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Zeroing In On An Overlooked Cancer

March 4, 2019 by Kristin Hanson

What Happened Next? | The Greenberg Bladder Cancer Institute

Unfamiliar with bladder cancer? You’re not alone. Despite its prevalence among men and particular lethality among women, it’s a chronically underpublicized — and underfunded — form of cancer. That lack of support inspired philanthropists Erwin Greenberg and Stephanie Cooper Greenberg in 2014 to make a $15 million gift, part of a $45 million co-investment with Johns Hopkins Medicine, to create the Greenberg Bladder Cancer Institute (GBCI). Thanks to the largest gift dedicated to bladder cancer at Hopkins, the institute is unique in its globally collaborative approach and intensive focus on the disease.

Five years later, what impact has the GBCI made? We asked institute director and professor David McConkey and assistant professor Jean Hoffman-Censits in this installment of What Happened Next?

Where, in broad strokes, has the GBCI has made the most progress?

A portrait of David McConkey, director of the Greenberg Bladder Cancer Institute
GBCI Director David McConkey | photo by Larry Canner

McConkey: Our vision when we founded the institute — and it’s consistent with Erwin and Stephanie’s vision — was to create a global, collaborative network. We’ve established strong new research collaborations with groups in France, the United Kingdom, and Canada; and several U.S. partnerships, including with the University of California, San Francisco (UCSF), University of Texas at San Antonio, Northwestern University, Dana-Farber Cancer Institute, and Memorial Sloan Kettering Cancer Center. It’s not just about research but to also — as soon as possible — integrate what we learn into clinical decision-making. We’ve identified the strategies we want to use to support these efforts and begin to implement them.

Dr. Hoffman-Censits, what about the GBCI brought you to Johns Hopkins?

Hoffman-Censits: When I started in practice 10 years ago, there was only one treatment for advanced bladder cancer, Cisplatin [a chemotherapy drug]. It has a lot of toxicities, and not all patients are good candidates for this drug. Substantial progress has been made in the last decade with new FDA approvals for immunotherapy in bladder cancer, in part based on research from GBCI team members. But there is still so much work to be done, and to be a part of this team of world renowned experts at the GBCI, where the focus is solely on bladder cancer, is so exciting and rewarding.

What’s an example of an early research collaboration and its impact?

McConkey: One collaboration with the Southwest Oncology Group, Fox-Chase Cancer Center, Dana-Farber, and Memorial Sloan Kettering is a large, randomized Stage 2 clinical trial that is testing the hypothesis that we can use DNA sequencing and RNA expression profiling to identify patients who will benefit from chemotherapy. Right now, treatment often begins with chemotherapy, and then the bladder is removed. But those we identify through genetic data may be able to keep their bladders, and those that do not benefit can get alternative therapies. We’re analyzing the data right now. If we’re successful, within one or two years we can change clinical practice so that not everyone with muscle-invasive bladder cancer would get chemotherapy or have their bladders removed. The same kinds of research are possible with immunotherapy, which has become FDA-approved for patients who are Cisplatin-resistant.

One of the institute’s focuses is the relationship of gender to bladder cancer. Why is that important?

A portrait of oncologist Jean Hoffman-Censits.
Assistant Professor Jean Hoffman-Censits | photo by Larry Canner

Hoffman-Censits: Men and women tend to have the same symptoms prior to diagnosis, such as blood in the urine. But because bladder cancer isn’t common in women, and other factors such as urinary tract infection may also cause blood in the urine, diagnosis of bladder cancer may be overlooked early. Because of the delay in diagnosis that can occur, women tend to present with later-stage cancer, which can be more advanced and, unfortunately, metastatic. We want to increase awareness of the disease, potential risk factors like smoking, and signs and symptoms that should get patients to a doctor’s attention for further workup.

McConkey: We have identified individuals to collaborate with the GBCI to identify clinical and biological variables that differ in each gender. For example, there are organ-sparing surgical procedures for women that can leave sexual function intact that are not yet standard-of-care. Natasha Gupta, a resident here at Hopkins, and Sima Porten, a faculty member at UCSF, are using American Urological Association (AUA) and other databases to characterize practice patterns and identify outcomes in women who get organ-sparing versus non-organ-sparing procedures.

How is the GBCI leveraging the Johns Hopkins Medicine profile to influence practice and policy outside of Hopkins?

McConkey: Even though bladder cancer — particularly in men — is more common than a lot of other malignancies, its funding is only a small fraction of the National Cancer Institute’s (NCI) budget. Last summer, we co-hosted a meeting with the NCI on their campus, where we discussed some of the big research priorities with many national and international bladder cancer research leaders. The result was the first request for applications for R01 and R21 grants for bladder cancer [R01 and R21 grants are among the most common federal supports for health-related research and development].

Hoffman-Censits: In March 2019, we will co-host the first-ever academic meeting on women’s bladder cancer along with the AUA, with researchers coming from all over the United States and abroad. The AUA recognizes that their guidelines are not always adhered to when applied to women versus men presenting with hematuria [the presence of blood cells in the urine]. We expect this meeting will help define novel areas of research, foster collaboration, and help raise awareness that women with bladder cancer are a unique population deserving of focused research and clinical attention, with the goal of improving outcomes for women and all patients with bladder cancer.

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