Bladder cancer is the fifth most common cancer in Canada, yet it remains under-recognized and underfunded. Because of this, treatments have lagged behind, especially for muscle-invasive bladder cancer (MIBC), an aggressive form that typically requires chemotherapy followed by full bladder removal.
This standard approach to care comes with serious drawbacks. Many patients aren’t healthy enough for chemo, and for those who are, it doesn’t always work, even after enduring significant side-effects. Surgical removal of the bladder is associated with a high risk of complications and has a long-term negative impact on quality of life.
Now, a $3-million Terry Fox New Frontiers Program Project Grant will help a Vancouver Prostate Centre (VPC) research team change that. Their goal is to personalize bladder cancer treatment, improve outcomes and ultimately help more patients keep their bladders.
Predicting response, preserving quality of life
Many patients undergo bladder removal even if the chemotherapy seems to have worked, simply because there’s no way to confirm whether any invasive cancer remains.
“Until now, we haven’t had reliable ways to know if there is cancer left in an individual patient’s bladder, so we remove the bladder just to be sure,” says lead investigator Dr. Peter Black, VPC director, surgeon scientist and a professor at the University of British Columbia.
To address that, the team is developing new tools to predict and measure how well a patient is responding to treatment. Using blood and urine tests that detect tumour DNA, along with advanced magnetic resonance imaging (MRI), these tools will help care teams make more confident, individualized decisions.
This approach could also help when chemotherapy isn’t working. If clinicians can identify this early, they can change course sooner, switching to surgery or trying a more effective therapy for that patient.
Using data to drive decisions
Another part of the project is using machine learning to analyze patient data, including tumour sequencing and pathology results. The aim is to spot patterns that can help predict which patients will respond to chemotherapy, before they even begin treatment.
“We don’t want to patients to suffer through ineffective treatment. We want to move forward with the best treatment for each patient,” says Dr. Black.
The team is also studying why some tumours don’t respond at all. By examining how the immune system interacts with tumours, they hope to uncover vulnerabilities in resistant cancer cells, and find ways to prime the immune system to overcome them. This part of the program is led by Dr. Morgan Roberts, an assistant professor in the Department of Urologic Sciences and senior research scientist at the VPC.
They’ll also test two promising new drugs in laboratory models, targeting cancer-specific sugar structures found on the surface of treatment-resistant bladder cancer cells. If successful, these findings could lead to future clinical trials and new treatment options for patients who currently have few. This part of the program is led by Dr. Mads Daugaard, an associate professor in the Department of Urologic Sciences and senior research scientist at the VPC.
From bedside to bench and back again
“The project moves from patients to the lab and back to patients again,” says. Dr. Black. “It takes seamless integration across disciplines, all working toward a common goal.”
The team includes clinician scientists, who conduct trials and collect specimens from patients; computational scientists, who analyze large datasets; and basic scientists, who study the tumour microenvironment and test drugs in lab models.
Each role is essential to advancing this research, improving treatments and ultimately helping patients.
“I’m a surgeon. Surgery to remove the bladder is critically important to many patients – but I also clearly see the downsides of surgery, and I’m very excited to find ways to enable patients to avoid this complicated procedure,” he says. “I see the impact on each person."
For Dr. Black, this project is deeply personal.
“I grew up watching Terry Fox. I remember his Marathon of Hope very well. His dream means a lot to me personally. And professionally, it’s a massive opportunity to receive Terry Fox funding and work toward real improvements for patients.”
Funding the future of care
The VPC team is a top fundraiser for the annual Terry Fox Run – a reflection of their belief in Terry’s dream and the power of research.
“We have an amazing team that fundraises hard for the run because we know we couldn’t do this transformative work without it,” says Dr. Black. “This is productive, translational research – it’s uniquely Terry Fox and uniquely Canadian. We’re proud to be a part of it.”