Dr Schmidt on the Development of Novel Treatment Delivery Approaches in Bladder Cancer

“TAR-200 utilizes gemcitabine, which is an old, familiar drug, but [TAR-200] delivers it in a very different way. UGN-102 uses mitomycin—also an old, familiar drug—but delivers it in this reverse hydrogel formulation where it stays in the bladder and has a longer sustained delivery… The new delivery mechanisms are fascinating, and I think that's only going to improve how we treat our patients.”

Bogdana Schmidt, MD, MPH, an assistant professor in the Division of Urology at the University of Utah Huntsman Cancer Institute, detailed the development of novel treatment delivery modalities in patients with bladder cancer.

Of significance, novel treatment delivery systems currently under evaluation, such as TAR-200 and UGN-102, represent a shift in the bladder cancer paradigm by providing a touch of innovation, Schmidt began. She explained that TAR-200 still utilizes gemcitabine—a familiar drug in the oncology space—that is delivered in a novel format. Similarly, UGN-102 delivers mitomycin (Mitosol) with a new approach, in which it is administered as a reverse hydrogel formulation and remains in the bladder for sustained exposure, she said.

Regarding other developments in treatment delivery, Schmidt noted that there has been recent progress in utilizing MRI for staging, although this strategy has not yet been commonly adopted. However, she emphasized that although many treatment strategies are on the rise in the bladder cancer space, there are still challenges and current limitations. For example, evaluating areas to identify separate markers for bladder cancer has not been as advanced as the prostate cancer space, for example, with prostate-specific antigen and prostate-specific membrane antigen, she added.

Nevertheless, there are still other approaches that can add to treatment strategies, Schmidt continued. The use of artificial intelligence (AI) can help in enhancing pathology in bladder cancer, she said. If a patient has markers based on pathology signatures, the tool can help predict responses to various treatments, she explained. As an example, she noted that there is a company that can assess pathology slides to predict whether the patient’s tumor is most likely to respond to different treatments, such as an immune-mediated pathway, BCG, or chemotherapeutic pathways, including docetaxel and/or gemcitabine. AI tools like this are becoming more commercially available and more are in development, which are going to continue improving, Schmidt concluded.