Bladder cancer immunotherapy
Bladder cancer immunotherapy, also defined as biological therapy created to increase the body’s natural defense against cancer. It uses substances secreted or recognized by the body to improve or restore immune function.
Scientists report data on about 77,000 new cases of bladder cancer in the United States per year and 16,000 deaths.
About 3/4 of cancers occur in men making bladder cancer the fourth most common cancer in men. Treatment methods include surgery, chemotherapy and radiation, but these approaches are not very effective for advanced stage cancer.
Immunotherapy for bladder cancer in Israel is the use of drugs that stimulate a person’s own immune system to recognize and destroy cancer cells. Immunotherapy is used for precision bladder cancer treatment as well.
FDA approved immunotherapy for bladder cancer in Israel
• Atesolizumab (Tecentriq), Avelumab (Bavensio), Durvalumab (In Physi) have been approved for the treatment of patients with metastatic bladder cancer. These drugs inhibit the immune system’s brakes, allowing the system to attack the cancer. The containment molecule that is in the targeting of the drugs is called PD-L1 and is expressed on the surface of several cancer cells and immune cells. Blocking PD-L1 allows to strengthen the immune response to cancer cells and helps to reduce or slow tumor growth.
Treatment is effective even after chemotherapy has stopped working, so it can change patients’ prognosis.
• Nivolumab (Opdivo) and Pembrolizumab (Keytruda) are drugs that block another PD-1 target protein, which usually helps control the immune system. Blocking PD-1 can help the immune system fight cancer cells.
Any of these drugs can be used in patients whose tumors continue to grow after chemotherapy. Atesolizumab (Tecentriq) and Pembolizumab (Keytruda) may also be prescribed to patients who, for some reason, contradicted to to cisplatin chemotherapy.
All these drugs are administered intravenously, usually every 2 or 3 weeks.
Immunotherapy with BCG
BCG is a vaccine used to prevent tuberculosis and is an effective treatment for some of the superficial bladder cancer. BCG is a form of immunotherapy that stimulates body’s immune system to destroy cancer cells.
BCG administration is usually done at an outpatient clinic, once a week, for six weeks, and later in a follow up format to be prescribed by the attending physician. This is a liquid preparation that is inserted directly into the bladder through a catheter.
However, it is more difficult to treat successfully with BCG patients with progressive and metastatic bladder cancer. Those patients benefit FDA approved immunotherapy by control point inhibitors mentioned above.
Possible side effects of bladder cancer immunotherapy
Common side effects of these drugs include fatigue, nausea, loss of appetite, fever, urinary tract infections, rash, diarrhea and constipation. As these drugs basically eliminate the “brakes” of the body’s immune system, sometimes the immune system begins to attack the body that can cause serious or even life-threatening problems (in the intestines lungs, hormones, liver or others).
It is very important to immediately report any new side effects to the doctor. If serious side effects occur, treatment may need to be discontinued and treatment prescribed immediately to suppress immune system.
Currently, clinical trials also undergo other immunotherapy drugs, including checkpoint preparations, cell and targeted therapies, and immune stimulants as well.