Plenary Session 3: Promising biomarkers and novel approaches for patients with BCG failure

Plenary Session 3: Promising biomarkers and novel approaches for patients with BCG failure

Presenter Prof. Paolo Gontero (IT) launched Plenary Session 3 “Bladder cancer: Bladder-preserving strategies in NMIBC” at EMUC21 today with his presentation on the use of biomarkers in bladder-preserving strategies. Part of his lecture centred on surveillance, wherein one of the key points was that promising urinary markers challenge urine cytology and will likely replace it in clinical practice.

According to Prof. Gontero, among the numerous markers assessed over the years, two were notable:  cell-based urine cytology and fluorescence in situ hybridization (FISH). However, both have disadvantages.

“Guidelines-recommended urine cytology is the current gold standard. It has high specificity but the sensitivity has been very disappointing in the latest studies, even for high-grade diseases. Moreover, it requires a highly-trained cytopathologist,” said Prof. Gontero. He stated that FISH is “too complex”. It may be more sensitive than cytology but less specific than urine cytology.

With new commercially available urine markers, is there a game-changer that can be an alternative to urine cytology? Prof. Gontero explored this in his presentation by focusing on two genetic urinary biomarkers and one protein-based urinary marker.

“Detecting genetic abnormalities that are widespread in NMIBC is an excellent alternative. DNA- and RNA-based biomarkers have been recently assessed in several studies such as DNA-based Bladder EpiCheck, which detects DNA methylations, and RNA-based Xpert Bladder Cancer Monitor, which detects five messenger RNAs (mRNAs),” stated Prof. Gontero. He also discussed the check protein-based urinary marker ADX Bladder has shown triple the sensitivity than of urine cytology in a study. In the same study, Prof. Gontero noted that urine cytology performed below par.

“Collectively, all these markers have the sensitivity that can detect high-grade disease, and have extremely negative-predictive value for high-grade disease. This means that these markers can be used potentially to reduce the burden of cystoscopy. However, more studies are needed.”

For patients who fail after BCG

In his lecture “Innovative approaches for patients who fail after BCG”, Dr. Gianluca Giannarini (IT) stated that the era of bladder preservation with regard to bladder cancer is as strong as ever. In addition, he said that there are several novel bladder-sparing options for bacillus Calmette-Guerin (BCG)-unresponsive non-muscle-invasive Bladder Cancer (NMIBC) which have acceptable toxicity but with modest durable efficacy. He stated that this will pave the way for combination therapy and not single-agent.

Dr. Giannarini underscored that a better understanding of the molecular mechanisms of BCG response and resistance will enable personalised treatment. He concluded that urologists need to embrace multidisciplinarity and be an active part of the paradigm changes in the field of bladder cancer.

Plenary Session 3 was chaired by oncologist Dr. Ronald de Wit (NL), EAU Section of Oncological Urology (ESOU) Chair Prof. Morgan Rouprêt (FR), and European Urological Scholarship Programme (EUSP) Chair Prof. Dr. Axel Merseburger (DE).

(Re)view the full presentations of Prof. Gontero and Prof. Giannarini and other highly-informative lectures of Plenary Session 3 via the Resource Centre.


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