Sloan Kettering Bladder Cancer Doctors

Project : Immunologic Predictors Of Bcg Immunotherapy For Bladder Cancer

Bladder Reconstruction | Memorial Sloan Kettering

Project Co-Leaders:

The standard treatment for patients with high-grade non-muscle-invasive bladder cancer is cystoscopic resection followed by intravesical bacillus Calmette-Guérin , which is the most effective/ least invasive therapy for that stage of bladder cancer. However, not all treated patients remain disease-free, and there are currently no reliable methods to predict an individual patients outcome. Our work shows that BCG acts by infecting cancer cells, leading to lysis and presentation of cancer antigens, which triggers a T-cell response that eliminates cancer cells. Thus, we will determine if BCG strains with enhanced infectivity, enhanced or impaired survival within cancer cells, or enhanced ability to induce an inflammatory response will improve the efficacy of BCG in a mouse model of bladder cancer. We will also determine the magnitude and diversity of the BCG-induced antitumor T-cell responses and test whether cancer neoantigen vaccination can enhance BCG-induced tumor elimination. Finally, we will use tumors from BCG-treated patients with NMIBC to determine whether neoantigen load and measures of the immune response directed against tumor neoantigens are predictive of therapeutic efficacy. In sum, this project will seek to develop a clinically useful tool to predict an individual patients likelihood of therapeutic response to BCG therapy and to identify strategies to enhance the efficacy of BCG therapy.

Cystectomy With Urinary Diversion

Cystectomy is the most effective treatment for fast-growing or advanced bladder tumors. During this surgery, surgeons remove the bladder and often remove some of the nearby organs, too.

Our urologic cancer team has extensive experience in the safest surgical techniques for bladder surgery. When possible, we use the latest minimally invasive and robotic surgery methods. These procedures require smaller incisions, so you have less pain, fewer complications and a faster recovery.

Removing the bladder also requires urinary diversion, or a new way for urine to exit the body. Our surgeons are skilled in various urinary diversions, so you have choices. We explain the options and help you decide which one is right for your needs and lifestyle.

Our urinary diversion options include:

Squamous Cell Carcinoma Of The Bladder

Squamous cell carcinoma is the second most common type of bladder cancer. It accounts for about 5 percent of bladder cancers in North America and Europe. This cancer begins in the thin, flat squamous cells that may form in the bladder after chronic inflammation and infection. Squamous cell carcinoma is most often found in parts of the world where a parasitic infection called schistosomiasis is widespread, such as the Middle East.

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Cystectomy Neobladder And Urinary Diversion

A cystectomy is surgery to remove the bladder. This procedure is used to treat bladder cancer that has grown into the muscle. A partial cystectomy removes only a portion of the bladder. A radical cystectomy removes the entire bladder as well as nearby lymph nodes and organs that may contain cancer.

During a partial or radical cystectomy, the surgeon may be able to create a new bladder, called a neobladder. It is built from part of the small intestine. If a neobladder is not possible, the surgeon may divert urine through part of the small intestine to an opening on the outside of the abdomen. This is called a stoma.

Bladder Cancer Doctors Surgeons And Experts

Study Clarifies How Bladder Cancer Treatment Works

As a Memorial Sloan Kettering patient, you benefit from the experience and compassion of a team that treats nearly 400 people with bladder cancer each year. Were committed to getting you the best outcome possible. We maintain our relationship with you after you complete treatment, so you get the follow-up care you need not just to survive but to thrive.

Working as a team, our bladder cancer specialists in urology, medical oncology, urologic surgery, radiation oncology, pathology, and radiology will shape the best treatment approach for you.

Select from the list below to learn more about how our bladder cancer experts can help you.

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Weill Cornell Medicine Urology Lower Manhattan

Appointments: 962-9600

For word-class and compassionate urologic care in downtown Manhattan, Weill Cornell Medicine and Brady Urologic Associates has a clinical urology practice at 156 William Street and affiliated with New York-Presbyterian Lower Manhattan Hospital. This practice is housed in a newly renovated clinical space, equipped with state-of-the-art medical technologies, exam rooms, and procedure rooms.

Improper Bladder Cancer Treatment Costing Lives

You may not know it, but bladder cancer is the fifth most common form of cancer in the U.S. More than 70,000 Americans were diagnosed with the disease last year, and nearly 15,000 died from it.

New research shows a big problem may be that almost no one gets the recommended treatment, as CBS News correspondent Dr. Jon LaPook reports.

Six years ago, Adam Schaffer was enjoying Thanksgiving with his family until, he said, “I went to the bathroom, and there was a whole bunch of red. And it was very scary.”

He was just 44 years old. The doctor’s diagnosis floored him.

“He said you have bladder cancer,” Schaffer recalled. “And you could feel the room spinning.”

His first doctor removed the tumor but did not follow up with standard recommended treatment. Failure to follow guidelines is dangerously common and one reason bladder cancer survival has not improved in 25 years, says UCLA’s Dr. Karim Chamie.

“If we were to get a report card based on our performance with these guideline measures, I’d say we’d be failing our patients right now,” said Chamie, a uric oncologist at the schools’ Jonsson Comprehensive Cancer Center.

For the first two years after finding early bladder cancer, doctors are supposed to test the urine for abnormal cells and examine the inside of the bladder every three months. They’re also supposed to fill it with an anti-cancer drug at least six times.

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Ial Cystectomy After Neoadjuvant Chemotherapy: Memorial Sloan Kettering Cancer Center Contemporary Experience

Harry W. Herr

1 The Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA

Abstract

1. Introduction

In 2014, it is estimated that there are 608,620 bladder cancer survivors living in the United States, and an additional 74,690 cases will be diagnosed . Neoadjuvant chemotherapy followed by radical cystectomy is now considered the standard of care for muscle-invasive bladder cancer after numerous trials demonstrated a survival benefit, most notably in patients with advanced pathologic stage disease .

For highly selected patients, bladder-sparing surgery such as transurethral resection of bladder tumor or partial cystectomy may provide similar oncologic outcomes to RC while maintaining bladder and sexual functions. Of the two bladder-sparing options, PC has advantages over TURBT as a third of patients are understaged with TURBT and PC allows for full thickness examination of the bladder wall and concurrent lymphadenectomy resulting in more accurate staging and prognosis .

We herein report our contemporary experience with a highly select cohort of patients who received neoadjuvant chemotherapy followed by PC performed for curative intent at a single tertiary institution.

2. Patients and Methods

Moving From The Lab To The Clinic

Cancer Care Can’t Wait | Memorial Sloan Kettering

Dr. Glickmans laboratory is now collaborating with urologic surgeon Bernard H. Bochner to explore the clinical implications of this discovery particularly, whether analyzing a patients bladder cancer cells can reliably predict his or her responsiveness to BCG therapy.

With the support of a grant from The Society of MSKCC, Dr. Redelman-Sidi is trying to develop a lab test that would analyze urine samples, which usually contain cancer cells shed from the bladder. These cells could be tested both for their tendency to take up BCG and also for the presence of BCG-activating, cancer-causing mutations.

This would allow us to screen early-stage patients routinely before starting BCG therapy to make sure its the best course of treatment, Dr. Glickman says.

What Are The Risk Factors For Bladder Cancer

Tobacco use is by far the biggest risk factor for developing bladder cancer. People who smoke cigarettes are up to four times more likely than nonsmokers to develop the disease. Studies have shown that smoking is responsible for approximately 50 percent of bladder cancers.

People who work in the textile, dye, rubber, leather, paint, or printing industries may also be at an increased risk of bladder cancer.

Mutations Open The Door

An important insight into what makes the entry of BCG into cells possible arose from a collaboration between the Glickman lab and Memorial Sloan Kettering cell biologist Xuejun Jiang. In June 2012, this team reported in the Journal of Biological Chemistry that cancer cells with mutations in the gene PTEN are highly susceptible to mycobacterial infection. The PTEN protein normally acts as a tumor suppressor impaired PTEN function appears to increase a cells vulnerability to becoming cancerous and also to mycobacterial infection.

To investigate whether this correlation holds true in bladder cancer cells, Drs. Redelman-Sidi, Glickman, and colleagues treated six distinct cell lines groups of genetically identical cells developed from a single cell with BCG and measured the degree to which the BCG bacterium was taken up by the cells.

They discovered that the cell lines that most readily took up BCG contained one of several cancer-causing mutations, including mutations in PTEN, known to be involved in the onset of bladder cancer. The cell lines resistant to BCG did not have these particular mutations, but they could be converted to BCG-receptive cells if the mutations were induced. Moreover, these converted cells readily took up BCG via a pathway different from the one BCG usually employs to enter immune cells.

These mutations activate a mechanism in the bladder cancer cells that allows BCG to enter and destroy them, Dr. Glickman says.

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What Is Bladder Cancer

Bladder cancer is a disease that usually begins in the cells that line the inside of the bladder. It typically affects people older than 70 and occurs more often in men. Bladder cancer is the fifth most common form of cancer overall and the fourth most common among men.

Bladder cancer usually responds well to treatment when diagnosed early. However, people who have been successfully treated for bladder cancer should be monitored afterward. Bladder cancer can return even years later.

Genetic Analysis Of Bladder Tumors

For people with advanced bladder cancer that has spread, we use a test called MSK-IMPACT. It can look for genetic mutations and other changes in a tumor. This test provides essential information that can guide treatment choices and, in some cases, identify candidates for a clinical trial. It can also spare people from treatments that are not likely to be effective. MSK-IMPACT was developed by MSK pathologists and researchers. It has been used to analyze the tumors of MSK patients with advanced cancer since January 2014. It was authorized by the Food and Drug Administration in November 2017.

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How Is Bladder Cancer Diagnosed

Doctors use several tests to diagnose bladder cancer. One common method is a cystoscopy. In this procedure, a small tube with a camera is inserted into the urethra and slowly moved into the bladder.A doctor can then examine the lining and take a sample, called a biopsy.Another method is a urine cytology. This test analyzes a urine sample to see if it contains tumor cells. Doctors also use a variety of imaging tests to examine the urinary tract.

Project : Elucidating Mechanisms Of Sensitivity And Resistance To Checkpoint Blockade Therapy For Rational Multi

Project Co-Leaders:

For patients with metastatic urothelial carcinoma whose disease has progressed despite first-line chemotherapy, treatment with immune checkpoint blockers is now a standard of care. However, response rates are low and reliable prognostic markers have yet to be identified. To identify predictive biomarkers of treatment response and resistance that could guide the rational development of more effective combination strategies, this project will systematically investigate the tumor and immune microenvironment of patients treated with immune checkpoint inhibitors utilizing blood, plasma, peripheral blood mononuclear cells, and tumor samples collected within the context of both therapeutic clinical trials and standard of care treatment. The cohort under study represents treatment with immunotherapy alone and in combination with other agents, across the full metastatic disease spectrum, in both treatment-naïve and treatment-resistant settings. This will allow cross-comparisons of checkpoint blockade inhibition alone and in combination with VEGF inhibition, CTLA-4 inhibition, standard cisplatin-based chemotherapy, TGF-beta inhibition, and antibody-drug conjugate therapy. The goal of these analyses is to develop more robust biomarkers of immunotherapy response, identify rational targets for effective combinatorial therapies, and understand acquired resistance to immune checkpoint blockade in patients with urothelial cancer.

Christopher B Anderson Md

Dr. Anderson’s research interests include factors that influence the quality of surgery, access to care for patients with bladder cancer, outcomes after robotic prostatectomy, and active surveillance strategies for men with prostate cancer. Dr. Anderson has published several peer-reviewed articles and was recognized as “Best Reviewer” in 2014 by The Journal of Urology and in 2016 by Cancer.

Dr. Anderson has clinical expertise in robotic prostatectomy for the treatment of prostate cancer, radical cystectomy with orthotopic neobladder for patients with bladder cancer, and partial nephrectomy for the treatment of kidney tumors. He also specializes in the multidisciplinary management of men with testicular cancer, including the use of primary and post-chemotherapy retroperitoneal lymph node dissection. He is currently the site leader for several clinical trials investigating the use of immunotherapy in patients with invasive and non-invasive bladder cancer.

Why Should I Choose Memorial Sloan Kettering For Bladder Cancer Treatment

Dr. Bochner on Molecular Profiling in Bladder Cancer

Memorial Sloan Ketterings team of bladder cancer experts delivers the highest quality compassionate cancer care. We take into account each individuals needs and develop a personalized treatment plan.

At MSK, we offer:

A multidisciplinary team of experts that is among the most experienced in the field. The team includes world-class specialists in surgery, chemotherapy, radiology, pathology, and nursing.
Close collaboration among these experts. Our team meets regularly to discuss each of the people we care for. We draw on our vast experience to determine the best course of treatment. For example, our surgeons and oncologists work closely together to ensure that people who need chemotherapy before surgery begin this treatment as soon as possible. Starting care right away has been shown to produce better outcomes for our patients.
Skilled and specialized surgeons. Our surgeons use a variety of advanced approaches to remove bladder tumors. We take every measure to preserve urinary and sexual function. For many people with early-stage bladder cancer, we can successfully treat the disease with minimally invasive procedures, including robot-assisted surgery.