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Advanced Bladder Cancer: Should I Consider a Clinical Trial?

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Published on August 5, 2021

The Importance of Clinical Trials for Advanced Bladder Cancer

Keep watching to hear Nataliya Mar, MD, of UC Irvine Health, discuss the importance of advanced bladder cancer patients considering a clinical trial. She explains the process of joining a clinical trial and the questions you should ask your doctor, and reminds us that the standard of care treatment always remains an option in cases where a clinical trial doesn't produce the desired outcome.

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Transcript | Advanced Bladder Cancer: Should I Consider a Clinical Trial?

Dr. MarHi, my name is Nataliya Mar. I am an Associate Professor at University of California Irvine, and I specialize in treating genitourinary cancers.

When Should a Patient With Advanced Bladder Cancer Consider a Clinical Trial?

Dr. Mar: Everything that we have has come out of clinical trials and patients have graciously donated their time, so that way we could study new treatments, which eventually became FDA approved. So,I  would always recommend considering a clinical trial before any standard of care therapy. There are a couple of reasons why this is important. Number one is that being part of a clinical trial gives you access to new and exciting therapies that might not be otherwise available to you in the community. Also, it provides patients with an extra line of therapy because FDA-approved treatments are always there, they're always available.
Meanwhile, clinical trials are opportunities that are there at that particular moment but may not be there months down the road. Sofor that reason, I think that clinical trials are always something that has to be considered first. And if available, and the patient matches to them, then I would recommend that the patient proceed with the clinical trial.I think that the patients should always be proactive, if possible, in terms of looking up the clinical trials that are around them in their geographic area that might be of interest to them. Whether a doctor recommends a clinical trial for you is completely dependent upon the doctor that you have. Some doctors believe that clinical trials should be considered firstand some don't. Soit depends on the relationship that you have with your doctor. I always recommend clinical trials for my patientsif I think that they would match into one, or if we have one available for their stage of the disease. But it's always good to...for the patient to be proactive, so that way the discussion may be more likely and informative.

What Are the Important Questions to Ask Your Doctor When Considering a Clinical Trial?

Dr. MarThe things that I would think are important for a patient to ask would be, why is this clinical trial better than the standard of care in my situation? Another question to ask would be the details. For example, how do the clinical trial drugs work? What would be the schedule that I would need to follow? What would be the side effects of the medications that I'm receiving? Is there any flexibility? For example, if I have to travel, do I have flexibility in terms of the schedule, the duration of treatment? What happens after I finish the treatments? And what would be the circumstances under which the trial has to stop, or I no longer would be receiving these medications? For example, if you have a side effect that you cannot overcome with supportive measures, or for example, if I don't want to do the trial anymore. Sowhat would be those circumstances? 
The bladder cancer field has evolved tremendously in the past five years and continues to evolve very rapidly. There are multiple trials that are going on right now. Sosome of them that I can think of in advanced or metastatic bladder cancer would be, using drugs that are not chemotherapy-based upfront for untreated patients with advanced or metastatic bladder cancerFor example, there is an exciting combination of two non-chemotherapy drugs that is currently being investigated. And we actually have this clinical trial at UC Irvine. It combines two drugs, one is called Keytruda (pembrolizumab), the other one is called Padcev (enfortumab vedotin-ejfv), both are not chemotherapies for patients who have not previously received treatment in the locally advanced metastatic bladder cancer setting. So that's one thing.
And another interesting strategy is combining chemotherapy with other medications, like for example, immunotherapies, kind of being more aggressive upfront with the therapies that we give for our patients. Other approaches test new drugs, entirely new drugs that have not been approved yet, with new mechanisms of action, to see if they are effective for advanced or metastatic bladder cancer. These drugs are commonly tested in pretreated patients, patients who have received standard therapies and have few or no treatment options remaining.
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