Garje Assesses Sarcomatoid vs Classic Urothelial Carcinoma

Rohan Garje, MD, chief of genitourinary oncology at the Miami Cancer Institute, explains some of the differences between the sarcomatoid and classic carcinoma of the bladder.

According to Garje, though it is predominantly a cancer associated with men, bladder cancer is in the top 10 cancers found in male and female patients, and the most common variant is called classic variant urothelial cancer. However, a fraction of patients have sarcomatoid histology, a cancer that looks different compared with traditional urothelial cancer.

The issue patients with those variant histologies are often faced with is that there is no standard of care that currently exists. Additionally, ongoing trials tend to exclude patients who have predominant sarcomatoid histology.

Transcription:

0:10 | The primary obvious difference is histology. The patients who have sarcomatoid, they have both combinations of mesenchymal and epithelial differentiation, they have mutations which drive the cancer are different, and another thing is because it has been rare, the big issue has been that their enrollment to clinical trials has been very limited. These patients are generally not part of the studies which include classic variants. So, histological differences, molecular differences, and because of the rare nature of the cancer, they have not been represented in clinical trials.

0:50 | We also have noticed that it is a male predominant cancer, but relative to classic urothelial, females have had a little bit higher incidence of this cancer. We also see that this cancer is predominantly associated with higher staging, and the other important aspect we noticed are the risk factors. The traditional risk factor for the classic variant in general has been smoking. Now, similar risk factors exist for sarcomatoid, but exposure to radiation therapy for prior pelvic organ radiation or cyclophosphamide-based chemotherapy for various other reasons tend to be high-risk factors for sarcomatoid cancers.