. By leveraging microbiome biomarkers for risk stratification, I think we can identify high-risk patients and customize therapeutic strategies. I will say, for example, microbiome composition has been shown to predict response to therapies such as pembrolizumab [Keytruda] or microbiome modulation. Potential probiotics or prebiotic interventions could restore microbiome balance and potentially mitigate immunotherapy-related toxicities or enhancing therapeutic efficacy.

There is always a lot to do in terms of implications for personalized medicine. I will say integration of microbiome insights into clinical workflow will potentially advance precision oncology and potentially offer tailored treatments that improve survival and also quality of life for patients with bladder cancer, not only for bladder cancer, basically, implications for personalized medicine can be applicable for all cancer types.

Bukavina: My biggest hope for people reading this review is to understand that there are some golden opportunities for research. The second thing I would love for readers to understand is that there are certain guidelines when you're doing microbiome research. If you're doing urine-based research, it's important to understand that urine does not have the same amount of bacteria that stool has. So this bio burden, the amount of bacteria that's in the urine, is more likely to be contaminated. In order to reduce that contamination, we have to be able to collect sterilely, so sometimes catheterization is necessary. We have to also understand that we need to have very strict decontamination protocols when we're running the analysis.

And the same thing for gut; when we're talking about the gut microbiome, we have to standardize how we're collecting samples, how we are freezing the samples, how we're analyzing it. In the past, people have used the cheapest possible method just to get the genus of a bug, but not really getting the species. It's a bit like comparing you to a zebra. You're both animals, but it doesn't necessarily mean that you're part of the same group. I don't expect you or the zebra to be very similar. That's how the previous microbiome research has been done. It's been very high in terms of order and family and really not getting down to the species level, because it's more costly. It's better to analyze fewer samples, but on a species level, clean samples that are not contaminated, than being able to collect 300 samples and being able to do the analysis much cheaper. And I hope the readers understand that is more important in microbiome studies than the sheer volume of patients.

This transcript was AI generated and edited by human editors for clarity.