“There was a natural thread from what my mom and dad were doing in service to patients, which was always our true north, but also the way they were doing it,” says Dr. Cutie, Vice President and Disease Area Leader for Bladder Cancer at Johnson & Johnson. “You may not be in the clinic every day or seeing patients every day, but you’re trying to advance the science of the field every day.”
Bladder cancer is the tenth most common cancer globally. Every year, more than 1 million people are impacted, including those newly diagnosed and newly recurrent. In the U.S. alone, nearly 85,000 people are diagnosed annually.
And yet the standard of care for treating certain types of bladder cancer hasn’t changed much in the last 40 years. Current treatments include immunotherapy, radiation, chemotherapy, targeted therapy and surgery, and in some cases, complete removal of the bladder. The treatment that’s ultimately recommended for each patient depends on the cancer’s stage and specific type, Dr. Cutie explains.
The most common form is non-muscle-invasive bladder cancer (NMIBC), which occurs when cancer cells develop in the bladder’s inner lining or the connective tissue below this layer but haven’t yet grown into the bladder wall’s muscle layer. With muscle-invasive bladder cancer, tumor cells invade the bladder muscle. And in advanced and metastatic urothelial cancer, tumors have spread to the bones or nearby organs, like the lungs or liver.
In its ongoing quest to get in front of cancer, Johnson & Johnson recognizes the unmet needs and urgency of treating bladder cancer. “We’re investing in this disease and in these patients,” says Dr. Cutie, adding that his team’s mantra is “a solution for every patient across the spectrum of disease.”
We spoke to Dr. Cutie about the challenges of treating bladder cancer and how Johnson & Johnson is working to advance the development of better, more targeted therapies.
Q:
Bladder cancer has always been difficult to treat—why is that?
A:
The bladder is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. We can get drugs and therapies to it reliably, but it’s hard to get them to stay there. The bladder is really good at expelling things.
Until recently, we’ve seen limited innovation in how we dose patients. That’s why we’re excited to see the world moving toward novel ways of delivering therapies that will provide improved results to bladder cancer patients.
Q:
What’s the prognosis for people with bladder cancer, and how has that changed since you first began practicing medicine in the early 2000s?
A:
For metastatic patients, it’s quite dire—the
five-year survival is about 8%. That’s remained the case, even with some new next-generation therapies.
For NMIBC patients, it depends on how aggressively their tumors are growing and whether they recur. If a patient responds to treatment, usually their ability to maintain that response at five years is less than 50%. That’s why we survey patients for decades. Even if their tumor has gone away, we follow them every three to six months for the rest of their lives. We never really use the word “cure.” We try to just prolong the time between recurrences or progression.
Patients who are diagnosed today have many more options, in addition to life-altering treatments like radical surgery. When I was training and first practicing two decades ago, patients were often referred for surgery to remove their bladders. That has totally changed.
There are some novel and next-generation therapies, and now we’re able to talk about things beyond surgery. If a patient doesn’t respond, we have surgical techniques that have also evolved, but they still require the patient to have their bladder removed.
Q:
How is Johnson & Johnson working to address the unmet needs for bladder cancer patients?
A:
We seek to work on therapies that provide a solution, no matter where a patient is on the spectrum of bladder cancer. As we’re building drugs, therapies and systems to treat bladder cancer, we have a whole army of people—engineers, scientists and developers—working on surgical technologies to improve how we stage these tumors, grade these tumors, diagnose these tumors and remove these tumors so that we work synergistically.
Where we really wish to go is to develop therapies that are bladder-sparing across non-muscle and muscle-invasive disease and to also offer therapies that are dosed systemically—throughout the whole body—to treat disease beyond the bladder.
We don’t really have a preferred route of administration. If it’s delivered locally or systemically, if it’s a patch, if it’s a pump on your skin—we’re aggressively pursuing any modality that allows us to access bladder tumors and treat them. That’s exciting because we’re not limited to just one technology or one science.
Q:
How does your earlier career as a urologist treating patients inspire your work today?
A:
I had a mentor who left clinical practice as a urologist to work in drug development. I was contemplating doing the same. I said to her, “Clinical practice is so meaningful. You’re sitting there with the patient; you’re holding their hand; you’re explaining the surgery that you may be offering them, and what to expect. Their family is there. You become like a member of their family in a way. That’s irreplaceable.”
We may be treating patients globally that we’ve never met, but we have a hand in their care.
At the same time, I was really struggling. It was one patient at a time. You may do a really good job, and you’re excited and proud, and the patient does well and they’re high-fiving you in the recovery room. But then there are 10 more patients in the waiting room.
This mentor said to me, about getting into drug development, “You need to be comfortable with no longer treating Mrs. Jones on an individual basis but knowing that you may be treating a thousand Mrs. Joneses at a population level.”
That’s very philosophical, but it’s true. We may be treating patients globally that we’ve never met, but we have a hand in their care. That’s what ultimately motivated me. I do miss operating. At the same time, that population-level potential benefit is quite compelling.
Q:
If we were to speak again in 20 years, what would you be most excited to share about the advances in bladder cancer?
A:
What patients are looking for is the potential to preserve the bladder, for us to offer an option that’s a nonsurgical approach across the field. That’s been a real push.
Twenty years from now, I hope to hear someone say in disbelief, “You actually used to remove bladders to treat bladder cancer?” That would be something that I think is possible. I would be proud if we rendered irrelevant a pretty life-altering surgery that was once a standard of care. Having outcomes that are just as effective, if not better, without the need to fundamentally change the trajectory of someone’s life—that would be compelling.
The access or democratization of these therapies is also really critical. Many patients don’t have access to top-tier surgical centers. There are parts of the country, parts of the world, where the nearest surgical center is 10 to 12 hours away. To be able to access therapies at a local physician’s office that may be able to treat their cancer and allow them to reclaim time to do what they love most—that’s one of the opportunities I really look forward to seeing as the field evolves.
