New Advances in Bladder Cancer Treatment: What You Need to Know

October 10, 2024  

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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.

I’m pleased to welcome Dr. Ashish Kamat, returning for a third time on Bladder Cancer Matters. Dr. Kamat is an endowed professor of urology and cancer research and director of bladder cancer research at MD Anderson Cancer Center in Houston, Texas. He is also founding president of the International Bladder Cancer Group, the IBCG, and a member of the Bladder Cancer Advocacy Network’s Scientific Advisory Board.

Dr. Kamat’s expertise is in multidisciplinary management of urologic cancers with an emphasis on bladder and prostate cancer, organ-sparing therapies, minimally invasive techniques, and bladder replacements like my neobladder. A major focus of his research is to develop novel treatments for bladder cancer and identify resistance mechanisms and ways to overcome them. Welcome. Dr. Kamat.

Dr. Ashish Kamat:

It’s always a pleasure to be here with you, Rick. And thank you for having me.

Rick Bangs:

Oh, our pleasure. So, in today’s episode, we’re going to refresh that very first podcast that we did in the winter of 2021 on BCG and BCG alternatives, and you’re going to provide new information and new drugs that are available since then because the good news here is that so much has changed. So let’s just start with some fundamentals. What is BCG, and how does it work?

Dr. Ashish Kamat:

You’re absolutely right, Rick. I mean, so much has changed, but also, so much has stayed the same. And what stayed the same, of course, is the fact that BCG still today offers our patients the best chance of cure when it comes to treating non-muscle invasive bladder cancer. Now, what is BCG, right?

BCG is the short form of Bacillus Calmette-Guérin, which is a bacteria that was named after the two folks that developed it as a attenuated form of the tuberculosis vaccine bacteria as a vaccine against TB. And that’s how it was first developed. Over the years, people recognized that it has immense immune-stimulating properties, and it was used initially actually to treat leukemia, melanoma, and other cancers until it found its home in the treatment of patients with bladder cancer.

So it is an immunotherapy. It boosts the immune system. It recruits a whole slew of immune active cells to the bladder, and it allows our patients to fight their bladder cancer with the highest efficacy of any immunotherapy to date, including the new major designer drugs. So it’s an immunotherapy designed initially as a vaccine against tuberculosis, still used as such across the globe. But relevant to our discussion, it is the best immunotherapy for bladder cancer today.

Rick Bangs:

And what I’ve always loved is that it was an immunotherapy before immunotherapy really exploded in the last 10 or 15 years. So very cool. So it’s three years since we first covered the topic, as I mentioned, and many years, I think it’s probably almost 15 years, close almost, since the start of the shortages. So we’re on a third shortage and still dealing with this shortage. It’s been a fairly lengthy period where this particular shortage has been in play. So why is that?

Dr. Ashish Kamat:

Yeah, there’s a huge demand for BCG when it comes to treating patients with bladder cancer because there are so many patients across the globe that have bladder cancer, A, and B, because BCG is so effective that every patient needs or should be getting BCG. So it’s a huge demand for the supply. Now, the supply dwindled or literally was cut to half back in 2014 when one company that made a particular type of BCG in the US stop making it.

And there’s only one company currently, Merck, and makes BCG that’s approved for use in the United States. So that’s why there’s the shortage of BCG. I do want to emphasize, however, that there’s plenty of BCG in the world. Kids infants get BCG at birth as vaccinations against tuberculosis in many countries right now. So there’s plenty of BCG across the globe. And in fact, in some countries, there’s no shortage of BCG, even when it comes to bladder cancer patients, because they have approved BCGs that’s approved by their regulatory bodies.

But in North America, because we only have the ability to use the one BCG that is approved, which is the one that’s made by Merck, and Merck cannot keep up with the demand until its new building and new factory hits production, we have a relative shortage in the United States. Now, of course, relative shortage doesn’t matter to the patient when he or she is facing the news that they have a shortage because, for him or her, it’s an absolute shortage. So that’s what it is.

Rick Bangs:

Right. Okay, so you mentioned this new plant, this new factory, and the last I looked, it was not going to be ready in production until late 2025 at the earliest, and then they suggested maybe even late 2026. So how long do you anticipate we might have a shortage?

Dr. Ashish Kamat:

The manufacturing process for BCG is complicated, and it’s not complicated because it’s a newer, fancier drug. In fact, quite the opposite. It’s complicated because it’s a natural bacteria, mycobacterium, that’s grown on natural media such as potatoes, right. So it’s not a designer drug where you could put it in the lab, alter a few molecules or change some molecular structures, ramp up production, et cetera, et cetera.

It actually is a mycobacteria that’s grown on this natural surface. It then has to go through quality control. It’s gone through multiple processes. So even when they say ’25, ’26, I do believe them. They have the intent. But I would say, realistically speaking, it’d be at least 2027 before we have any semblance of the shortage being abrogated. Now, that’s not too bad if we actually hit it. So another two and a half, three years, and I’m hoping that we will have enough BCG to meet the requirements, at least for patients in North America.

Rick Bangs:

Okay, let’s hope on that. And you kind of hinted at this about when it impacts you personally. So why do some doctors have an adequate supply and others don’t?

Dr. Ashish Kamat:

Rick, that’s something that we’ve all tried to understand, and of course, we’ve spoken to folks from the company itself, and they’ve tried to explain it to us. The best that we can understand is that these allocations of limited drug supply, and this is something that I believe comes from the government, they’re made based on a needs assessment. So whatever the snapshot of the use was before the shortage hit is where the supply is allocated. Now, this has obviously led to disproportionate allocation sometimes.

In a place like ours, MD Anderson, where we treat a lot of patients all the time, we are fortunate enough that we have a allocation that allows us to meet the requirements of our patients. But say, for example, there’s hospital A that, for whatever reason, when the snapshot was taken, did not have enough patients a requiring BCG, they’re currently in that pool where they’re not getting enough allocation. So it’s almost like a vicious cycle where you didn’t have enough, so you don’t have enough, but because you don’t enough… have enough, you will not get enough.

Rick Bangs:

Okay, so we obviously have to deal with the shortage. So what steps have been taken, and how are we working through the shortage?

Dr. Ashish Kamat:

Several different ways, Rick. One way is when you have a shortage of something, how can we best allocate this to the people that need it most? So guidelines committees such as the AUA, the IBCG, BCN, of course, with all its reach and advocacy efforts, have put together certain best practice guidelines when it comes to using BCG appropriately and intelligently. First things first, there are some patients who have bladder cancer that’s lower risk to where they don’t necessarily need BCG because they can get similar results with intravascular chemotherapy, for example.

Now, if a patient needs BCG and should get BCG, it’s also been shown that because of the variability from one vial to another BCG, there’s about a hundredfold variation, you can safely decrease the dose of BCG given to a particular patient without really significantly affecting his or her outcomes. So what we have done and what’s recommended is that you can split a vial of BCG to allow three patients, so you give each patient one-third the dose. That way, three people can benefit from a single vial of BCG rather than just one person getting the full dose.

BCG been shown in prospective studies and retrospective studies that really doesn’t take away from the efficacy of BCG either. Now, of course, in places where there’s absolutely been no BCG and BCG was indicated for the patient, we’ve unfortunately seen a jump and, in some reports, almost a 300% increase in radical cystectomies. That’s really not fair, right. To have 300% increase in patients losing their blotters because we don’t have BCG is not acceptable.

In order to address that, really hats off to the team from Iowa that came up with this combination, Mike O’Donnell’s combination of gemcitabine and docetaxel intravesical combination chemotherapy that was used initially to fill in the gaps where there was no BCG and has now been translated into a clinical trial because it might actually be almost as good if not as good as BCG. So there have been these efforts where we can allocate BCG used more appropriately, divvy up the vial to meet the requirements of three patients, and then come up with alternatives such as a combination intravesical chemotherapy.

Rick Bangs:

Any idea when the GemDoce trial, the gemcitabine and docetaxel trial will have results published? I don’t think it’s closed yet, has it or…

Dr. Ashish Kamat:

No. No, it’s not closed, Rick. It is still actively recruiting by the time it recruits, and it reads out. It’s a trial that’s designed to essentially address the question is gemcitabine and docetaxel inferior or not. It’s not meant to show that BCG is better-

Rick Bangs:

Right, right.

Dr. Ashish Kamat:

… but it’s a non-inferiority trial. So the results should likely, again, I don’t know the results obviously, but just based on the number of patients that we’ve treated off trial with our experience, most of us suspect that these gemcitabine and docetaxel will be proven to be non-inferior, but we likely won’t have the results of the trial for at least two to three years. And of course, by that time, if there’s sufficient BCG because the shortage is resolved, then the question will become, well, what did we do with this data?

Rick Bangs:

All right. Right.

Dr. Ashish Kamat:

So it’s an interesting time, and we need to do this study for sure, but let’s see. Let’s see what happens in 2027.

Rick Bangs:

Okay. So since the last time we talked, there are some additions to the guidelines for BCG unresponsive or BCG-exposed bladder cancer for select patients. So can you define first what those terms mean?

Dr. Ashish Kamat:

Yeah, I’m glad you asked that because patients will often come and sit down in front of me, and I love the fact that our patients are able to do so much research now with so many resources, but it also overwhelms them, right. And some patients will sit and say, “You know, Dr. Kamat, I researched you. I don’t care about my disease. You just tell me what to do.”

But there are also patients that have researched their disease and get so confused that they ask this very question. So these terms were developed more to help the FDA and investigators, including pharmaceutical companies, design appropriate clinical trials. So they’re not meant to necessarily label a patient with these labels. So Mr. Jones or Mrs. Smith are not BCG unresponsive or BCG exposed. It’s not a label for patients. I hate labeling patients in the first place.

Rick Bangs:

Right.

Dr. Ashish Kamat:

So BCG unresponsive essentially means that term is developed to indicate a group of tumors in patients that would not likely respond well enough to more BCG that you can have a single arm study with no control arm back in the day, 2016 is when this definition was proposed, and allow a trial to move forward with no control arm. So BCG unresponsive is a very strict definition that allows pharmaceutical companies and the FDA to say, “Okay, we have drug X, and we currently have approved drugs, which I’m sure we’ll talk about.

It can go in a clinical trial, no control arm because there was no control arm at that time, and we can use the data and the results to see if the drug should be approved.” Now, of course, we don’t want people and patients wasting their time or their energy enrolling in trials that are not meaningful. And there were some trials that were designed where they didn’t fit the definition of being BCG unresponsive, but patients were still being offered a single-arm study. And, of course, it’s not fair to the patient if they’re enrolling in a study that’s not going to inform them or anyone else.

And that’s the BCG-exposed patients where they get some BCG, their tumor doesn’t respond, and they’re seeking another treatment, but they don’t meet the BCG unresponsive definition. So if a patient receives some BCG that’s BCG exposed, within that, if they have met very strict criteria, that’s BCG unresponsive. But I tell all patients that ask me that question that unless you’re enrolling in a clinical trial, these terms really don’t matter or should not matter to you. But if you’re enrolling in a clinical trial, absolutely, these are relevant definitions.

Rick Bangs:

And you are right. This gets very confusing for patients. So thank you. Okay, so we’ve got some new therapies in the NCCN, the National Comprehensive Cancer Network guidelines, and probably in some other guidelines. We have Pembrolizumab, which is immunotherapy, and Adstiladrin, which is something called gene therapy. Can you tell us about those two agents and when they might be used?

Dr. Ashish Kamat:

Absolutely. So Pembrolizumab is a checkpoint inhibitor, and it’s a new class of drugs that was developed largely by work done by Jim Allison who got the Nobel Prize for it along with his contemporary in Japan. Jim Allison happens to be at MD Anderson. Great guy. Basic scientist that has done truly a lot of work in this field. Pembrolizumab belongs to a class of drugs, and it’s the only one approved for non-muscle invasive disease, but there are others approved for more advanced disease.

What it does essentially, in a simple terms, is it takes the break off the break for the immune system. So when patients have tumors, naturally, our body’s able to recognize viruses, bacteria, and tumors as being foreign. But cancer is smart. It’s trying to trick our body. So it puts a break on the immune system and tells the immune system, “Hey, I’m not something you need to fight. Don’t fight me.”

Rick Bangs:

Yeah. “Leave me alone.”

Dr. Ashish Kamat:

What… Exactly. So what these drugs do is it takes that break, that false break off the immune system, in simple terms, obviously, and allows the immune system to recognize tumor and fight it. So that’s Pembrolizumab, and that was the first drug to be approved by the FDA under this new paradigm of BCG unresponsive disease. So it is approved for the use of patients that have tumors that are classified as BCG unresponsive and can contain carcinoma in situ.

Adstiladrin was the second drug to be approved in the same space in patients that have BCG unresponsive disease with CIS present. Adstiladrin is a gene therapy. And again, that’s a broad class of drugs that use manipulation of genetic code, somehow or the other, to either change the tumor biology or release or manufacture certain substances in the body by the body. Adstiladrin is a gene therapy that essentially increases the production of interleukin in the bladder and interferon through multiple pathways and creates essentially a surge in immunotherapy in the bladder itself.

It doesn’t change the genetic makeup of the tumor per se, but essentially creates like a bioreactor within a patient’s bladder by modifying the production of localized cytokines. And that too is approved again in the same space. So they’re both options for our patients. And again, the discussion as to which is more appropriate is a very involved discussion, but it’s not one size fits all.

Rick Bangs:

Okay. And we’ve got a third, another therapy, ANKTIVA, which is, I understand, something called an interleukin-15 receptor agonist. So can you explain what that category of therapies might be and how is ANKTIVA used in combination with BCG?

Dr. Ashish Kamat:

Absolutely. So it’s great to see such drugs being developed, Rick, because they look at the mechanism of action of BCG, and that’s what gave the clue to Adstiladrin, for example, and even Pembrolizumab. And now we have the N-803, or ANKTIVA, which is the trade name of this IL-15 receptor agonist. It was recognized that BCG stimulates a whole range of cytokine production, and some patients have a better response, and some don’t have such a good response because of differential cytokine production in the bladder recruitment of certain natural killer cells, et cetera.

So the IL-15 essentially is a boost that’s given to the immune system when it’s already stimulated by BCG to ramp up that response and to bring in the NK killers, natural killer cells, et cetera. Again, it’s a complicated mechanism, not really lends us well to a podcast, but in short, it’s a boost to the efficacy of BCG. And in combination, it really is very, very effective in patients with BCG unresponsive disease.

So Pembrolizumab was the first drug to be approved, has a decent efficacy. Adstiladrin, second drug, decent efficacy. The bar was really raised with this combination IL-15 and BCG to literally twice to three-fold increase in efficacy based on its results. And again, it was approved. Now again, it’s used in combination with BCG and in places where there’s a BCG shortage, and that’s a big negative when it comes to using IL-15 agonist, which obviously you can’t get without BCG.

Rick Bangs:

Right. Okay. But three exciting new possibilities depending on your circumstances. So excellent. All right, so now I was part of a retreat you put together via the IBCG, the International Bladder Cancer Group, and there was discussion of options regarding the sequence of therapies for BCG unresponsive disease. So can you shed some light on what the consensus is and any insights on how to select the best agent for a given patient?

Dr. Ashish Kamat:

That’s a very insightful question, Rick, and something that patients ask all the time. I just want to go back to 2016-ish when these trials were being designed. We didn’t know how long it would be safe for a patient to try to save her or his bladder, and we all felt that if a patient had BCG unresponsive disease, they should go to radical cystectomy. But clearly we don’t want patients to lose their bladder, but we also don’t want them to lose their life. So we said that we’ll try one drug, and if it doesn’t work, go straight to radical cystectomy.

Fortunately, what we’ve learned, and it’s partly because of better imaging, better cystoscopy, et cetera, et cetera, we’re able to detect recurrences earlier and also stage patients better. So in the clinical trials for all these three agents that we just talked about, what we’ve learned is that the window is actually longer. It’s not that patients have to rush in and rush to have their bladder taken out, for the most part, if something does not work once. So then the question becomes, well now if I try drug A and it doesn’t work and I can try drug B, should I try drug B or C, or what should I do, right?

And that is the question that we need to answer, and that’s what the retreat was all about. We have options. Now we have patients. How do we recommend the right drug for the right patient? Just to summarize, it’s not a clear-cut one drug is best for all patients. We have to personalize this. And without being specific, I’ll just say, for example, if a patient is coming from far away and has to have his or her grandson take time off from work and come and see me to get treatment, then that person might do better with a drug that’s given once every three months rather than one that’s given every week.

Rick Bangs:

Sure.

Dr. Ashish Kamat:

On the other hand, if a patient lives close by and says, “Well, I want the drug with the better efficacy, even if it means coming more often because I want to try that first,” then we would try the drug that with the higher efficacy at the cost of the time toxicity. And the only reason we can do this now is because we know that we don’t lose that much, right.

Because otherwise, if we knew that you can only try one drug, then we’d use the best, quote, unquote, drug for every patient all the time. But because we now know that if you try one drug, even though it’s not the best and by best of numerically not the best, it might be good to try it for that patient. Because if he responds to that and he doesn’t have to come every week, then he saved himself the financial and time toxicity.

And if he doesn’t respond, then we can go to option. So that’s really how we talk to patients, counsel them. I always like to have patients involved in their decision-making and tell me what matters to them. You do have a wedding coming up in the family. Do you have a family trip coming up? Do you actually have the ability to come and get every week or not?

Rick Bangs:

Sure.

Dr. Ashish Kamat:

And what matters to you more, right? Is it the numerical first best chance, or are you wanting to try something less involved first and then go on to the next step? And every patient’s different, Rick. You know that.

Rick Bangs:

Yeah. Yes. This whole concept of shared decision-making is such a wonderful thing to do. So, all right. So now what about this hopefully small group of patients who just can’t get BCG? What are their alternatives, and how effective are they compared to the BCG?

Dr. Ashish Kamat:

Yeah, so this is something I do want to spend a little bit of time on. Patients will see all these drugs and trials being performed in the BCG unresponsive space. And I’ve had patients come and tell me, “Oh, I saw this new drug that was approved for bladder cancer, and I want it.” And you say, “Well, but you haven’t had BCG yet.” And they say, “Well, but I heard in some podcast, or I heard somewhere that BCG’s been around for 40 years. I don’t want the whole thing. I want the new thing.” So it’s up to us to educate patients too that the best treatment for a bladder cancer is BCG, not the newer, later, greater thing because it doesn’t work as well as BCG, right. So that’s number one. Now, of course, you’re asking me about patients who need BCG but can’t get BCG.

Even in those patients, the newer approved drugs are not appropriate because they have not been studied for patients who are what we call BCG naive. So, as I mentioned earlier, there is a lot of evidence that suggests that these drugs might work only in patients that have already had their bladder’s immune system ramped up, revved up, whatever you want to call it, by immunotherapies such as BCG. And if you go and give a patient, say, Pembrolizumab, without the patient ever having had BCG, it likely won’t work as well. Same thing with the other drugs. It’s never been studied in this patient. So even if a patient, and I see this sometimes where patients are given these drugs by their physician because they asked for it and it doesn’t work, and then they’ve had a whole bunch of toxicity, and that’s irreversible.

So for patients who cannot get BCG, what is the option? It is intravascular chemotherapy. Intravascular chemotherapy has been used for decades across the globe. Single agents work not as well as combinations. In the United States, the de facto standard option for patients that we talked about earlier who can’t get BCG is gemcitabine and docetaxel. If they can enroll in the clinical trial, great, but if they can’t enroll in the clinical trial, they should ask for intravascular BCG alternative, which is gemcitabine and docetaxel off-label essentially. Now that’s for patients with higher-risk disease. If they have lower-risk disease than single-agent chemotherapy is easier for them, less toxic, and they should get that.

Overseas, the option for patients who can’t get BCG also includes hyperthermic chemotherapy. So essentially, anything that enhances the activity of single-agent chemotherapy, whether it’s heating it or combining it with another chemotherapy, is really the current alternative of the patients who can’t get BCG. And they’re fairly equivalent we think. Again, without randomized head-to-head studies yet being completed, we do believe that they’re not as good at BCG, but they’re close enough that it’s definitely better than doing… Well, it’s 100% better than doing nothing. But it’s not a huge negative to get that rod if you can’t get BCG.

Rick Bangs:

So the hypothermic they’re warming up the chemo before they put it into my bladder?

Dr. Ashish Kamat:

Rick, so no, you’re not wrong. Yes, there is one avenue to do that, which is just warming up the chemo and putting in the bladder, but that’s not as effective because you can’t warm up the chemotherapy to get it to that temperature and then put it to the urethra because you would burn the urethra, right.

Rick Bangs:

Yeah.

Dr. Ashish Kamat:

So just warming it outside and then putting it in the bladder isn’t as effective as the devices that actually use radiofrequency waves to heat up the chemo within the bladder.

Rick Bangs:

Ugh.

Dr. Ashish Kamat:

So once it’s in the bladder, they heat up the chemotherapy or the bladder wall within the bladder itself. Now, of course, there are companies that are working on putting hot chemotherapy into the bladder HIVEC type, which are doing clinical trials. And I believe they’re actually launching a phase three study in the United States soon to be able to be evaluated appropriately and, hopefully, if they show positive results be approved in the US.

Rick Bangs:

Uh-huh. Something else to watch for, which is great. All right, so are there other new treatments that you can anticipate that we’ve not already discussed? Things that are in the pipeline that might be actively occurring new patients or things that might be awaiting data analysis and publication? What ever haven’t we talked about?

Dr. Ashish Kamat:

Rick, when I started working in bladder cancer, gosh, almost 25 years ago now, there was nothing going on, right.

Rick Bangs:

Right.

Dr. Ashish Kamat:

Nothing going on, literally. And now there’s so much going on. So yes, there’s several new treatments that are being looked at and developed. There’s nanoparticles that are being developed to allow patients to get deeper penetration of drugs into the bladder. There’s drug delivery devices where you can put chemotherapy into a what we colloquially call like a pretzel device and put that in the bladder, and then it releases chemotherapy slowly over time.

There’s other gene therapies which don’t use actual viral transfection vectors that are being developed where you can actually put genetic manipulating code in the bladder without using viruses. And, of course, there are other gene therapies where you’re actually using viruses, but you’re activating other pathways, targeting other pathways. There’s a ton of stuff, right. There’s also refining radiation therapy, which traditionally has not been effective when it comes to non-muscle invasive bladder cancer, but there are some patients where it might work, and there’s a renewed interest in seeing if we can refine radiation therapy, for example.

So a lot of activity, a lot of research, a lot of work being done. I think the ultimate holy grail is not the treatment, but how can we identify markers, molecular markers, genetic markers, clinical markers, whatever it is that will allow us to identify which patient benefits the best from a particular treatment? So all of this is work that’s ongoing. I mean, there’s groups of people not just in the US but across the globe that are coming together at the think tank, for example, at the IBCG meeting, putting their heads together, coming up with ideas, and trying to solve this problem as a global community. And I’m really looking forward to seeing what the next few years has to hold for us.

Rick Bangs:

So exciting. So different from when you started and when I was diagnosed. This is just amazing. So hopefully the next 15, 25 years, we’re going to see every bit as much or more so unbelievable. So, Dr. Kamat, I want to thank you for returning to provide the latest information on BCG, the BCG shortage, and BCG alternatives. If you would like more information on bladder cancer, please visit the BCAN website, www.bcan.org. In case people would like to get in touch with you, could you share a Twitter handle or any other information you would like people to have?

Dr. Ashish Kamat:

Absolutely, Rick. I mean, patients often will get in touch with me through the BCAN website, which I strongly encourage all my patients to visit because there’s so much information on there that’s really, really useful. And it’s curated, right. It’s not junk, and it’s not biased by necessarily commercial entities that have… Again, they all have biases, but I really love the information on BCAN.

So directly through BCAN is great. And, of course, I do have patients reach out to me directly. I find social media is easy. So my Twitter handle, which someone made for me many years ago when I asked them to make, they said, “Well, you’re a doc, and your name is Ashish, so let’s make it UroDocAsh. So it’s U-R-O-D-O-C-A-S-H. That’s my Twitter handle. Feel free to send that out, and people can reach me there too.

Rick Bangs:

Excellent, thanks. Just a reminder, if you’d 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. Kamat.

Dr. Ashish Kamat:

My absolute pleasure. Always.

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.