Bladder cancer begins when cells in the bladder's inner lining become abnormal, causing them to grow and divide out of control. As cancer grows, it can spread into the bladder wall. Some of these cancer cells can also break off and travel to other parts of the body.
More than 3000 Australians were estimated to be diagnosed with bladder cancer in 2020, with the urological cancer estimated to make up two per cent of all cancer deaths last year. Men are three to four times more likely than women to be diagnosed, but survival rates for women are worse.
A/Prof Ian Vela in the lab
Having already built the largest bio-bank of bladder cancer in Australia much of the advancement of their work has been led by patients eager to help others.
"We collect clinical samples from patients who very generously agreed to provide their samples for research purposes," Associate Professor Vela said.
"We collect the whole gamut of bladder cancer from low grade non-invasive all the way through to very aggressive, high-grade, muscle invasive bladder cancer, which is the very lethal form of the disease.
"Bladder cancer is just not one disease, it's a spectrum of disease. It behaves differently at different stages and in different patients. One of the difficulties when you're treating bladder cancer patients is the heterogeneity of behaviour of the disease and also responses to treatment.
"We're doing trials to see if the drugs work in individual patients, but also, patients are extraordinarily generous in their willingness to donate their clinical samples so that this may not happen to somebody else. There's a real altruism in patients which never ceases to amaze me.
"They're donating much more than just tissue. They also donate to us blood and urine samples, and the data that goes with it, which is also extremely helpful in advancing the research," Associate Professor Williams said.
A/Prof Elizabeth Williams
One of the reasons the QBCI are confident of making further inroads in their quest to increase survival rates is the ability to trial new treatments with patients at every different stage of bladder cancer.
"A lot of what we're talking about with bladder cancer is in the high-grade lethal disease which unfortunately still has only a 50% five-year survival, even with our best treatments and care," Associate Professor Vela said.
Although some of these new treatments, like cancer immunotherapy checkpoint inhibitors, are coming on board, only about 20% of patients may respond to them. There's a big area where we can try and identify which patients will respond to these drugs and improve survival in patients with the deadly form of the disease.
"The reason we also look across the spectrum is that even in the people that have low grade disease to start with, a significant proportion of them convert to the nasty type. We want to know why, and can we identify them earlier, and do they need particularly intensive follow-up to try and catch them earlier, so can we change the course of their disease," A/Prof Williams said.
"I think the clinical trials that I'm involved with are offering potential hope to patients and offering drugs that they wouldn't otherwise get access to. The only reason we're getting that sort of buy-in from pharma and international multicentre studies is because of the work we're doing," A/Prof Vela said.
"It's not just lab and clinical work, it's completely overlapping, success in one area brings success in the other. From that perspective, when a patient hears the potential prognosis of a very, very deadly disease, but you can offer them additional potential treatments they may not get at other places, I think that's incredibly important."
A/Prof Williams said ongoing funding from the PA Research Foundation's donors has been a game-changer for the group's work, allowing the QBCI to support post-doctoral research fellow Dr Pat Thomas who works with several Masters and Ph.D. students.
Post-doctoral research fellow Dr Pat Thomas
"Pat is a key part of the engine room, making all of this work happen. He co-supervises the students that are on the projects with us and works very closely in all of the bladder cancer projects," she said. As the QBCI gears up to publish its first laboratory papers in bladder cancer this year, PA Research Foundation's support has been a key driving factor in the advancement of the team's aims to personalise patient treatment in bladder cancer.
"It's absolutely vital, because it takes a number of years for research to mature, to the point where we can gain traction," Associate Professor Vela said.
"Some exciting work we're focusing on this year is looking at the personalised responses of treatment to not only the standard drugs but some of the new drugs with immune therapy. Our new assays are going to be coming into their own this year, they have taken a lot of work to develop. This will be a world-first sort of approach in not only bladder cancer, but a lot of other cancers as they don't have this either."
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