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Immunotherapy drug durvalumab, sold under the brand name Imfinzi, could help reduce the risk of bladder cancer progressing or returning to patients, according to a new study.
Published in the New England Journal of Medicine, researchers at University of Sheffield and Barts Cancer Institute at Queen Mary University of London conducted a study on 1,063 patients with operable bladder cancer.
Patients were given either standard chemotherapy (cisplatin and gemcitabine) and surgery (530 people), or chemotherapy plus durvalumab before surgery and eight cycles of durvalumab after surgery (533).
The final-stage phase 3 clinical trial found patients were 32% less likely to experience cancer recurrence or progression if they had immunotherapy, and were more likely to still be alive after two years.
Experts involved in the study describe this as a significant breakthrough in bladder cancer treatment, and hope it will be approved by the Medicines and Healthcare products Regulatory Agency to become the new standard of care.
But, what treatment options for bladder cancer are currently available through the NHS, and what symptoms should we be aware of?
What is bladder cancer?
“Cancer of the bladder involves abnormal growths that can cause symptoms both within the bladder and beyond if it spreads around the body,” explains Mr James Douglas, consultant urologist at University Hospital Southampton. “It is the 7th most common cancer in men, and the 11th commonest cancer overall in the UK for men and women.
“Mutations to the DNA of bladder cells cause the cancer and these are usually associated with old age and environmental factors such as smoking.”
Dr Rachel Orritt, health information manager at Cancer Research UK adds: “That doesn’t mean that everyone who has ever smoked will develop bladder cancer, but tobacco does increase the risk of the disease, and of at least 15 other types of cancer.
“And it doesn’t matter what form of tobacco you’re smoking – cigarettes, pipes, cigars, shisha – there is no safe way to use tobacco and they all increase your cancer risk.”
What are the symptoms?
The most common symptom is blood in the urine.
“Blood that is painless is usually a worse sign compared to blood associated with pain,” highlights Douglas. “Other symptoms include new urinary urgency and frequency, and in very advanced stages of the disease weight loss, back pain and bone pain can be present.”
So, talk to your doctor if you notice anything that isn’t normal for you.
“The chances are it won’t be cancer, but if it is, spotting it at an early stage means treatment is more likely to be successful,” says Orritt.
How is it diagnosed?
A specialist can diagnose bladder cancer using a variety of tests.
“Bladder cancer can be diagnosed through a combination of imaging in the form of an ultrasound or a CT scan, and a flexible cystoscopy (this is a small thin camera placed into the bladder),” explains Douglas.
Who is most at risk?
About 10,000 people are diagnosed with bladder cancer in the UK every year, according to Nuffield Health, and the condition is more common in men.
“Men are diagnosed more frequently that women with a ratio of 3:1, however women often present with more advanced disease and as such earlier diagnosis is a priority,” reflects Douglas.
Orritt adds: “But it’s also more common in older age groups, and people with a first degree relative (a parent, sibling or child) who has had bladder cancer.
“You can talk to your doctor to understand your risk if you’re concerned, and for advice.”
What are the treatment options?
In cases of non-muscle-invasive bladder cancer, the cancerous cells can usually be removed without affecting the rest of the bladder.
“About 70% of all new bladder cancers are easily treated if diagnosed early,” says Douglas. “They are normally removed by passing a camera into the bladder and excising them.
“More advanced disease requires more invasive treatments.”
According to the NHS website, people with intermediate-risk non-muscle-invasive bladder cancer should be offered a course of at least six doses of chemotherapy.
And those with high-risk non-muscle-invasive bladder cancer, are usually offered a transurethral resection of a bladder tumour (TURBT) – a surgical procedure that removes tumours from the bladder. A CT scan or an MRI scan may also be needed.
But, Douglas is hopeful about the research into immunotherapy drugs.
“For patients with advanced disease, the new systemic therapies such as the immunotherapy drugs and antibody drug conjugates, which include durvalumab and enfortumab vedotin combined with pembrolizumab, are presenting game-changing benefits to bladder cancer patients,” says Douglas. “The exceptional responses being seen in clinical studies is leading to the drugs being trialled in the earlier stages of disease to try and improve outcomes.”
