Cancers of the reproductive and urinary organs, known as genitourinary cancers, affect millions of people worldwide each year. Yousef Zakharia, M.D., a Mayo Clinic medical oncologist, leads clinical research aimed at improving treatment results for patients with kidney, bladder and prostate cancers.
We've made significant progress in cancer therapies. There is still more work to do, especially for patients whose disease no longer responds to standard therapies. Clinical trials help us expand options and move the field forward."
Dr. Yousef Zakharia, chair of the Genitourinary Disease Group, Mayo Clinic Comprehensive Cancer Center
Expanding treatment options in bladder cancer
For many years, cisplatin-based chemotherapy was the primary treatment for bladder cancer. Researchers have recently identified newer treatment options that improve outcomes and are generally well tolerated, including enfortumab vedotin, an antibody-drug conjugate, and the immunotherapy drug pembrolizumab.
Initially approved by the U.S. Food and Drug Administration for advanced disease, the combination is now being evaluated before surgery in patients with localized cancer, meaning the cancer has not spread to distant organs.
Dr. Zakharia is co-author of an international study examining this approach in patients with muscle-invasive bladder cancer, in which the cancer has grown into the bladder wall and typically requires surgery.
Based on the study findings, Dr. Zakharia says the combination may become standard therapy before surgery for patients eligible to receive cisplatin.
Improving outcomes in kidney cancer
In metastatic kidney cancer, today's first-line treatments are significantly more effective than those available in the past. Many patients receive dual immunotherapy or a combination of targeted therapy and immunotherapy.
"These combinations shrink tumors in 60% to 70% of patients," Dr. Zakharia says. "With certain immunotherapy combinations, 10-year follow-up data show that about 30% of patients with advanced disease and higher-risk features are alive and doing well. That was previously unheard of in metastatic kidney cancer."
Despite these advances, many patients eventually experience disease progression.
One study led by Dr. Zakharia combines very high-dose selenium in the form of Seleno-L-methionine, which is a nutritional supplement studied for its potential anticancer effects, with a standard targeted therapy with axitinib. In an early-phase clinical trial involving patients whose cancer had already progressed on other treatments, the combination produced tumor shrinkage in about half of the participants, with some responses lasting more than two years. The results were published in Clinical Cancer Research in 2025.
Mayo Clinic is also opening additional kidney cancer trials studying next-generation drugs with established treatments. The goal is to improve response rates and extend survival while maintaining quality of life.
Clinical research leadership at Mayo Clinic
As leader of the Experimental Therapeutics Program at Mayo Clinic in Arizona, Dr. Zakharia develops and evaluates new treatments for patients whose cancer has progressed after standard therapies.
"We're continuing to refine treatment approaches based on what we learn through research," Dr. Zakharia says. "Mayo Clinic's research and multidisciplinary teams make it possible to move discoveries from the laboratory to patient care more quickly."
With multiple new studies underway in kidney and bladder cancers, Mayo Clinic continues to advance collaborative research aimed at improving long-term treatment results for patients.
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