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Biomarkers and Molecular/ Genomic Testing in Genitourinary Cancers

Opinion
Video

Siamak Daneshmand, MD, explores unmet needs in the bladder cancer treatment landscape at ESMO 2023.

This is a video synopsis/summary of a panel discussion involving Sia Daneshmand, MD.

Daneshmand discusses unmet needs in bladder cancer treatment. In non–muscle invasive bladder cancer, more medications are needed for BCG-refractory disease to avoid cystectomy. In muscle-invasive bladder cancer, cure is still uncommon. Many patients progress rapidly despite gemcitabine and cisplatin treatment. Immunotherapy with checkpoint inhibitors has helped, but many patients do not respond in later lines of therapy.

FGFR (fibroblast growth factor receptor) alterations represent an exciting area of investigation and treatment in bladder cancer. Unfortunately, they are only present in 40% to 50% of upper tract tumors and in 20% to 30% of metastatic disease. FGFR alterations also occur in some non–muscle invasive bladder cancers. Though not highly prevalent, targeted therapies for FGFR-altered tumors provide a new treatment option when identified through genomic sequencing.

Daneshmand notes that most muscle invasive bladder cancers now undergo genomic analysis to identify targetable mutations, particularly in later lines of therapy. Each bladder cancer has multiple complex mutations, many of which currently lack matched targeted therapies. While checkpoint inhibitor efficacy is now less reliant on PD-1/PD-L1 status, FGFR alterations represent an actionable mutation to guide treatment decisions when available.

Video synopsis is AI-generated and reviewed by AJMCÒ editorial staff.

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