Tracy Rose, MD

Tracy Rose, MD, MPH, assistant professor of Medicine in the Division of Oncology at the University of North Carolina at Chapel Hill, discusses the promising outlook of the current bladder cancer space.

Though cisplatin-based chemotherapy as the standard-of-care for muscle-invasive bladder cancer prior to surgery with radical cystectomy works, researchers are always aiming to come up with new and innovative treatments. According to Rose, investigators are currently working on how to avoid surgery altogether for these patients.

As of now, there are various large, randomized studies ongoing, including RETAIN-2 (NCT02710734) and A031701 (NCT03609216), which look to create greater responses in this patient population.

Rose notes that understanding which patients should or should not get combination therapies, immunotherapies, or other targeted therapies is key in gaining a further understanding of what works. Additionally, the field is moving quickly towards personalized care and finding what treatment works best for each individual patient.

There's lots of big, randomized studies. All of the current combination studies right now are using gemcitabine and cisplatin backbone as what we're combining immunotherapy with, and I think some of those studies should consider using other backbones, like the dose-dense regimens, to see if perhaps that can give us even greater responses or be better partners for immunotherapy.

 Figuring out which patients should get combination therapies, and which shouldn't, figuring out which patients should get immunotherapy and which shouldn't, should get other targeted therapies that have slightly higher response rates [is exciting]. I think that is really where the field is going and sort of personalized care and not a one size fits all for either perioperative therapy or metastatic therapy of sort of what treatment is really best for you.

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Tracy Rose, MD, discusses the promising outlook of the current bladder cancer space.

Bladder Cancer Field Leans Towards Patient-Centered Care

Tracy L. Rose, MD, MPH, an assistant professor of Medicine in the Division of Oncology at the University of North Carolina at Chapel Hill, discussed important and ongoing research in bladder cancer.

Rose states that much of the research in bladder cancer is aimed at improving upon the standard of care which is combination chemotherapy including cisplatin. Improving these combinations has involved administering more doses of chemotherapy and added immune checkpoint inhibitors.

 So we've had a ton of, you know, trying to build on the current standard of cisplatin-based combination chemotherapy. So, you know, the first thing that happened was instead of sort of conventional dose [of] cisplatin, there have been several studies that have come out now with randomized data of what's called dose-dense cisplatin, or dose density. And that's essentially giving chemotherapy more frequently to try to increase dose density and tumor response. And we've seen some good outcomes that look like, you know, these regimens are safe. They're associated with slightly higher pathologic response rates.

 And just last year, at ESMO, there was a presentation that actually 1 of the dose-dense regimens; dose-dense MVAC was associated with a longer progression-free survival than gemcitabine and cisplatin after surgery. Now, they gave different doses of cisplatin between those 2 regimens. So, the jury's still out whether, you know, the same amount of cisplatin really would improve outcomes or not, but it [is] certainly provocative.

 And then there's been several combination studies of, you know, cisplatin-based combination chemotherapy, plus immune checkpoint inhibitors, which have really changed the landscape of metastatic disease. And so those all look safe and relatively consistent across the trials that we're getting pretty good pathologic, downstaging and pathologic, complete response with those combinations. They now need to be tested in the randomized setting to see if we can improve on just chemotherapy alone. And then, in the cisplatin-ineligible group of patients that can't get chemotherapy, how can we improve their outcomes and so there's been a number of studies recently looking at immune checkpoint inhibitors alone, which actually look like they have activity and are now going to be studied randomized against surgery alone. And the enfortumab vedotin [Padcev] is a drug that's being studied extensively now in the neoadjuvant setting, including an exciting abstract that was presented of enfortumab alone given before surgery.

Tracy L. Rose, MD, MPH, discusses ongoing research in bladder cancer that aims to add onto the standard of care and improve patient outcomes. 

Tracy Rose, MD | Authors

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Bladder Cancer Field Leans Towards Patient-Centered Care

Improving Cisplatin-Based Combinations in Bladder Cancer