Immunotherapy

Bladder Cancer

Bladder cancer begins when healthy cells in the bladder lining, most commonly urothelial cells, change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Bladder cancer was the first cancer type to receive an approved immunotherapy agent, which was a breakthrough for modern immunotherapy. This agent, bacillus Calmette-Guérin (BCG) was approved by the FDA in 1990 and is now one of the main treatments for nonmuscle-invasive bladder cancer. BCG is a weakened version of the bacterium that causes tuberculosis, and it is delivered directly into the bladder through a catheter. This is called intravesical therapy (see Figure below). BCG attaches to the inside lining of the bladder and stimulates the immune system to destroy the tumor. BCG is used for early-stage bladder cancer and as treatment to reduce the risk of recurrence in noninvasive bladder cancers, commonly after surgery to remove the tumors.

Although other treatment options are available for bladder cancer, BCG was the only immunotherapy for bladder cancer until recently. A checkpoint inhibitor, specifically, a PD-L1 inhibitor, is now approved for locally advanced or metastatic urothelial carcinoma, the most common form of bladder cancer, in people in whom disease progressed during or following chemotherapy containing a platinum drug or in whom disease progressed within 12 months after neoadjuvant or adjuvant treatment with platinum-containing chemotherapy.

Although other advancements have been slow for this disease, research is ongoing to develop treatments, including immunotherapies, for bladder cancer. Several drugs are in clinical trials, and immunotherapy continues to show promise for additional bladder cancer treatment options in the near future. One strategy being explored through clinical trials is combinations of immunotherapies. Future research could open the door to more treatment options involving immunotherapy, which could offer new hope to people who have bladder cancer.

Be sure to talk with your doctor about which treatment options are best for you, especially since not all immunotherapies are approved for all types and stages of bladder cancer.

Additional Resources

 

FDA-Approved Immunotherapies for Bladder Cancer
As of 10/26/2016
atezolizumab (Tecentriq)
bacillus Calmette-Guérin (BCG)

 

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