With support from a new $3-million Terry Fox Frontiers Program Project Grant, researchers from the UBC Faculty of Medicine and Vancouver Prostate Centre hope to transform how bladder cancer is treated — making it more personalized, improving outcomes and helping more patients keep their bladders.
Bladder cancer is the fifth most common cancer in Canada, yet treatments have lagged behind, especially for muscle-invasive bladder cancer (MIBC) that typically require chemotherapy followed by full bladder removal.
Many patients undergo bladder removal even if the chemotherapy seems to have worked, simply because there’s no way to confirm whether any invasive cancer remains. This approach comes with serious drawbacks, as surgical removal of the bladder is associated with a high risk of complications and has a long-term negative impact on quality of life.
“Until now, we haven’t had reliable ways to know if there is cancer left in an individual patient’s bladder, so we remove the bladder just to be sure,” says lead investigator Dr. Peter Black, professor and head of the UBC Department of Urologic Sciences and director of the Vancouver Prostate Centre.
To address that, the team is developing new tools to predict and measure how well a patient is responding to treatment. Using blood and urine tests that detect tumour DNA, along with advanced magnetic resonance imaging (MRI), these tools will help care teams make more confident, individualized decisions.
Using data to drive decisions
This approach could also help when chemotherapy isn’t working. If clinicians can identify this early, they can change course sooner, switching to surgery or trying a more effective therapy for that patient.
Another part of the project is using machine learning to analyze patient data, including tumour sequencing and pathology results. The aim is to spot patterns that can help predict which patients will respond to chemotherapy, before they even begin treatment.
“We don’t want patients to suffer through ineffective treatment. We want to move forward with the best treatment for each patient,” says Dr. Black.
The team is also studying why some tumours don’t respond at all. By examining how the immune system interacts with tumours, they hope to uncover vulnerabilities in resistant cancer cells, and find ways to prime the immune system to overcome them. This part of the program is led by Dr. Morgan Roberts, an assistant professor in the UBC Department of Urologic Sciences and senior research scientist at the Vancouver Prostate Centre.
I’m very excited to find ways to enable patients to avoid this complicated procedure.
Dr. Peter Black
They’ll also test two promising new drugs in laboratory models, targeting cancer-specific sugar structures found on the surface of treatment-resistant bladder cancer cells. If successful, these findings could lead to future clinical trials and new treatment options for patients who currently have few. This part of the program is led by Dr. Mads Daugaard, an associate professor in the UBC Department of Urologic Sciences and senior research scientist at the Vancouver Prostate Centre.
From bedside to bench and back again
“The project moves from patients to the lab and back to patients again,” says. Dr. Black. “It takes seamless integration across disciplines, all working toward a common goal.”
The team includes clinician scientists, who conduct trials and collect specimens from patients; computational scientists, who analyze large datasets; and basic scientists, who study the tumour microenvironment and test drugs in lab models.
Each role is essential to advancing this research, improving treatments and ultimately helping patients.
“I’m a surgeon. Surgery to remove the bladder is critically important to many patients – but I also clearly see the downsides of surgery, and I’m very excited to find ways to enable patients to avoid this complicated procedure,” he says. “I see the impact on each person.”
This article has been adapted from its original version on the Terry Fox Research Institute website.