If you have advanced metastatic bladder cancer and are not a good candidate for chemotherapy, your doctor may try to use immunotherapy to treat your disease.
“This is the hardest for us to treat because we don’t really have any curative options,” says Dr. Jay Shah, urologic oncologist at the Stanford Cancer Center. “You’ve just found out that you have a cancer in your bladder that has already spread to your lymph nodes, or to your lungs, or to your liver, to your bone, etc.”
Read More While immunotherapy drugs or checkpoint inhibitors have generated a lot of excitement in cancer care, the options are limited for patients with bladder cancer. Unfortunately, immunotherapy does not work in most patients, according to Dr. Shah. “The lure with immunotherapy is that…in those patients where it works, there are responses that are phenomenal.” He adds that a miracle-type response only happens for a minority of patients. “Most people don’t experience that,” he says. The big question in cancer is: Why doesn’t immunotherapy work for more patients? Doctors are trying to understand how to better predict which stage four patients will see a response from immunotherapy such as checkpoint inhibitors. Checkpoint inhibitors are man-made antibodies that shut down key proteins on immune cells like PD-L1 essentially halting a cancer's ability to spread. Research is currently being done on specific mutational profiles to understand if it may or may not work well for you. Recently, the FDA approved a new type of drug for people with advanced bladder cancer. Padcev (enfortumab vedotin-ejfv) is an antibody-drug conjugate, which means that a combination of two different types of drugs work together to kill the bladder cancer cells. The FDA based its approval of Padcev on a clinical trial of 125 people with advanced bladder cancer who had already been treated with platinum chemotherapy and immunotherapy. The results show that 44% of patients had either a partial or complete response to treatment. While the FDA has granted Padcev accelerated approval, another clinical trial will need to be completed to confirm the results.
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