Breakthroughs in Treatment of Advanced Bladder Cancer

Publish date:2020-11-05



Bladder cancer is more common in men than women, and occurs more often in the older population. The most common symptom is blood in the urine. Smoking greatly increases the risk of this cancer

The common type of bladder cancer is broadly divided into 3 forms - early superficial forms where the cancer has not penetrated deeply into the bladder wall, the more serious muscle-invasive form where the cancer has penetrated deeply into the bladder wall, and finally the advanced metastatic disease where the cancer has spread beyond the bladder.

Although the commonest form is the superficial form, which is treated by urology specialists using endoscopic removal, the advanced metastatic disease is the most life-threatening.

There has recently been much scientific breakthrough in the treatment of advanced metastatic bladder cancer. Until only a few years ago, chemotherapy was the only available treatment for this condition, and once the patient has failed chemotherapy, there were very limited treatment options. However there has recently been a marked improvement in this treatment landscape as it is recently found that immunotherapy could be effective in this cancer, given either immediately after chemotherapy or when the patient has failed chemotherapy. A large recent study shows that when the drug Avelumab is given as a “maintenance” therapy immediately after chemotherapy, 71% of patients remain alive at 1 year compared to only 58% in those not receiving this maintenance treatment immediately after chemotherapy. A proportion of patients can derive very durable tumour control and prolonged survival with immunotherapy, which is generally well tolerated. In addition to immunotherapy, further exciting breakthroughs have been made in the form of new target therapies for patients who have failed conventional treatments. A novel antibody-drug conjugate (enfortumab-vedotin) has recently been approved by the FDA for this cancer. Furthermore, another novel agent Erdafitinib has been developed and approved for patients found to have the FGFR gene alteration.

The availability of these new treatment options have not only transformed but also increased the complexity of the management metastatic bladder cancer patients. Patients are advised to discuss with their oncologist in the selection of the most appropriate treatment at every step.

Source: Clinical Oncologist, Dr. Conrad Lee
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