Advanced bladder cancer, also known as stage 4 bladder cancer, is more challenging to treat. However, new research is uncovering potential improvements in treatments and long-term outlook for this disease.
To learn more, read about the latest studies and newest treatments for advanced bladder cancer below.
Chemotherapy, one of the first-line therapies for advanced bladder cancer, can come with a range of harsh side effects. Because of this, some people may want to take a break after treatment.
Research presented at the 2020 American Society of Clinical Oncology Virtual Scientific Program revealed that people with bladder cancer might be better off starting immunotherapy shortly after chemotherapy to help prevent the cancer from recurring.
The study evaluated 700 participants with locally advanced or metastatic bladder cancer who had already received chemotherapy.
People who received infusions of the immunotherapy drug avelumab (Bavencio) before any sign of cancer recurrence had a median overall survival of more than 21 months compared with 14 months in those who did not receive the drug.
Based on these research results, in July 2020, the Food and Drug Administration (FDA) approved avelumab for people who have been on chemotherapy with a platinum-based drug.
In April 2019, the FDA approved the first treatment for the most common type of bladder cancer, metastatic urothelial carcinoma, that specifically targets a genetic alteration.
The agency also gave the green light to a new test that can help doctors identify cases in which bladder cancer may respond well to this therapy.
The drug, erdafitinib (Balversa), blocks the activity of a group of proteins that can help bladder cancer cells grow in people with certain gene mutations.
Early data from a clinical trial found that erdafitinib was effective at decreasing tumor size in about 40 percent of cases in which bladder cancer didn’t respond to chemotherapy.
Researchers are now looking at whether erdafitinib is more effective at treating advanced bladder cancer than chemotherapy or another drug called pembrolizumab in a phase 3 clinical trial. It’s set to complete on November 24, 2020.
In December 2019, just 8 months after approving the first targeted therapy for bladder cancer, the FDA granted approval for a second targeted drug, enfortumab vedotin-ejfv (Padcev).
The treatment is approved for treating advanced urothelial carcinoma that didn’t improve after chemotherapy and immunotherapy.
Enfortumab vedotin is an antibody-drug conjugate, which means the medication has two connected parts:
- an antibody protein
- a chemotherapy drug
During treatment, the antibody part binds to a protein found on most bladder cancer cells. When this happens, it brings the chemotherapy directly to the cells, which helps fight the cancer.
The FDA gave the drug accelerated approval after the results of a small clinical trial involving 125 people with metastatic bladder cancer showed that 44 percent of cancers shrunk or stopped growing. In addition, 15 participants had their tumors completely disappear.
Researchers are now studying whether enfortumab vedotin should become a first-line treatment for advanced bladder cancer.
A study published in
Around half of participants had robotic surgery, which involved a doctor using a control panel to perform surgery with a robotic arm, while the rest had traditional open surgery. Both groups had almost equal rates of progression-free survival and complications.
Robotic surgery isn’t available at all hospitals, and it takes longer and costs more than traditional surgery. However, study participants who had robotic surgery had:
- faster recovery times
- less bleeding
- shorter stays in the hospital
The findings could further help people with bladder cancer and their doctors make decisions about surgery.
The FDA changed the approved use of two immunotherapy drugs, pembrolizumab (Keytruda) and atezolizumab (Tecentriq), for advanced bladder cancer in July 2018.
These treatments had been approved in 2017 to treat advanced bladder cancer in people who can’t receive cisplatin, a chemotherapy drug, for health-related reasons.
Since the approval, two larger clinical trials found that people who received pembrolizumab or atezolizumab to treat metastatic bladder cancer died sooner than people who received the standard chemotherapy regimen.
Participants who had very low levels of the protein PD-L1 in tumor cells had the worst outcomes.
After these findings, the FDA limited the use of these immunotherapy drugs as first-line treatments only for advanced bladder cancer in people who can’t receive cisplatin-based chemotherapy and also have tumors with high levels of PD-L1.
Doctors can use an FDA-cleared test to check PD-L1 levels in patients.
The blood test shows patterns of a certain type of chemical tag on DNA. Based on these patterns, the researchers used artificial intelligence to understand whether the research participants had cancer and where the cancer was located in the body.
Researchers are now looking at whether this new test can give earlier diagnoses of kidney and brain cancer.
While more progress is needed, advancements in treatments and prevention are helping improve the outlook for people with advanced bladder cancer.
Keep an eye on the latest research and clinical trials to see what’s on the horizon.
Talk to your doctor to determine if the latest treatments are appropriate for you.