Bladder Cancer: New Trials Target Local Delivery, Bladder Preservation

The future of bladder cancer treatment is looking bright, with research focusing on improving local delivery of gemcitabine for high-risk non-muscle invasive bladder cancer (NMIBC).

One promising approach is the TAR200 device, which delivers a sustained release of gemcitabine directly into the bladder. This method is being evaluated in clinical trials for both non-muscle invasive and muscle invasive disease.

Other areas of exploration include gel-based platforms and gene therapy. Additionally, researchers are investigating interleukin-type combination agents to target the disease more precisely.

The ultimate goal is to develop effective localized therapies that minimize side effects and preserve patients' bladders. Removing the bladder should become obsolete for non-muscle invasive bladder cancer.

Here, Stephen Williams, MD, MBA, MS, FACS, FACHE, professor and chief of the Division of Urology, Department of Surgery at the University of Texas Medical Branch in Galveston, TX, discusses the exciting and evolving field of bladder cancer treatment.

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0:05 | A current very arm of trials involves the TA R200 device, which is a device that uses intravesical gemcitabine [that have] been instilled within a pretzel-like device. This remains in the bladder. This allows a sustained release of this medication over time. This is currently being evaluated in several sunrise trials, both in the non-muscle invasive state but also muscle invasive disease. So once again, I think that is a wonderful illustration of this.

There is a gel-like platform that has currently been developed that is primarily used an upper tract urothelial carcinoma and has not really been robustly tested in the non-muscle invasive bladder cancer state.

I think the TAR200 device instillation, either alone, which we do have some robust data present, very exciting, up to 70% [complete response] rate up to almost 1 year.

1:05 | We are looking at gene therapy, precision technology, and current platforms that are waiting to be FDA approved. In addition, there are a number of other interleukin-type combination agents that are currently tested, and that's very exciting as well.

Although it has not gained a lot of traction, it is the use of the local [agents] and systemic. [There are] additional toxicities whenever you present a systemic agent, so our hope is more localized therapy. But really, the optimal goal is retaining one's bladder. Our hope is that in the future, removing someone's bladder, particularly for non-muscle invasive bladder cancer, will be obsolete. That should be our goal.