T. Muilwijk MD

Optimising treatment and follow-up of patients with bladder cancer: Risk stratification and biomarkers

SUMMARY

Patients with high-risk non-muscle-invasive bladder cancer (NMIBC) are at risk for disease progression, which encompasses significant treatment-related and cancer-specific morbidity and mortality. Therefore, stratification of patients is important to identify patients that are at risk for progression of disease. However, current risk stratification lacks accuracy to identify which patients will progress and ultimately succumb to their disease. This PhD thesis focused on identifying prognostic biomarkers to optimise risk stratification of patients with NMIBC. The tumour immune microenvironment (TIME) and markers for basal and luminal differentiation were analysed using an immunohistochemical (IHC) panel in patients with high-risk T1 NMIBC. Interestingly, we identified fibroblast activation protein-α (FAP) expression as a prognostic marker for progression in highrisk NMIBC. FAP is a marker for cancer-associated fibroblasts (CAF), which play an important role in the TIME.

(BELG J MED ONCOL 2024;18(1):29–32)

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Management of high-risk non-muscle invasive bladder cancer: adjuvant intravesical BCG therapy and alternatives

SUMMARY

Intravesical BCG is the standard of care in the treatment of high-risk non-muscle invasive bladder cancer as it decreases the risk of recurrence and progression. Although it has been used for more than 40 years, it is currently still superior over chemotherapy and other immunotherapies. The worldwide shortage of BCG stresses the need for alternatives of BCG, for which the only curative treatment option outside clinical studies is an early radical cystectomy.

(BELG J MED ONCOL 2021;15(2):57-62)

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High-risk non-muscle invasive bladder cancer: What are the options?

Non-muscle invasive bladder cancer (NMIBC) makes up about 75% of all bladder cancers. Unfortunately, the majority of patients with NMIBC will experience a disease recurrence and a substantial proportion of them (~20–25%) will progress to muscle-invasive disease. Patients with high-risk NMIBC represent a particularly challenging patient group that is confronted with an increased 5-year risk of recurrence (up to 80 %) and progression (up to 50 %).¹ At BMUC 2020, an entire session was dedicated to the different treatment options for these patients: Dr. Tim Muilwijk (University Hospitals Leuven, Leuven, Belgium) discussed BCG therapy, Prof. Dr. Joan Palou Redorta (Fundació Puigvert, Barcelona, Spain) talked about the potential of early cytoreductive therapy, Prof. Dr. Anthony Zietman (Massachusetts General Hospital, Boston, USA) made a case for the use of radiotherapy in high-risk NMIBC patients and Prof. Dr. Yohann Loriot (Gustave Roussy Cancer Campus, Paris, France) provided an overview of the data generated with targeted therapy in this setting.

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Robot-assisted radical prostatectomy, an update of the current evidence

SUMMARY

Robot-assisted radical prostatectomy has become standard-of-care in most centres of excellence in the treatment of prostate cancer. Recent literature shows a reduced complication risk, reduced transfusion need, shorter hospitalisation and functional and oncological benefit in comparison with open radical prostatectomy. Long term follow-up data and large randomised clinical trails are currently lacking.

(BELG J MED ONCOL 2017;11(1):4–6)

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