Grant: Project Grant

Bladder cancer that has spread to other organs (metastatic cancer) is generally not curable and few people survive beyond five years. Excitingly, new and emerging therapies can significantly improve life expectancy. However, while providing meaningful benefit to some, most patients gain little or no benefit from new treatments, yet endure toxic side effects. Unfortunately there are currently no tests that can profile metastatic cancer to predict treatment benefit. A major barrier to developing such tests is that they usually need to be performed on metastatic tissue. Obtaining biopsies of metastases is invasive and has risks of complications and so we have very little understanding of the biology of metastatic cancer. To address this, we have developed new methods to isolate and study each patient's cancer using a blood sample. We profile cancer DNA that is shed into the blood: known as circulating tumour DNA (ctDNA). Our early data suggests that ctDNA tests can provide the same information that is present in a tissue biopsy. To bring this technological advance to the clinic, the next step is to examine large numbers of Canadian patients, to use novel technologies to learn more from blood-derived ctDNA and to match this with their treatment outcomes. To this end, we have compiled the first large standardized cohort of serially collected blood samples from people with metastatic bladder cancer. We have assembled a unique team including a urologist, medical oncologist, pathologist, and genomic scientist. We plan to determine the precise relationship between genetic alterations detected in ctDNA and bladder cancer response or resistance to different types of therapy. Our work will establish the clinically-important DNA features of metastatic bladder cancer that can be identified via blood tests. This framework can then be used in clinical trials to test new strategies that direct treatments only to those patients whose quality or length of life will be improved.