The Hope Behind Tomorrow’s Bladder Cancer Treatments

July 23, 2026

Transcript

Voice over:

This is Bladder Cancer Matters, the podcast for bladder cancer patients, caregivers, advocates, and medical and research professionals. It’s brought to you by the Bladder Cancer Advocacy Network, otherwise known as BCAN. BCAN works to increase public awareness about bladder cancer, advances bladder cancer research, and provides educational and support services for bladder cancer patients and their loved ones. To learn more, please visit bcan.org.

Rick Bangs:

Hi, I’m Rick Bangs, the host of Bladder Cancer Matters, a podcast for by and about the bladder cancer community. I’m also a survivor of muscle invasive bladder cancer, the proud owner of a 2006 model year neobladder and a patient advocate supporting cancer research at the Bladder Cancer Advocacy Network, or as many call it, BCAN, producers of this podcast.

Today we’re featuring CG Oncology as June 2026 partner in progress. CG Oncology sees a world where bladder cancer patients can benefit from our innovative immunotherapies to live with dignity and have an enhanced quality of life. I’m pleased to welcome today’s guest, Dr. Rob Svatek, who makes a return visit to our podcast.

Dr. Svatek is a professor and chair of urology at the University of Texas Health San Antonio and recently joined CG Oncology as vice president of clinical development. His practice is devoted to the care of bladder cancer patients. He provides state-of-the-art surgical options including robotic assisted and open approaches as well as all available urinary diversion options. Dr. Svatek is actively involved in clinical trials for bladder cancer, including SWOG S160 on the Japanese strain of BCG, which was covered a prior podcast. And he runs an NIH funded cancer immunology lab.

Dr. Svatek, thanks for rejoining us on Bladder Cancer Matters.

Dr. Robert Svatek:

Hey, Rick. It’s great to be here.

Rick Bangs:

Great to have you. So start with when did you start working in the bladder cancer space and why?

Dr. Robert Svatek:

Yeah. This question makes me feel old, Rick, because it dates me a little bit here. When I was a resident in urology, it seemed to me that all the research was going on in prostate cancer. And if you wanted to be a researcher, you would go into prostate cancer.

Rick Bangs:

Yeah.

Dr. Robert Svatek:

And at the time, there wasn’t a lot of headway being made in bladder cancer. And that was a motivation for me was to be a part of taking care of a disease that really needed more research, really needed more attention. I was also fascinated with immunotherapy and bladder cancer is one of the solid tumors that I would say immunotherapy has been used for a long time with BCG therapy.

Rick Bangs:

Right.

Dr. Robert Svatek:

And so I think a combination of a large unmet need and an interest in immunotherapy is what drove me to seeking a career of taking care of patients with bladder cancer.

Rick Bangs:

All right. We’re glad you’ve made that choice. So you’ve had a broad range of roles in bladder cancer. You’ve been a clinician surgeon, you’ve been a clinical trialist and a researcher. So I’d like to talk a little bit about each role and any insights about that role that you’d like to share. So let’s start with clinician surgeon.

Dr. Robert Svatek:

I think that bladder cancer is unique in terms of it has a large surgical demand. So the resection of the bladder tumor and the removal of the bladder are surgical techniques that are currently a major part of the treatment paradigm for these patients. And so if you’re going to be interested in treating bladder cancer, the surgical component is a major part of the treatment paradigm.

Now the surgeons have direct access to tissues, direct access to urine, and those allow for complement the ability to conduct research. So I think they go hand in hand. And that’s why we see a lot of surgeons that are doing cystectomies, bladder removal also participating in research because of the access to tissue, because of the access to patients who are interested in participating in trials.

And then in running a lab, to me, one of the major decisions that I tell my trainees is, “Look, you can be a grant funded researcher or not.” And a grant funded researcher is someone that’s writing grants at night or on the weekends to try to get additional support to conduct the research that you’re doing. And for me, at least the best way to do this, and I wanted that career path, the most sensible way for me to be a grant funded researcher was to have a laboratory and where we’re looking at very basic questions, immunotherapy basic questions from a laboratory approach, and so that’s kind of why that formed.

My initial plan was to just conduct clinical research, but I realized that to be able to get grants and really meaningful grants through clinical research is challenging. You can only do so many trials in one institution, whereas in the laboratory, there’s lots of different studies that can be done. And so that’s kind of what facilitated that for me.

Rick Bangs:

Okay. And then clinical trialist, any comments you want to make on that? Because that’s where I first met you is in the clinical trialist context.

Dr. Robert Svatek:

It’s a great story. I mean, as soon as I got out of fellowship, I went to San Antonio and went to this thing called a SWOG meeting, and because that’s what Ian Thompson had recommended. And I remember you vividly in this we had this, it seemed like a square room where everybody was surrounding. The table was surrounding a circle and you were in the middle talking about 0337 and how the trial was almost failing because we were not accruing.

And this is a trial for gemcitabine and non-muscle invasive bladder cancer. Really, I’ve never seen a patient out talking to scientists and clinical researchers about the need for this and it really moved me. And I said, “Well, why are we not enrolling in San Antonio? Well, maybe we could do something to help.”

And so I went back empowered by your speech and activated our site. And we ended up enrolling if not the highest number of patients, the second highest, something really high and helped to avert closure from the NIH on that study. I was really moved by your speech. And I think clinical trials are a fantastic way to start your career because you get to know experts, you get to know the disease really well. And usually the clinical trialists are very appreciative and generally want to help young researchers.

So if you participate and you work hard, you’ll end up developing your own trial and running your own trial eventually.

Rick Bangs:

Yeah. And that S0337 trial, that was a gemcitabine trial and it changed the standard of care. So it was going to close and we turned it around. So thank you for being, if not the top accruer, close to the top there. That was wonderful.

Okay. So I want to switch gears. I want to talk about CG Oncology. So what attracted you to go to CG Oncology because you’d spent a lot of time in the academic side?

Dr. Robert Svatek:

I had worked with CG Oncology for many years. I mean, back in COVID, I helped to develop one of the trials for CG Oncology. So I was very knowledgeable of the drug, knowledgeable of the company and the people. And I think that in my career, I had been a chair, I had run a lab, I’d run trials. And I think a part of me was looking for a change or something, a new challenge. And this position became available and I wasn’t actively looking to go into industry, but I knew this company well. I knew the people well. I knew the drug well. I was like, “This would be fun to try to explore that.”

So it was just a combination of looking for something else and this opportunity becoming available. And I’m the VP of clinical development. I helped to run the ongoing trials and helped to design new trials. I’ve never been a part of a BLA submission directly. And I think that’s something that I’m very interested in and want to learn this aspect of research. It’s a different side of research that I’m not exposed to. So that’s part of the appeal, Rick, to be honest.

Rick Bangs:

Okay. So explain what a BLA is.

Dr. Robert Svatek:

So a biological license application, this is how we get drugs approved by the FDA. And so CG Oncology is currently filing a BLA to approve cretostimogene for patients with BCG unresponsive non-muscle invasive bladder cancer. Hopefully if we’re successful, this will enable us to bring the product to patients. Just to be clear, we’re not approved. We’re in the process of submitting our package.

Rick Bangs:

Excellent. Excellent. Okay. So talk a little bit about the bladder cancer segments that CG Oncology plays in. What are the agents?

Dr. Robert Svatek:

Yeah. So I think we principally started in patients with BCG unresponsive non-muscle invasive bladder cancer. This is a type of tumor which is there’s not a lot of great options. I mean, we had cystectomy has been traditionally the gold standard. Valrubicin was FDA approved for treatment of CIS that was unresponsive to BCG, but it didn’t work that well. A lot of us recognized the limitations of that.

And so that’s where CG Oncology started. It was to look at a third drug in that space. And so this is an intravesical agent giving it kind of in a similar fashion in terms of the timing weekly. It’s similar to BCG. So once a week for six weeks, for example, that regimen was kind of carried over from the BCG treatment era.

And so that’s the segment, as you say, of population that we started in. But we’re now looking into other populations. For example, patients that are, let’s say, BCG naive, the AUA has different risk categories, low risk, intermediate risk and high risk based on their likelihood that they will relapse or progress. And we have a trial in the intermediate risk population called PIVOT-006, which tests the drug in that population. So I think we’re now exploring other populations to consider for treatment.

Rick Bangs:

Excellent. Excellent. So in the process of doing things like this, how do you use and engage patients at CG Oncology?

Dr. Robert Svatek:

One of the appeals of working in this space in bladder cancer is that patients are generally interested and motivated to participate in clinical trials. I know that from firsthand experience. We have a fairly high rate of patient willingness and acceptance of trials. And maybe you could speak to that too, Rick.

I mean, why is it that patients suffering from bladder cancer are interested in trial participation? But we certainly benefited from that. I think part of it is that they’re looking for better options. Part of it is that they’re altruistic and they want to help other patients.

Rick Bangs:

Yeah.

Dr. Robert Svatek:

It’s not 100%, but it’s really high in terms of the patient’s willingness and openness to participating.

Rick Bangs:

I don’t know that that was historically true, hence the first time you and I met talking about this trial that was going to close. But I think we have so many promising agents and I think people have options are not optimal, let’s say. So I think it’s great that we have this very receptive environment from the patient side because if we don’t do the clinical trial, if people don’t consider the clinical trial, which is always the recommendation I make no matter what the diagnosis, we’ll never advance the cause. Right?

Okay. So what kind of work have you and CG Oncology done with BCAN in the past or present?

Dr. Robert Svatek:

I’ll take a few minutes just to talk about our main asset, which is cretostimogene. This is a oncolytic immunotherapy. And so what it is, Rick, as you know, it’s a virus that we put into the bladder and it’s an oncolytic virus, which means that if it’s expressed, if it’s transcribed, it will kill the cell for which it’s being transcribed.

So imagine that this virus is put into the bladder through a catheter and it just naturally gets acquired into let’s say urothelial cells, including cancer cells indiscriminately. However, it doesn’t replicate in all cells. It will preferentially replicate in cells that harbor what we call E2F factor or pathway alterations. And cancer cells have high levels of E2F. It’s a transcription factor. And by virtue of it having that, the virus will then replicate preferentially in cancer cells. And when it’s replicating, it is oncolytic. So it’ll lyse that cell, it’ll kill it.

And we’ll also, because it encodes a protein called GM-CSF, which is a colony stimulating factor that helps to recruit immune cells. So that extra amount of GM-CSF there is thought to recruit healthy, good immune cells to the bladder environment to aid in immunogenic cell death and immunotherapies.

And so imagine it like two different mechanisms here. One is killing the cell and the other is releasing GM-CSF, which then recruits immune cells like T-cells to help immune therapy or T-cell mediated cancer killing capacity. And we’ve worked closely with BCAN for many years in terms of being sponsors for the BCAN think tanks and meetings. We’ve also participated in creating grant programs to allow for resources to fund translational projects that can benefit patients with bladder cancer. And we’re proud of that collaboration partnership that I think will help enable young researchers to pursue careers in bladder cancer, and to hopefully get some new novel concepts into the clinic for patients.

Rick Bangs:

Yeah. Developing new clinicians and investigators has always been part of the mission of BCAN. So thank you for that support as well as the additional support you’re providing here. So I want you to kind of step back. You’ve kind of hinted at it, but I want to kind of get your take on the last 10 or 15 years since I’ve known you. How has the bladder cancer space changed?

Dr. Robert Svatek:

I feel really grateful to have chosen this career path in bladder cancer because like I said when we started, I chose this because of the unmet need because people were going through these major operations, sometimes six, seven-hour operations. And these are patients that have, they’re older, right? They have significant comorbid illness that you get as you get older. And so there is a large unmet need.

And in my lifetime, I’ve seen dramatic improvements in the therapy that we have for bladder cancer and largely in immune therapy. I remember seeing a patient who had bladder cancer spread to his spinal cord and thinking that I would not see him again, but he got an immunotherapy, not ours, but an immunotherapy and I saw the tumor melt away. And I had never seen that before in my training.

And I remember thinking, “Man, this is a new era.” And that’s the beauty of research and what it can do for patients. And so we’ve seen dramatic shift in terms of the treatment of metastatic disease, whereas it used to be purely chemotherapy. Now it’s moving to largely immunotherapy.

Rick Bangs:

Yeah.

Dr. Robert Svatek:

We’ve seen dramatic shifts in how we treat the patient from a complimentary approach. So it’s not just surgical, it’s now combining medical oncology with surgery and radiation. And so these three different types of treatment need to come together and have been coming together to treat patients more effectively. But there’s still a lot to be done, Rick.

I mean, we still are dependent on doing cystectomies. We still have patients dying from metastatic disease. We have a long way to go. And I think in non-muscle invasive bladder cancer, we still have a significant progression rate and we still have high rates of relapse. So our surveillance regimen, which is every three months for two years, has not changed. And we have to follow patients for five or six years doing cystoscopy on a frequent basis.

So I think there’s still a lot of room for improvement. And I think that’s going to be the next major shift is to really impact the non-muscle invasive disease space. And I hope to see that over the next 10 years or so.

Rick Bangs:

I hope so too. I hope so too. Okay. Any final thoughts?

Dr. Robert Svatek:

No, I think I’m curious, Rick, you’ve been doing this a long time. We’ve worked together. And what’s been your kind of feeling about how… You were there in that early SWOG era, are you optimistic about treatment of bladder cancer? And how do you feel through what you see the changes that have been made for bladder cancer?

Rick Bangs:

I’m smiling from ear to ear because when I started, there was just so little, there’s very few trials, very few possibilities. Prognosis was not so good. And I’m not saying that where we are today is perfect because you’ve kind of talked about some of the challenges we have and the opportunities that we’re hoping to address. But considering where we were and I could never have expected in the, let’s say 15 or 16 years since I’ve known you, I would never have expected to have made all the progress we’ve made. And it’s just so exciting to see that happen. And it just makes you really wonder how many possibilities we’ll see in the next 10 or 15 years because it’s going to be even better. So it’s an exciting time.

Dr. Robert Svatek:

Yeah. I agree. I agree. And you’ve been a major part of it and I really want to thank you for motivating a young emerging urologist. And so I mean, I think SWOG has, which is Southwest Oncology Group, was an integral part of my career and meeting you through there and enabling me to kind of grow intellectually. And I really am appreciative to you and to that community for taking me in and welcoming me and for pushing me and pushing our group to do more. So I just want to say thank you for that.

Rick Bangs:

It has been so rewarding and it’s just been a wonderful experience and all of you are so great to work with and so dedicated and focused. I just wish other patients could just see how passionate people are and all the work that goes into trying to move the needle. So thank you for the opportunity.

So Dr. Svatek, I want to thank you for sharing some highlights of your bladder cancer work along with your transition to CG Oncology and for your part in creating better today’s and more tomorrows for bladder cancer patients and families.

Dr. Robert Svatek:

Thank you, Rick.

Rick Bangs:

If you’d like more information on bladder cancer, please visit the BCAN website, www.bcan.org. For more information on CG Oncology, you can visit www.cgoncology.com, www.cgoncology.com or head to the BCAN website at bcan.org/cgonc.

Just a reminder, if you’d like more information about bladder cancer, you can contact the Bladder Cancer Advocacy Network at 1-888-901-2226. That’s all the time we have today. Be sure to like, comment and subscribe to this podcast so we have your feedback. Thank you for listening and we’ll be back soon with another interesting episode of Bladder Cancer Matters. Thanks again, Dr. Svatek.

Dr. Robert Svatek:

Thank you.

Voice over:

Thank you for listening to Bladder Cancer Matters, a podcast by the Bladder Cancer Advocacy Network or BCAN. BCAN works to increase public awareness about bladder cancer, advanced bladder cancer research, and provide educational and support services for bladder cancer patients. For more information about this podcast and additional information about bladder cancer, please visit bcan.org.