David Miyamoto, MD, PhD

Pioneering a Liquid Biopsy for Bladder Cancer

David Miyamoto, MD, PhD, and his team at the Massachusetts General Hospital are developing a new blood test to personalize treatment for patients with muscle-invasive bladder cancer (MIBC). The innovative assay will help identify which patients can be effectively treated with bladder-preserving trimodality therapy (TMT), a combination of radiation, chemotherapy, and limited surgery to remove the tumor, instead of the more traditional radical cystectomy, an extensive surgery to remove the entire bladder. The novel “liquid biopsy” would also offer a non-invasive method to monitor disease recurrence in patients treated with TMT, which requires close surveillance using expensive imaging and invasive procedures following therapy.

MIBC can grow rapidly and spread to other parts of the body if not treated aggressively, and between 20% to 30% of patients initially treated with TMT eventually require surgery to remove the entire bladder. “We need a better way to select patients who are most likely to benefit from TMT,” says Dr. Miyamoto. “Our team has developed a highly sensitive microfluidic chip technology that efficiently isolates circulating tumor cells (CTCs) that are shed from the cancer into the blood stream. Unlike most other liquid biopsy approaches, our innovative method enables sophisticated molecular profiling of tumors based on RNA expression in the CTCs.”

With the Biomarkers for Radiation Oncology Award, Dr. Miyamoto’s team is:

• Optimizing their novel blood assay by increasing the number of bladder cancer-specific genes detected in the CTCs.
• Developing a pretreatment bladder cancer CTC RNA signature that predicts clinical outcomes by evaluating the tumor’s sensitivity to chemoradiation therapy.
• Producing a non-invasive test aimed at detecting the presence of any bladder cancer cells in the blood to monitor minimal residual disease or early recurrence following TMT.

A reliable and accurate molecular biomarker to identify patients who are the best candidates for TMT could increase utilization of TMT and allow more bladder cancer patients to preserve their bladder, providing them with a better quality of life. A non-invasive blood test to monitor these patients for the early detection of relapse would save time and money by reducing frequent visits to the clinic for costly imaging and invasive procedures. The liquid biopsy that Dr. Miyamoto and his team are developing would be a practice-changing breakthrough that shows great promise to improve outcomes for patients with muscle-invasive bladder cancer.

Presentations 

• Genomic Determinants of Response to Trimodality Therapy for Muscle-Invasive Bladder Cancer was presented at the 2022 ASTRO Annual Meeting.