Highlighting Clinical Trials NonMuscle Invasive Bladder Cancer Part III QA

I'd like to start with a quick question which I think really is really important for patients how do I bring up a clinical trial with my doctor he's never mentioned it but he's not at a large teaching hospital you know obviously each doctor is a little different and doctors who I pick my book commonly see patients per second third opinion in part because many patients and some physicians want to see if there are other options that we have available that maybe they don't I don't know that there is a perfect way I think patients have to be proactive because after all as much as we're empathetic of the patients really have a lot more at stake than we do and obviously the be can cite has you know a lot of information about clinical trials the National Cancer Institute actually has every clinical trial but you know online and you can you can identify a bladder cancer trials I really think that the best you can do is to you know you can print out a list of crawls or you can engage your position that with what is their thoughts about clinical trials in general I'm not sure that there's any real strategy beyond just being honest with your position that that you want to see what else can be done especially in the case where for standard treatments are not working well and I just want to add to that that there are urologist that are in you know in the community or not in necessarily big academic centers that are really active in clinical trial research so it would just start writing re are you participating any medical trials and bladder cancer and if so what are they start the dialogue okay thank you very much there's another question what's the value of blue light cystoscopy if you could speak to that bluelighter flores and cystoscopy is a method that has been approved primarily for use in the operating room up from now where you instill a substance called HEK HEK 6 which is really short for X amino love you Lana cats it and what it does is if they a substance that's not toxic and it gets taken up by cancer cells but when you look at it under a blue light it looks pink and there have been several randomized trials have shown that it can improve the detection of cancer and by about ten to twenty percent in particular personal months I to which is often difficult to detect most of the time it's used in the operating room in patients who have no bladder cancer to try to identify new lesion but there's actually a large national trial right now to use it in office with a flexible business hope to try to figure out which patients we don't you cancer in might actually have cancer that you may have missed with a white light they're still lacking evidence that it improves survival of progression but it did reduce recurrence in several large trials so there's probably a role for it in some patients with bladder cancer if not many great that's really helpful thank you so that sort of segues into the next question are there any trials that you know of that are looking at early diagnosis or trial specifically looking at surveillance for recurrence I think this is a question specifically looking at family members and others who might be at risk for bladder cancer yeah so you know actually dr. Loe tanager I would say one of the national leaders in early detection of bladder cancer he did a one of the very few screen settings and I quote him and I actually work together and in urinary biomarker to aid in detecting cancer early generally I we both feel that there is a role for early detection there are older studies that have found that detecting bladder cancer early probably will improve survival because you can reduce the chance of finding bladder cancer when it invaded the wall of the bladder or metastatic which unfortunately about twenty-five percent of all patients with newly diagnosed bladder cancer already have Muslim faces disease one of the biggest problems we have right now is a lot of people have microscopic blood in the urine but don't get adequately evaluated until these are see blood in the urine or have many times and so dr. sondik and I actually working on a trial to try to find it a certain urine markers will help detect those patients early as far as a family connection it's a complicated issue because in fact the doctors thought they pointed out the genetics of bladder cancer are very weak there are many cancers such as prostate cancer and breast cancer but there's a strong family link but in bladder cancer most of the time whenever genetics are involved they're not inherited their acquired in other words something like tobacco smoking caused you to have genetic changes that let the cancer and as far as I can tell the biggest risk for family members if they also smoke or if the parents smoke but we don't really have a good we don't usually strain family members unless they have microscopic blood and the only thing that I've had recommended is so if you have a relative who adds water cancer and you have risk factors such as smoking then you can look for blood in the urine or you know your doctor can and if you find it then you want here to evaluate it by having somebody look in your bladder but but we don't currently extremely members for example okay I have another question are there any types of trials that are available that you know of that you could speak to if BCG is not working yeah this isn't actually one of the most exciting areas from a clinical trials perspective because for two reasons one is that there are a lot of new agents that are being kind of developed and this is one area where a lot of those agents are being tested I can think of three maybe four trials right now that are kind of in the works for this specific population the other reason that it's an exciting area is because look the fact is that this this is a really challenging disease which when BCG has failed the most patients get their bladder removed and that that seems like a drastic maneuver but we know that that's one of the only ways that we could prevent it from progressing so the FDA is actually been approached and had been to develop a kind of platform for licensing of new drugs specifically for these stations and so it's kind of been spelled out we've met with the urologist and bladder cancer experts and we have a very spelled out platform of how we can get like licensing for these new drugs in this particular disease state so as an example of some drugs that are being evaluated to there is a gene therapy drug which which seems to a pro do not have the earthly the bots are cells making interferon that's one drug that's being evaluate and as we build into the bladder there is a drug immune therapy is there really interesting and exciting agents for bladder cancer so there's what we call checkpoint inhibitors returning the in therapies that are going to be evaluated in this particular population so and there's a few of them out there so there are there's different tests or I say different trials depending on the agent so there this is an exciting time for us a lot of cancer field particularly in that method be state great thank you all right I have another question what can we learn from a tibia and pathology and cytology this is this a bit of a complicated question in some respects because for the most part it's the meaningless finding in the sense that the pathologist typically have with different ways of characterizing cells in the urine they could be completely normal they could be a typical that can be reactive they can be suspicious or they can be malignant atypia common is we find about fifteen to twenty percent of patients and it's common because we are constantly doing things to the bladder that irritated looking in the bladder and putting treatments in it and so the cells look a little bit abnormal but not as normal enough be suspicious or cancerous there for the most part these findings should be ignored but at some institutions including ours we use the of your marker such as Eurovision to try to figure out which one is which of those patients have cancer and and that essentially is the case when we see something in the bladder because BCG causes inflammation sometimes the lining looks a little bit red and then we don't know that in combination where they tippy up means the patient has carcinoma in situ it's a genetic more props and help sort that out when the vast majority of institutions atypia by itself doesn't mean anything in terms of cancer and can be safely ignored unless there's also some finding other you know when they look in the bladder I'd like to take a moment and thank you both very much for a very informative program and I'd like to thank Merck and Genentech for providing grants to enable us to have the patient insight webinars series on our website