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STAG2 Genetic Test Could Reduce Overtreatment in Some Patients With Bladder Cancer

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Key Points

  • The STAG2 test is 2.4 times more accurate in identifying tumors likely to recur after treatment than current diagnostic procedures.
  • It is also 1.9 times more accurate at predicting which tumors will likely progress, invade the bladder wall, and spread.

A new genetic test in bladder cancer could be key to reducing the cost of care while avoiding overtreatment in some patients, according to research published by Waldman et al in Clinical Cancer Research.

Deciding whether to treat bladder cancer aggressively can be difficult—predictive diagnostic data are limited. Up to 70% of patients treated for early-stage lesions that have not invaded the bladder wall will experience recurrence of these lesions, and 20% of these patients will develop an invasive cancer. 

Many clinicians opt to perform an intensive postsurgery surveillance regimen, including cystoscopy as frequently as every 3 months for 2 years after removal of the tumor, and every 6 to 12 months for the years after. But now researchers say they have found a fairly simple test significantly improves the identification of bladder tumors that will likely become invasive.

The study “validates this test that helps predict whether an early-stage bladder cancer will recur and progress,” said the study’s senior author, Todd Waldman, MD, PhD, Professor of Oncology at Georgetown Lombardi Comprehensive Cancer Center, Washington, DC.

STAG2 Genetic Test

Working with researchers from the United States and Denmark, Dr. Waldman has found that, compared with using current diagnostic procedures, the new test is 2.4 times more accurate in identifying tumors likely to recur after treatment and 1.9 times more accurate at predicting which tumors will likely progress, invade the bladder wall, and spread. The test involves examining bladder tumors removed during initial surgery for overexpression of the STAG2 gene, which Dr. Waldman earlier identified as key to the development of potentially deadly bladder tumors. 

Checking for STAG2 is a “very simple and very robust” procedure for pathologists who routinely examine excised tumors, Dr. Waldman said. His studies have described how to run this test. Using the test could, in some cases, reduce constant surveillance in patients and, in others, support forgoing aggressive treatment that can produce significant side effects, the researchers explained.

“We are closer to our goal of lowering the risk of both aggressive bladder cancer and oversurveillance and treatment side effects in bladder cancer patients,” Dr. Waldman concluded. “In principle, it might be possible to reduce the frequency of postresection surveillance and therapy in patients whose cancer is STAG2-negative, and, conversely, treat patients and keep up high frequency surveillance in patients who have positive test results.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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