Bladder Cancer Highlights - Stephen Williams
October 16, 2022
Stephen B. Williams, MD, MS, FACS, Chief, Division of Urology, Professor of Urology and Radiology (Tenured), Robert Earl Cone Professorship, Director of Urologic Oncology, Director of Urologic Research, Co-Director Department of Surgery Clinical Outcomes Research Program, Medical Director for High-Value Care, UTMB Health System, Galveston, Texas
Alicia Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts
AUA 2022: Final Clinical Results of Pivotal Trial of IL-15R&[alpha]Fc Superagonist N-803 with BCG in BCG-Unresponsive Non-Muscle Invasive Bladder Cancer (NMIBC) CIS and Papillary Cohorts
Perioperative Optimization for Patients Undergoing Radical Cystectomy - Sarah Psutka
Alicia Morgans: Hi, I'm thrilled to be at AUA 2022, where I have the opportunity to speak with Dr. Stephen Williams. Thank you so much for being here.
Stephen Williams: Well, thank you for inviting me.
Alicia Morgans: Wonderful. Well, I wanted to invite you because of course you are a giant in bladder cancer care, and also someone who has such a perspective on AUA as a meeting and has some great take-home points for everyone, whether you're here, or whether you're not. And so why don't we start with your highlights from the non-muscle invasive bladder cancer space?
Stephen Williams: Sure. Well, thank you so much. And first off, it's just such an exciting time in bladder cancer, whether that's non-muscle invasive, muscle-invasive, or even in the metastatic setting. One of the studies that I found quite interesting is the QUILT study that was presented by Dr. Karim Chamie from UCLA. And this is just a wonderful study in the BCG unresponsive space, comparing N803 plus BCG. And what they were able to demonstrate is over 70% complete response rate at 12 months. In addition, the toxicity was very minimal in this population, and I think really does provide some pivotal evidence and benchmarks to test other future agents as well in this space.
I think for our patients that had BCG unresponsive disease, historically the only other option was to either remove their bladder or even in select patients consider trimodal therapy options or other options. I think this really is a game-changer. And the results itself from a safety profile, I think are quite remarkable. Further, long-term follow-up are going to be needed for bladder-sparing options, I think in this space, but this is definitely very exciting work that was presented at this meeting.
Alicia Morgans: Absolutely. And as you mentioned, really a population that has had fewer options than we wish for them. And so, really exciting to think that we might have some new options there to maintain, keep their bladder for as long as possible, potentially if we can save some more.
Stephen Williams: Absolutely. And this doesn't take into account a number of other options that are currently being investigated as well. But I think with the combination therapy, that's something that I had taken away, whether we're looking at non-muscle invasive, muscle-invasive or metastatic, but particularly in the non-muscle combination agents. In addition, exploring also IO therapies or whatnot, we won't get into today perhaps, but there is some pivotal work being done using intravesical devices, such as the TAR-200 device, which is a pretzel, if you will. I know it's a cute term, but the size of a quarter that's inserted into the bladder and eludes chemotherapeutic agents. So getting back to the QUILT study, I think this does provide really a pivotal change in regard to the management and treatment options, hopefully in the near future for these patients.
Alicia Morgans: I agree. And I look forward to seeing further data, really as a follow-up there. One of the other things that you mentioned was really important at this meeting is something that is not necessarily therapeutic driven exactly, but helps us get therapies to patients. And it's something that I think we should all make sure we raise awareness about. And this was Sarah Psutka's presentation.
Stephen Williams: Yes, yes. So, Dr. Psutka has done an amazing job in this field, really trying to better understand, describe the patient population in the muscle-invasive setting, that are to undergo, or consider radical stacking, or even definitive therapeutic option, trimodal therapy as well. And what they did at the University of Washington is presented a pilot study, if you will, on a comprehensive geriatric assessment tool to be performed prior to a radical cystectomy, to better understand and describe not patients' frailty, but their mental health and overall well-being and suitability to undergo radical cystectomy. And what they were able to find was quite tremendous. First off the clinician in the time that it takes to perform this assessment was approximately 18 minutes. It was performed in a multidisciplinary clinic.
And from at least from how she described it, this really didn't add additional length to the visits per se, but more importantly, the patients thoroughly enjoyed it. There was an over 80% response rate for the assessments and in this population, they tend to be older, more frail, was actually taken quite nicely by their population. And it's a single center of excellence, a multidisciplinary team, but I think really needs to be critically assessed. And it's a part of our guidelines to perform these assessments. But I think far too often is underutilized, largely in the community, or even in the academic settings.
Alicia Morgans: I really think that's such a good point. And I think we often have, as barriers, timing, or "oh, the patients aren't going to want to do this." But particularly when we're trying to capture an understanding of their whole self, their psychological wellbeing, their physical wellbeing, nutritional, risk of all of these things that can come into these types of approaches. I think patients actually appreciate the fact that you're trying to make sure that you understand them as a clinical team. I'm not sure what your thoughts are there.
Stephen Williams: Well, you hit the nail on the head with that. We need to better comprehensively take care of our cancer patients. Not only their cancer, which is critical, but also to ensuring their health-related quality of life costs, financial toxicity, psychological, and psycho-oncology. I think these are all such pivotal areas that we have just a number of brilliant investigators like Dr. Psutka and others that are really paving the way so that we improve the entire care of our patients. And that's something that I've had the pleasure to work with several others that have taught me a tremendous amount on the psychosocial components, in addition, the cost of care. And then we've even developed a radical cystectomy survival calculator at our institution, it's readily available. But having these active discussions that really comprehensively assess our patients so that we can improve value to them.
Alicia Morgans: And that's so important, not just value in terms of bladder cancer, specific outcomes, but other outcomes that matter, including their quality of life.
Stephen Williams: Absolutely.
Alicia Morgans: Yeah. So what would your message be to those who are wrapping up AUA 2022, or who have wrapped it up, what is your overarching message to the listeners?
Stephen Williams: I think this is just such an exciting time in bladder cancer. We have a unique break. There's no surge right now. So just actually meet people, have genuine conversations and really explore innovative technology, ideas, and paving the way forward. I think we've all been through some hard times over the last couple of years, but I think also too, this is such a tremendous opportunity to improve the care that we're able to provide to our patients improve value to the patient. And we have just an exciting group of investigators and wonderful studies and presentations that have been conducted during this meeting. And I'm sure to carry us forward to the next stage.
Alicia Morgans: Well, what a message that is, and I agree wholeheartedly. I so appreciate you for your time, for your expertise, and for sharing those tidbits of information on AUA 2022.
Stephen Williams: Thank you so much.