Advances in classifying BCa variants to boost therapeutic options

14 May 2018

Recent gains in precisely identifying bladder cancer variants and their respective classification can go a long way in enabling physicians to determine the proper treatment, which leads to better or timely therapies for many bladder cancer patients.

Bladder cancer treatment is currently in a flux due to new research discoveries in the molecular characteristics of various bladder cancer types, a phenomenon that prompts cancer specialists not only to re-think their standard treatment plans but also to refine management approaches and anticipate prospective therapies.

“It is important that surgical pathologists be aware of the potential for multi-directional differentiation of urothelial carcinoma. The correct characterization of the tumours may have diagnostic, therapeutic or prognostic implications, significantly impacting management,” said pathologist Prof. Rodolfo Montironi, resource speaker and moderator at the upcoming  EAU Update on Bladder Cancer (BCa18) to be held on 8 and 9 June in Munich, Germany.

Organised by the European Association of Urology (EAU) as part of the recently launched educational update series on onco-urological malignancies, the two-day BCa18 is a highly focused, interactive meeting that aims to provide a concise and critical examination of new and prospective management strategies in bladder cancer treatment.

Describing molecular features

Montironi, pathology professor and chief of the Genitourinary Cancer Program at the Polytechnic University of the Marche Region in Ancona, Italy, will speak on the updated 2016 WHO Classification, particularly key changes in classifying various tumour types and new descriptions of molecular characteristics. He underlined that for non-pathologists these changes have a significant bearing on how physicians will diagnose and select the most appropriate treatment for their patients.

“The novelty of the 2016 WHO classification is represented by the precise identification of the morphologic spectrum of bladder cancer.  In particular, the revised classification includes a detailed and comprehensive description of the urothelial carcinoma with divergent differentiation, such as glandular, squamous and small cell,  and of its variants, such micropapillary and plasmacytoid. Such tumors can be aggressive, even when still in the subepithelial connective tissue and are considered as high-risk non-muscle invasive bladder cancer (NMIBC),” according to Montironi.

High-risk NMIBC is particularly notorious for its aggressive recurrence and presents treatment dilemmas to physicians. With an accurate description of molecular types and more detailed laboratory results, doctors can examine tumour burden or the depth of micro-invasion aiding them to select those patients that are fit for certain types of radical therapies, such as chemotherapy or an early cystectomy. Montironi said there are two aspects that are new with the 2016 WHO classification.

“The first is that for some variants specific molecular alterations have been identified. For instance, at the molecular level, overexpression or amplification of ERBB2 is more common in the micropapillary variant than in conventional urothelial carcinoma. This can be the target of specific therapeutic approaches,” he explained.

At the BCa18 meeting, participants will be given a concise update on each topic such as developments in pathology, systemic and local treatment, among other key topics, before they break into several groups for case discussions. The case discussions will zero in on specific clinical problems and examine, point-by-point, the role of standard care such as multidisciplinary approaches and the value of emerging or novel therapies.

Molecular subtypes

Montironi further noted that another aspect in the  2016 WHO classification is that the urothelial tumors and variants can be further classified from the molecular point of view, for instance as basal type or luminal type.

“The molecular subtypes of bladder cancer have distinct clinical behaviors and sensitivities to chemotherapy,” he said, emphasizing that a good knowledge of these developments are essential for doctors to enable them to determine an optimal treatment plan.

Asked what participants in the BCa18 meeting can look forward to, Montironi said BCa18’s comprehensive programme will add depth to the stock knowledge of any specialist currently working in this area of urological malignancies.

“BCa18 covers the morphologic and molecular challenges in the identification, classification, and precise diagnosis of variant histology of bladder cancer,” he said, adding that with this knowledge physicians can further improve decision-making and fine-tune their management skills.

CME-accredited, BCa18 benefits from the EAU’s collaboration with its affiliate offices, related medical disciplines and the European School of Urology, enabling it to access expertise from various institutions across Europe.

If you want to learn more about BCa18, explore this meeting website for details on the Scientific Programme, registration and other information.

Article by Joel Vega