The Role of Medical Oncologist
The current position of the medical oncologist is clear in those patients who have metastatic disease at the time of diagnosis, or who develop metastatic disease following radical treatment. However, the role of the medical oncologist in the management of bladder cancer is rapidly changing. The advent of immune checkpoint inhibitors (those targeting PD(L)-1 and CTLA4) is already beginning to change the way advanced bladder cancer is treated. It is likely that these new interventions will not only improve outcomes where used in combination (either simultaneously or sequentially) with chemotherapy, but also broaden access to systemic therapy to a wider group of patients. It is, therefore, likely that the oncologist will become a more active member of the multi-disciplinary team for a wider group of patients with bladder cancer across a broader spectrum of the disease. Moreover, since we move into the age of molecular stratification and precision medicine, a streamlined engagement between surgeons, medical oncologists, molecular pathologists and radiation oncologists has the potential to improve outcomes and better meet the needs of patient with bladder cancer.
KeywordsMedical oncologist Immune checkpoint inhibitors Precision medicine
- 1.Flannery K, Black-Shinn J, Boyd M, Robert N, Kamat A. Second-line treatment patterns and outcomes of metastatic bladder cancer patients in clinical practice. ESMO annual meeting, Madrid, abstract 877P; 2017.Google Scholar
- 3.International Collaboration of Trialists, Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group), European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group, Australian Bladder Cancer Study Group, National Cancer Institute of Canada Clinical Trials Group, Finnbladder, Norwegian Bladder Cancer Study Group, Club Urologico Espanol de Tratamiento Oncologico Group, Griffiths G, Hall R, Sylvester R, Raghavan D, Parmar MK. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol. 2011;29:2171–7.CrossRefPubMedCentralGoogle Scholar
- 7.Bellmunt J, de Wit R, Vaughn DJ, Fradet Y, Lee JL, Fong L, Vogelzang NJ, Climent MA, Petrylak DP, Choueiri TK, Necchi A, Gerritsen W, Gurney H, Quinn DI, Culine S, Sternberg CN, Mai Y, Poehlein CH, Perini RF, Bajorin DF, KEYNOTE-045 Investigators. Pembrolizumab as second-line therapy for advanced urothelial carcinoma. N Engl J Med. 2017;376:1015–26.CrossRefPubMedPubMedCentralGoogle Scholar