UroToday - Although in high-risk non-muscle invasive bladder cancer intravesical therapy seems to reduce short-term tumor recurrence when compared to surgery alone, the choice of the right regimen for each patient is still controversial. As an example, although BCG has been shown to be most effective in high grade or recurrent Ta /T1 tumors, a percentage of patients ranging between 20% and 40% will fail, and, to date, it is not clear which alternative treatments should be done in those patients. The same controversies are found in patients treated with intravesical gemcitabine or mitomycin c. All these considerations, taken together, strongly suggest that it would be desirable to individualize intravesical treatment.

This translational oncology trial demonstrates that a molecular chemosensitivity assay is predictive of response to intravesical treatment in a group of patients with non-muscle invasive bladder tumors. This chemosensitivity assay has been designed in order to select for each subject his own optimal regimen, and to assign patients to the drugs for which they have the greatest probability of response, according to an individual molecular profile.

Using a panel of genes involved in drug resistance, we traced for each patient a specific chemosensitivity profile towards mitomycin c, BCG and gemcitabine, which are the drugs most commonly used in the post-TUR treatment of high-risk patients, and found a correlation with response to therapy in 96% of patients. The assay we propose is easy to perform, with low costs and rapid time of execution. After blood drawing, the chemosensitivity profile may be performed in 12 h, using an easy and inexpensive test such as RT-PCR.

Our results are encouraging in the future view of an individualised therapeutic approach, which may help the urologist in the hard choice of how to treat high risk non muscle invasive bladder cancer, selecting for each patient the optimal regimen, with the aim to provide a higher treatment success rate while sparing patients unnecessary toxicity from drugs that are not suited for their tumors.

Paola Gazzaniga, MD as part of Beyond the Abstract on UroToday

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