Dr Joshua Meeks on the Benefits, Challenges of Many Options to Treat Bladder Cancer

There are many options to try for patients if one therapy doesn’t work, but there are challenges around getting new treatments into the clinic, said Joshua Meeks, MD, PhD, of Northwestern University Feinberg School of Medicine.

With additional new therapies available to treat bladder cancer, if one option doesn’t work, patients can try another or another, which is better than in the past when a cystectomy was the next option when patients didn’t respond to Bacillus Calmette-Guerin (BCG), said Joshua Meeks, MD, PhD, associate professor, Urology, Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine.

However, getting these new treatments into the clinic and pharmacies and educating providers on them remains a challenge, he said.


As bladder cancer treatment evolves, how is the sequencing of treatments in the real world changing?

The key thing that I think about as the provider in this is that it used to be cystectomy was the gold standard, if you don't respond to BCG. But now it's like, “Well, you didn't respond to first-line [therapy], so we're going to quickly go to second-line [therapy], and if [the tumor] doesn't respond, then...I have 3 or 4 different choices.” I think where we could get stuck is you keep giving a drug that doesn't work. Then that's when people are at risk for progression.

If it's possible, to say, “OK, we're going to give this, we're going to look and see how you do. If you don't respond, [we’re] moving on to the next.” And when you have options that are all well tolerated, you just got to find—the analogy I give is—you just have to find the right key to turn the keyhole on their disease so that you can get it to go away and stay away.

It's not like muscle-invasive bladder cancer, which is a lethal cancer in every case. In this case it’s that you just don't have the right drug for the patient where the BCG just didn't work. And there [are] a lot of reasons why BCG doesn't work, but just because that doesn't work doesn't mean other things won't. So, now we have a bunch of different keys to try.

What are the biggest challenges regarding implementing innovative therapies for bladder cancer in real-world practice?

I think right now the biggest thing is getting them into our clinics. So, we have drugs that were approved by the FDA within the last year and getting them into our pharmacies and then educating our nurses, having our pharmacy be able to produce them, and be able to actually implement them and give [them], that's where we're at now. In a year, it could be totally different. In a year the problem could be figuring out sequence, but now it's all about taking what's been approved and actually translating that into patient care. And the patients are coming and asking for therapy. So, I think that's really a credit to them in the community that they know that there [are] other options. But...there's the administrative part of it that we're all trying to get done as fast as we can.

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