Your Questions? Answered! Hear From Bladder Cancer Researchers

Interested in hearing what experts have to say about bladder cancer treatments? We asked our Facebook community, "What questions do you have for a bladder cancer researcher?"

After gathering your questions, we passed them along to the Crush it for Curtis Foundation Medical Board. They share their answers to each of your questions.

Meet the doctors

Dr. Michael R Harrison, MD
Medical Oncologist, Board Certified, Associate Professor of Medicine, Duke Cancer Institute, Chairman of Crush It For Curtis Foundation Medical Board.

Dr. Mark B Monahan, MD
Urologist, Board Certified, Member of Crush It For Curtis Foundation Medical Board

Dr. Ryan Raddin, MD
Medical Oncologist, Board Certified, Member of Crush It For Curtis Foundation Medical Board

When to start BCG after TURBT

Your question: Is one week after having TURBT too soon to start BCG treatment?

Dr. Monahan: There is nothing written in the guidelines about when to start BCG for non-muscle invasive bladder cancer (NMIBC), however I did find recommendations from several organizations that state it should be started within 2-6 weeks after tumor resection (TURBT). Most of us at Virginia Urology use 4 weeks to allow the bladder to heal. If given before the bladder heals and the BCG gets systemic it can cause life threatening sepsis.

Future of standard biomarker testing remains unclear

Your question: Should biomarkers be tested in clinical practice for non-muscle invasive bladder cancer (NMIBC) now? ie: FGFR, PD-L1 etc?

Dr. Harrison: There is a lot of research on such biomarkers but I don’t believe they are validated to the extent that they’ve become standard of care. For example, FGFR3 mutations may identify a group with favorable prognosis and abnormalities in p-53 may identify a group with less favorable prognosis in non-muscle invasive bladder cancer (NMIBC), but there need to be studies linking this knowledge to change therapy and, as a result, improving outcomes.

BCG remains as a first line therapy over PD 1 inhibitor

Your question: Would a PD 1 inhibitor be better than BCG for noninvasive high grade bladder cancer?

Dr. Harrison: On Jan 8, 2020, the US FDA approved pembrolizumab for BCG-unresponsive, high-risk, non-muscle invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) with or without papillary tumors who are ineligible for or have elected not to undergo cystectomy.

Dr. Raddin: Non-muscle invasive bladder cancer has historically been managed by urologists, rather than oncologists. However, now with the recent approval of pembrolizumab in this setting (mentioned by Dr. Harrison), I imagine medical oncologists will start to see more of these patients. Regarding the question "would a PD1 inhibitor be better than BCG for noninvasive high grade bladder cancer," at this time BCG remains the preferred first line therapy for these patients. In patients with BCG refractory high risk disease, radical cystectomy remains the preferred next step. Currently, pembrolizumab would only be recommended in a high risk patient that is unresponsive to BCG and not a candidate for cystectomy.

Determining risk of recurrence after treatment

Your question: If you had high-grade stage one which was treated, then at the second test there was no cancer, is there still a high chance of it coming back?

Dr. Harrison: Exact risk depends on other clinic details, but a general problem with non-muscle invasive bladder cancer (NMIBC) is that is often continues to recur and then, in some cases, progresses to a higher stage, i.e. muscle-invasive bladder cancer (MIBC).

Recurrence rates in people diagnosed younger

Your question: Are recurrence rates different in people diagnosed earlier in life who are otherwise healthy?

Dr. Michael R Harrison, MD: I don’t believe there is enough evidence to know the answer.

Get stats about bladder cancer recurrence from our recent survey.

A second opinion can help with treatment decisions

Your question: How can patients and doctors get better data on how to choose the ideal treatment in this new landscape where there are so many choices?

Dr. Harrison: Get a second opinion with a urologist or a medical oncologist who is an expert in bladder cancer treatment before making the next management decision. Many times, this may only reinforce the initial management chosen, but there may also be other considerations or clinical trials available.

Thank you Curtis Garbett, founder of the Crush It For Curtis Foundation for making this article possible. Special thanks to Dr. Harrison, Dr. Monahan and Dr. Raddin for sharing their answers with our bladder cancer community!