Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Metastatic bladder cancer is a lethal and under-studied disease. Chemotherapy has historically been the most effective treatment for metastatic disease, but long-term survival is rare. Exciting new treatment options have recently emerged, however, responses to these new therapies are highly variable and we lack a reliable method of predicting who the responders will be. Therefore, efforts are underway to develop tools to determine the ideal therapy for each individual based on their tumor's molecular features. My research aims to develop a blood-based test for identifying genetic changes (mutations) present in metastatic bladder tumors. This test relies on the fact that when cancer cells die they often shed their DNA into the circulating bloodstream (known as circulating tumor DNA, ctDNA). We can therefore use ctDNA to evaluate the mutations in metastatic cancers that correspond to treatment response or resistance. In my preliminary research, I found that most patients with metastatic bladder cancer can have their tumors analyzed in this manner. Importantly, my initial work showed that it was feasible for patients to have real-time testing of their cancer's molecular features, without the need for invasive tissue biopsy - which is often impractical, costly and can cause significant patient morbidity. In this project, I will identify mutations in the ctDNA of hundreds of Canadians with metastatic bladder cancer, and determine which mutations predict a patient's subsequent response to treatment. Success with my project will help explain why some metastatic bladder cancers are intrinsically responsive or resistant to the most commonly used therapies. Furthermore, I will have developed a clinically-practical framework (requiring only a blood sample) that may ultimately help guide rational therapy selection in advanced bladder cancer.