Jeannie Hoffman-Censits: Thanks for having me.
Tian Zhang: I want to focus our conversation today about women leading change in bladder cancer, and you happen to direct a bladder cancer for women program. So tell us about your program at Hopkins and what you do.
Jeannie Hoffman-Censits: Sure. Well, one of the missions that I came to Hopkins for was to solely focus on patients with locally advanced and metastatic urothelial cancer. And I think being a woman, you and I may have some of the same experiences where women with bladder cancer will often seek out female providers if they can find them. And I happen to be at a program with a very invested female urologic oncologist, Dr. Armine Smith, who's actually the co-leader of the Women's Bladder Cancer Program. So it's a unique experience for women to see both a medical oncologist and a urologic surgeon with interest and expertise in women with urothelial cancer.
Tian Zhang: Wonderful. So you share patients in the same clinic space? Or tell me a little bit more about that.
Jeannie Hoffman-Censits: Yeah. Johns Hopkins is an entity that's across various different areas, so we see patients in North Baltimore, East Baltimore, as well as the Sibley campus down in Washington, DC, and that's where Armine and I practice together. Depending on the day and the complexity, we'll sometimes see patients in the same space. But like many urothelial cancer clinics, these multidisciplinary discussions and management options are really happening across conversations and across locations.
Tian Zhang: And tumor boards too, for sure.
Jeannie Hoffman-Censits: Absolutely.
Tian Zhang: So in all of your shared practice, what are some of the challenges you've faced in caring for women with bladder cancer?
Jeannie Hoffman-Censits: Well, I think the story still exists that women with urothelial cancer will come to their diagnosis having a somewhat different story than our male patients. Women will oftentimes have a delay in diagnosis, multiple rounds of antibiotic therapy that's given empirically, sometimes even with a negative urine culture, seeing different providers for really what is ultimately a urologic diagnosis, they're seeing a urologist much later compared to men, who may already have a urologist and seek out care and get it sooner because of that relationship. So that continues to exist, and some of the stage migration that probably goes along with that remains a problem. And that feeling and that inequity is often a challenge when patients are diagnosed with urothelial cancer and then thinking about some of the prodrome that occurred prior to that. So some of those considerations we think about and really address in a patient-centered program that we have specifically for women with urothelial cancer, run by our Patient and Family Services unit, really a wonderful series of lectures and interests that are really patient-driven by what the patients come to us and say it's important to them.
Tian Zhang: Yeah, so what kind of initiatives? And those lectures sound great, but are there any particular ones where, patient navigation or others, where you're implementing specifically for your clinic for women versus men?
Jeannie Hoffman-Censits: Yeah, so Armine Smith, again, the urologic oncologist that's a co-lead for this, she really has started to develop some clinical trials, prospective trials, looking at how patients respond to some therapies, including BCG, looking at psychologic outcomes, as well as looking at how patients deal with some of the side effects, both psychologic and sexual side effects of bladder cancer treatment from a usual perspective or if they have additional education as a part of that.
Tian Zhang: Yeah, that's great. And what do you think, some of these newer therapies that are coming forward for bladder cancer, any challenges in using them for women with bladder cancer?
Jeannie Hoffman-Censits: Yeah, from a challenge perspective, my sense is probably not, but like all of the newer therapies that are pretty exciting, really understanding who are the patients who are getting the best outcomes and why I think remains rather elusive. If you look at the wonderful programming at GU ASCO, a lot of the studies are really looking at that, trying to really understand better which patients or which kinds of bladder cancer may respond to one therapy versus another. I think one of the things about women with bladder cancer potentially different than men with bladder cancer, sometimes we're seeing more variant histology, and that may have something to do with some different outcomes. But I think thinking about these really important questions as trials are designed will remain an important thing for us to keep doing.
Tian Zhang: Yeah. Talk a moment about those treatments that we have now, because a lot of times we do see those trials enroll more men than women. For example, in the frontline space, take EV pembrolizumab, for example. Are you seeing any differences in your population of women with bladder cancer with these treatments?
Jeannie Hoffman-Censits: I don't think that I am necessarily, but my practice is pretty unique. So I only see patients with urothelial cancer. And then with our upper tract focus, about half of the patients I see have primary upper tract urothelial cancer. So even though it's a relatively rare disease, because I focus in the locally advanced and metastatic setting, of course those patients represent more patients with metastatic disease, the ones with upper tract. So it really is about 50/50 in my practice. And so we are seeing definitely, again, I think in part because of our interest and our drive and motivation to take care of women, we're also seeing a lot more women in our practice.
Tian Zhang: Yeah. And good responses overall, but any differences in toxicity profiles? Do you change your doses any differently for women than for men?
Jeannie Hoffman-Censits: I certainly do not change my doses for women. And especially with enfortumab and pembrolizumab, this is a very well-tolerated regimen. It's nice to practice medicine and not walk in the door and the first thing we're thinking about is whether or not someone is eligible or ineligible for platinum-based therapy. I'm glad that those days are fading away and that the playing field is much more even for all of our patients walking in the door with urothelial cancer.
Tian Zhang: Great. What do you think oncologists in the community, in our academic centers, what do you think we need to be thinking about when we're caring for women with bladder cancer?
Jeannie Hoffman-Censits: Yeah, I think taking a really good history and understanding what led to someone coming into the office and some of the things that have happened over the past decades. And whether or not that's a smoking history, an exposure history, I think really understanding some of those things may potentially help. Although when it comes to treatment, we don't necessarily make any treatment decisions based on that. But again, in terms of our understanding of what really is the best treatment for the patient in front of us, I think understanding those things a little bit better certainly helps.
Tian Zhang: Their disease course, for sure.
Jeannie Hoffman-Censits: Yeah.
Tian Zhang: Great. Any takeaways for our UroToday audience?
Jeannie Hoffman-Censits: That women with bladder cancer remain a unique population with a unique set of needs. I think oftentimes women will tell us that in a urology office, they feel somewhat out of place because it can be a male-centric place. And there may be things that really people don't recognize, like some of the intake forms. Sometimes women will tell us it has questions about their prostate function and things like that. So I think these are things to remain mindful of so women feel like they have a place in those practices, but I think those things are definitely changing.
Tian Zhang: Yeah, great. Hopefully women are included in all of those discussions and feel welcomed in those spaces.
Jeannie Hoffman-Censits: Absolutely.
Tian Zhang: Thank you so much for joining us today.
Jeannie Hoffman-Censits: Thank you.