Experts: First Targeted Therapy for Bladder Cancer Brings Hope to Patients

The first molecularly targeted therapy for patients with advanced bladder cancer is a breakthrough in the treatment of this cancer, experts say. As they emphasize, for patients with invasive, metastatic bladder cancer, it is a more effective and safer alternative to chemotherapy.

"The first targeted therapy for patients with bladder cancer can be considered a breakthrough treatment. It contributes to a statistically significant extension of progression-free survival compared to chemotherapy. It should be noted that this treatment is used in patients who have previously received at least one line of therapy and in the case of disease recurrence after surgery or metastases," said Prof. Paweł Krawczyk, head of the Immunology and Genetics Laboratory at the Department and Clinic of Pneumonology, Oncology and Allergology of the Medical University of Lublin.

The specialist added that thanks to this treatment, the patient can live for several to a dozen or so months without the disease progressing. In Poland, however, it is not a reimbursed therapy at the moment. "Let's hope that this will change soon," he noted.

Data collected in the National Cancer Registry (KRS) in 2022 indicate that in Poland approximately 7,000 people fell ill with bladder cancer and 4,000 died.

At a press conference at the end of May, Dr. Jakub Żołnierek, a clinical oncologist from the Urinary Tract Cancer Clinic of the Maria Skłodowska-Curie National Institute of Oncology – State Research Institute in Warsaw, emphasized that in terms of survival rates for patients with bladder cancer, Poland is lagging behind the European Union.

"The incidence of bladder cancer is rising, among other reasons, because we are living longer. At one point, statistics showed that we were approaching a certain plateau (stabilization period - PAP) in terms of the number of cases, especially in the male population, but the incidence began to rise among women," he said. In his opinion, this is related to the fact that the percentage of women who smoke cigarettes is growing, and inhaling tobacco smoke - even passively - is the main cause of bladder cancer.

As the expert noted, approximately 75 percent of cases of this cancer are non-invasive, i.e. limited to the bladder epithelium. In such cases, it can be treated minimally invasively – using the so-called transurethral electroresection (TURBT).

"A patient with urothelial cancer (originating from the epithelium lining the urinary tract - PAP) has a high risk of recurrence - it can occur in up to 70% of patients within three years. This is a ticking time bomb. In such a patient, we are obliged to carry out very systematic diagnostics and control, because we need to detect recurrence at an early stage, before we have to perform a mutilating surgery to remove the bladder and the surrounding organs," explained Dr. Żołnierek.

In about 25 percent of patients, bladder cancer is detected at an advanced stage when it has spread. At that point, the chances of surviving five years drop to 20 percent, the oncologist said.

He noted that in order to detect bladder cancer early, it is necessary to increase awareness in society and among primary care physicians (PCPs) about its symptoms, such as urination disorders, discomfort, pain or burning, and painless hematuria. In the vast majority of cases, it is the first symptom that appears suddenly and suddenly disappears. It is also often downplayed or attributed to other diseases, such as urinary tract infection.

Dr. Żołnierek assessed that it is also necessary to invest in better diagnostic methods – for example, replacing rigid cystoscopy with flexible cystoscopy. “Patients tolerate this test better, and doctors have much wider possibilities to examine the bladder, and therefore a lower risk of missing a neoplastic lesion,” he explained.

If bladder cancer is suspected, it is necessary to take a sample of the tumour for pathological examination, which will make it possible to determine whether the tumour is malignant and to determine its type.

In an interview with PAP, Prof. Krawczyk noted that the collected tissue should also be sent for molecular diagnostics and analyzed for the presence of genetic abnormalities – especially in the FGFR3 gene. This is a gene encoding the fibroblast growth factor receptor.

"The most common genetic abnormalities in bladder cancer are FGFR3 mutations, which - depending on the source - occur in 17-30% of patients with this cancer," the specialist explained. He added that in invasive - metastatic, worse-prognosis bladder cancer, this percentage is even higher. These patients should receive a molecularly targeted drug from the group of FGFR3 tyrosine kinase inhibitors.

According to Prof. Krawczyk, this drug should be used in the second and third line of treatment – ​​after chemotherapy and immunotherapy have failed. It works by blocking FGFR3 and inhibiting the division of cancer cells, as well as stimulating the processes of apoptosis, or suicidal cell death. Thanks to this, the tumor stops growing.

Prof. Żołnierek emphasized that efforts are currently underway to include this drug in the B.141 drug program. "I hope that in the next few months, six months, we will gain access to it," he said.

He added that molecularly targeted treatment improves the quality of life of patients and also reduces the risk of distant metastases – to various organs, including the central nervous system, and thus may prolong overall survival.

Prof. Krawczyk noted that molecular testing of material collected during a bladder cancer biopsy should be performed using the so-called next-generation sequencing (NGS). "This is a technique financed by the National Health Fund and very well priced," the specialist noted. However, it is important to properly collect and preserve the material for testing.

Experts also noted that patients with bladder cancer need better access to surgical robots, which increase precision, shorten hospitalization and reduce the risk of complications. "Treatment should take place in specialized centers where patients have access to the full range of therapies - surgery, drug therapy and radiotherapy - in accordance with a modern, multidisciplinary approach," concluded Prof. Żołnierek.

Science in Poland, Joanna Morga (PAP)

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