Dr Wang on the Importance of Personalized Treatment Approaches in Urothelial Cancer

Jue Wang, MD, professor, Department of Internal Medicine, member, Division of Hematology and Oncology, UT Southwestern Medical Center, discusses the importance of personalized treatment approaches in patients with relapsed or refractory urothelial carcinoma.

Relying on a trial-and-error approach isn't effective when treating patients with refractory urothelial carcinoma, Wang begins. With numerous active treatment options available, several factors, including the uniqueness of each patient's condition, guide treatment choices, he says. Community oncologists must identify individual patient characteristics and understand the dynamic nature of the disease, as refractory cancers often display features that deviate from those addressed with standard treatment plans, Wang notes. Overall, oncologists should acknowledge that, in addition to working with patients, they are grappling with the disease itself, Wang emphasizes.

When selecting treatments for patients with refractory diseases, one must consider aging, potential comorbidities, and lingering adverse effects (AEs) and complications from prior treatments, he expands. For instance, patients with diabetes may experience immediate AEs requiring steroid therapy, he explains. Each cancer treatment has its own AE profile, and AEs may overlap when patients transition between therapies, Wang says. Looking ahead, investigators should shift away from rigidly assigning treatments to specific lines of therapy and instead focus on understanding the disease's biology from the outset, Wang says.

Every cancer treatment decision should integrate patients’ disease burden, disease progression, comorbidities, and AEs, and treatment approaches should be personalized for every patient, he notes. Wang emphasizes the importance of disseminating knowledge and carefully evaluating each patient's specific circumstances to determine their suitability for the best available drugs.

There's no one-size-fits-all guide to addressing complex questions regarding treatment decisions for patients with relapsed or refractory disease, Wang continues. Clinical algorithms fall short in defining every clinical scenario, as real-world patients are often far more intricate than those enrolled in clinical trials, he says. To navigate this complexity, the medical community should collaborate to design clinical trials tailored to real-world challenges and utilize resources such as real-world data to address these nuanced questions, Wang concludes.