Dr Grivas on Addressing Unmet Needs in Urothelial Cancer

Petros Grivas, MD, PhD, physician, Seattle Cancer Care Alliance, associate professor, Division of Medical Oncology, University of Washington (UW) School of Medicine, clinical director, Genitourinary Cancers Program, UW Medicine, associate professor, Clinical Research Division, Fred Hutchinson Cancer Research Center, discusses several unmet needs within urothelial cancer, as well as how to potentially ameliorate them.

When attempting to improve quality of life for patients with urothelial cancer, it is important to employ strategies that account for both disease and treatment burden, Grivas begins. Accordingly, efforts should not just be focused on improving disease control, but rather also include obtaining and measuring patient-reported outcomes to better assess the patient's experience of their own care, he says.

Similarly, efforts to identify and address disparities in cancer care are critical to improve patient outcomes and increase equality, diversity, and inclusion in care across tumor types, Grivas explains. Strategies should aim to reduce barriers to treatment, improve the inclusion of minorities and other underrepresented groups in clinical trials, and facilitate social and familial support, Grivas states. Healthcare providers should also promote resources or programs that help patients and their families cope with financial toxicity, he adds.

The frequency of germline mutations in urothelial cancer, particularly in bladder or upper urinary tract cancers, has greatly increased in the last decade, Grivas continues, adding that the detection of germline mutations is therefore critical to informing treatment decisions in urothelial cancer. Moreover, it is important to ensure that a patient's family history has been obtained, and that they undergo germline testing. In turn, this may also educate families about their hereditary risk for developing urothelial cancer and direct them towards early cascade testing and other cancer prevention strategies, he notes.

Lastly, ongoing efforts to develop and validate biomarkers in urothelial cancer increasingly require tools like germline testing to identify patients who may benefit from targeted therapies, Grivas states. As these biomarker-driven therapies continue to expand and improve in efficacy, germline testing will become even more integral to patient selection, he concludes.