GUSTO
Research type
Research Study
Full title
GUSTO: Gene expression subtypes of Urothelial cancer: Stratified Treatment and Oncological outcomes
IRAS ID
1005487
Contact name
Jayne Swain
Contact email
Sponsor organisation
Sheffield Teaching Hospitals NHS Foundation
ISRCTN Number
ISRCTN17378733
Research summary
Recent research has suggested that the outcomes from bladder cancer can be improved by using the genetic information within each cancer to tailor treatments to individual patients. However, before this approach can be tested, it is necessary to understand whether this is possible within the NHS and if this approach appears to improve outcomes.
The current approach is to treat all individual patients as though they have the same type of bladder cancer, with everyone receiving the same treatment.
However, treating all bladder cancers in the same way may not be best for individual patients. For example, some cancers respond exceptionally well to chemotherapy and so may not need surgery. Other cancers may respond better to immunotherapy and so need this treatment alone or as a boost to chemotherapy. Finally, some cancers do not respond to either chemotherapy or immunotherapy and so need immediate surgery. Recent advances have suggested the genetic information within a bladder cancer may identify which treatment is best for an individual patient.
GUSTO aims to understand if tailored treatments are better than the current unselected standard of care. These tailored treatments include surgery with chemotherapy or immunotherapy and chemotherapy combined or surgery alone. Patients recruited will have their cancers profiled quickly (so that their treatment is not delayed). Patients will be randomly allocated to the new pathway or standard care. The study will look to see how many respond to chemotherapy and/or immunotherapy, and whether immediate surgery is better than standard care.
In GUSTO the practicalities of the proposed pathway will be assessed along with the underlying assumptions, preparing for a large trial that fully tests the tailored treatment approached. If successful, this approach would improve survival rates for bladder cancer, reduce the number of potentially toxic treatments individuals would need and reduce the cost of this treatment.REC name
West of Scotland REC 1
REC reference
22/WS/0153
Date of REC Opinion
12 Apr 2023
REC opinion
Further Information Favourable Opinion