Advanced bladder cancer is particularly difficult to treat, with few options available to doctors. Often, the first line of treatment is chemotherapy with or without radiation.
Treatments for advanced bladder cancer aren’t very effective. Following diagnosis, only about
Newer treatment options have recently undergone clinical trials, including a combination of enfortumab vedotin-ejfv (Padcev) with pembrolizumab (Keytruda). In early 2023, the combination therapy gained accelerated approval for use in locally advanced and metastasized bladder cancer cases due to the effectiveness it showed in treating these types of cancer.
“Locally advanced” means that the tumor is too large to operate on. “Metastasized” means the cancer has spread to distant areas of the body. Adding an effective method to treat these two types of bladder cancer may improve outcomes for people who have had few options and generally poor responses to treatment.
Currently, treatment options for advanced liver cancer are relatively limited. According to the
Doctors may recommend immunotherapy following the use of chemotherapy. However, not everyone is a good candidate for chemotherapy. Doctors may recommend radiation or immunotherapy in those cases.
They may also recommend surgery. But since it can’t remove all the cancer, it’s unlikely to be curative.
As available treatment options are unlikely to cure advanced bladder cancers, researchers are continuing to look into newer treatments to help improve outcomes.
In recent years, researchers have looked into several newer treatment options for treating advanced bladder cancer. Some newer options for treatments
- Immune checkpoint inhibitors: This class of medication allows the immune system to find and target tumor cells in the body. Not everyone responds to this type of treatment, but those who do benefit from it will often respond for longer periods of time. To increase their effectiveness, researchers are looking into developing biomarkers that may help the immune system target the cancer cells.
- Targeted therapies: Targeted therapies use specific medications to attack cancer cells and cause less damage to healthy cells. The Food and Drug Administration (FDA) approved erdafitinib (Balversa) in 2019 for advanced bladder cancer treatment. Other targeted therapies are still under investigation.
- Antibody-drug conjugates: One of the newest medications under development for advanced bladder cancer treatment — antibody-drug conjugates — combine antibodies with a medication. The result is a medication that targets cancer cells and leaves healthy cells undamaged. Enfortumab vedotin-ejfv (Padcev) received approval for use in advanced bladder cancer.
Padcev is one of the most recent additions to locally advanced or metastatic bladder cancer treatments, gaining accelerated approval in
Padcev is a type of antibody-drug conjugate that uses a combined antibody and drug to deliver targeted therapy to cancer cells.
The approval of the new combination followed cohort studies that showed the effectiveness at 68%, with 12% showing a complete response to the medication. In other words, researchers found enough evidence to suggest that it could help people with locally advanced or metastatic bladder cancer.
Doctors provide a dose of enfortumab vedotin-ejfv through an intravenous infusion over 30 minutes. A dose of pembroizumab (Keytruda) would follow the administration of Padcev.
The most common (20% or greater) adverse reactions to the combination include:
- increased glucose, aspartate aminotransferase (enzyme found in liver, heart, and muscles)
- increased creatinine (indicating lowered kidney function)
- decreased hemoglobin
- peripheral neuropathy
- decreased lymphocytes
- dry skin
- increased alanine aminotransferase (marker for liver inflammation)
- decreased sodium
- increased lipase
- decreased albumin (indicating a problem with your liver or kidneys or other health conditions)
- decreased phosphate
- weight loss
- itchy skin
- decreased appetite
- altered perception of taste (dysgeusia)
- decreased potassium
- increased risk of infection (decreased neutrophils)
- urinary tract infection
- increased potassium and calcium
- peripheral edema
- dry eye
- joint pain (arthralgia)
If you or a loved one have recently received a locally advanced or metastasized bladder cancer diagnosis, you may want to speak to a doctor about the possibility of trying this new form of therapy.
A doctor familiar with your case may be able to better determine whether you would be a good candidate for the treatment.
Combined enfortumab vedotin-ejfv (Padcev) with pembrolizumab (Keytruda) offers a new, effective way to treat locally advanced and metastasized bladder cancers. The combination may help a person with more advanced bladder cancer effectively treat the cancer and live a longer, healthier life.
Other newer treatments may also help. Immunotherapy may be done following chemotherapy in advanced cases of bladder cancer.
You may want to speak with a doctor about new therapies for bladder cancer if you or a loved one recently received a bladder cancer diagnosis. They can provide recommendations based on your situation and help determine whether enfortumab vedotin-ejfv with pembrolizumab may be effective for you.