Below the Belt Award
Andrew Redfern and Julien Van Damme — 2025
Validating tumour and stromal immune features that correlate with optimal benefit from BCG and Mitomycin: a translational study of patients in the BCG+MM Trial
When doctors find aggressive bladder cancer that hasn’t yet grown into the muscle wall of the bladder, they first remove all visible cancer using a special telescope inserted through the urethra (the tube you urinate through). After removing the visible cancer, doctors use drug treatments to kill any remaining cancer cells to prevent the cancer from coming back.
Currently, the main treatment involves putting a bacterial vaccine called Bacillus Calmette-Guerin (BCG) into the bladder. These bacteria help activate the body’s immune system which then kills remaining cancer cells. Another treatment put directly into the bladder is the chemotherapy drug mitomycin which has also proven effective in the treating these remaining tumour cells. Mitomycin works both by directly destroying cancer cells and may also cause release of cancer cell components that assist activation of the body’s immune system to help recognize and kill cancer cells.
The BCG+MM trial (ANZUP 1301) aimed to see if using both treatments together (BCG plus mitomycin) works better than using just BCG alone. 501 participants have been enrolled in this study. As part of this study, tumour and tissue samples were removed from participants’ bladders before, during and after treatment. The aim of this study is to look closely at these tissue samples for “biomarkers” – special signs in the cancer cell that might tell us whether BCG alone or combined treatment may be better for each individual patient. After reviewing many scientific studies, we have identified 18 potential biomarkers that could predict the best treatment. We’ve already tested these biomarkers in a small group of 23 participants whose cancer came back after trial treatment with promising results (not yet published).
Now we want to confirm these findings by looking at all 501 participants from the BCG+MM trial. We aim to create a personalised approach to bladder cancer treatment. By studying each patient’s cancer cells, we hope to predict which treatment will work best for them. This would help patients get the treatment most likely to cure their cancer while avoiding unnecessary treatments that might cause uncomfortable or harmful side effects from treatment without providing any benefit.
Currently, the main treatment involves putting a bacterial vaccine called Bacillus Calmette-Guerin (BCG) into the bladder. These bacteria help activate the body’s immune system which then kills remaining cancer cells. Another treatment put directly into the bladder is the chemotherapy drug mitomycin which has also proven effective in the treating these remaining tumour cells. Mitomycin works both by directly destroying cancer cells and may also cause release of cancer cell components that assist activation of the body’s immune system to help recognize and kill cancer cells.
The BCG+MM trial (ANZUP 1301) aimed to see if using both treatments together (BCG plus mitomycin) works better than using just BCG alone. 501 participants have been enrolled in this study. As part of this study, tumour and tissue samples were removed from participants’ bladders before, during and after treatment. The aim of this study is to look closely at these tissue samples for “biomarkers” – special signs in the cancer cell that might tell us whether BCG alone or combined treatment may be better for each individual patient. After reviewing many scientific studies, we have identified 18 potential biomarkers that could predict the best treatment. We’ve already tested these biomarkers in a small group of 23 participants whose cancer came back after trial treatment with promising results (not yet published).
Now we want to confirm these findings by looking at all 501 participants from the BCG+MM trial. We aim to create a personalised approach to bladder cancer treatment. By studying each patient’s cancer cells, we hope to predict which treatment will work best for them. This would help patients get the treatment most likely to cure their cancer while avoiding unnecessary treatments that might cause uncomfortable or harmful side effects from treatment without providing any benefit.
