For primary diagnosis, bladder cancer patients are treated by surgical resection of the tumor and may require additional treatment depending on tumor stage. Non-muscle invasive bladder cancer patients are treated by adjuvant intravesical chemotherapy (MMC) or immunotherapy (BCG) instillations. Muscle-invasive bladder cancer patients are treated by neoadjuvant chemotherapy followed by bladder resection, whereas patients with metastatic disease can be treated with chemotherapy or immunotherapy. Despite these intensive treatments, a selection of patients will not respond. Unfortunately, we are unable to predict which patients will benefit from these treatment options. Moreover, specific treatment options are costly and there is an ongoing global shortage for BCG intravesical instillations.
We have developed a patient-derived bladder cancer organoid culture system and have setup an organoid biobank. These organoids are being used to predict ex vivo treatment response in parallel to clinical treatment. Novel identified drugs are tested in these organoids and we use this model to improve our understanding on how urothelial cancer develops, by introducing cancer driver-mutations into normal urothelial organoids.