Rapid Developments to Enhance Patient Experience in GU Cancer

When I was a urology resident in the early 2000s, the management of any advanced genitourinary cancer was challenged by a frustrating lack of available treatments that could prolong the lives of individuals with cancer. The chemotherapy we used for prostate cancer was associated with quality-of-life benefit, but no survival benefit. If bladder cancer did not respond to the initial rounds of chemotherapy, we usually transitioned to palliative care. And kidney cancer was managed with nonspecific immunotherapies that were either incredibly challenging to give or that were associated with limited improvements in survival. As the articles in this issue highlight, the rapid development of new treatments for localized and advanced genitourinary cancers is challenging our paradigms of care and readjusting our treatment algorithms on a regular basis.

We are moving from an era of monotherapies to better understanding how combinations of treatments with different mechanisms of action can work together to help patients have better survival and quality of life outcomes. Combining drugs that block the impact of androgens on prostate cancer cells with drugs that keep cancer cells from repairing their own DNA so that they cannot divide and make more cancer cells is associated with patients living longer with advanced prostate cancer. Combining traditional chemotherapies with drugs that block cancer cells escape mechanisms that allow them to evade our immune system was associated with better survival in bladder cancer that invades the outer muscle layer of the bladder.

New advancements can also mean learning how to optimize treatments. The IMvigor211 trial was the first demonstrating the benefit of immune checkpoint inhibitors in metastatic bladder cancer. Yet in these large trials, we usually learn the difference in outcome for the average patient in a trial.

Some patients do better than average, and some do worse. Learning what additional factors can help patients have better health outcomes is a great motivator for secondary analyses of these trials, even ones published almost 10 years ago. In the case of the study highlighted in this issue, that means assessing the potential benefit of combining the immunotherapy with antihistamine medications. Sometimes, that means using biomarkers like the presence of circulating tumor DNA to better select patients for additional therapies. Either way, these secondary studies of large-scale trials help us as clinicians talk to patients when they ask us what they can do to optimize their health outcomes with these treatments.

Included in these studies are the individual experiences of hundreds of patients navigating their journeys with prostate cancer, bladder cancer, kidney cancer, testicular cancer and others. These are experiences that cannot be summed up in the aggregate data of these trials, because for these individuals, the trial has a sample size of one.

Beyond understanding traditional outcomes for clinical trials like progression of the cancer, recurrence of the cancer or death from the cancer, more and more studies are examining the patient experience. Whether new therapies that make survival better, or additional adjuncts to treatment that make that treatment work better, underlying all of these studies is the impact on patient experience with their cancer.

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