A critical problem associated with invasive bladder cancer patients, is that once metastatic, virtually all patients will die of their disease even with the best available chemotherapeutic regimens. In clinically localized patients, radical cystectomy with urinary diversion remains the standard treatment; however, it is associated with major impact on quality of life and 5-years overall survival of only 50%. Furthermore, many patients are not candidates for radical surgery as they are often elderly with multiple comorbidities.
For several years we have conducted studies to improve efficacy of conservative bladder cancer preservation approaches with radiation. However, lack of local control and significant toxicity remain problematic. Recently, promising results with immunotherapy in some cancers indicate its combination with chemotherapy and radiation could greatly advance the field of bladder cancer therapy. We intend to integrate immunotherapy to not only improve local control of invasive bladder cancer but also metastatic disease. In this sense, characterization of biomarkers and the underlying mechanisms of immunotherapy in the context of radiation will be fully investigated. Furthermore, we will conduct a clinical trial in patients treated with immunotherapy combined with radiation. Findings from our study have the potential to improve cure rates and increase our understanding to select which patient are best suited for radiation and preserve their bladders versus those best treated with radical surgery.