Immunotherapy is a type of cancer treatment that stimulates the body’s own defenses – the immune system – to fight cancer. The immune system is made up of white blood cells and organs and tissues of the lymph system that the body uses to fight infections and other diseases.
IMMUNOTHERAPY FOR BLADDER CANCER
WHAT IS IMMUNOTHERAPY?
TYPES OF IMMUNOTHERAPIES
USED TO TREAT BLADDER CANCER
Cancer Vaccines
Bacillus Calmette–Guérin (BCG) is a type of vaccine that is given intravesical (into the bladder via the urethra) to treat non-muscle-invasive (superficial) bladder cancer. It is a live bacterium that attracts immune cells, which then attack cancer cells. Since BCG is administered intravesical, the anticancer effects are local and side effects are primarily local as well.
Immune Checkpoint Inhibitors
This type of immunotherapy works by stimulating the immune system, allowing immune cells to attack cancer cells. Immune checkpoint proteins sit on the surface of some types of immune cells, especially T cells, and some cancer cells. These proteins help keep immune responses in check and can keep T cells from killing cancer cells. Cancer cells express such proteins to blunt the human immune system to react against the cancer. When these proteins are blocked with immune checkpoint inhibitors, the “brakes” on the immune system are released and T cells are able to kill cancer cells better. These drugs are given intravenously, typically every two to six weeks. This is an active area of research and many clinical trials related to immune checkpoint inhibitors are still ongoing. As a result, approvals for use of these drugs in Canada is also constantly evolving.
Please discuss with your oncologist which immunotherapy drugs are currently available and which ones your oncologist recommends. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of immunotherapy.
SIDE EFFECTS OF IMMUNOTHERAPY
Unlike BCG, currently available immune checkpoint inhibitors are given systemically (intravenous). Side effects of these drugs can include fatigue, loss of appetite, an allergic reaction, skin rashes and itchy skin. Since these medications work by removing the “brakes” on the body’s immune system, they can also cause inflammation of any normal tissue in the body (e.g. arthritis, colitis, pneumonitis).
This is because the immune system can start attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands or other organs.
It is very important to promptly report any new side effects to your health care team, both during or after treatment with immune checkpoint inhibitors. If serious side effects do occur, the immunotherapy may need to be held or stopped and you may be treated with corticosteroids (man-made drugs that closely resemble cortisol, a hormone that your adrenal glands produce naturally) to suppress your immune system.
Prompt recognition and treatment of these side effects is critical and may lessen the severity and duration of the side effects.
Immunotherapy may not be recommended for all patients, especially for those with pre-existing autoimmune conditions. Immunotherapy may also be used in combination with other treatments, such as surgery, radiation, or chemotherapy. Many immunotherapies for bladder cancer are currently being investigated in clinical trials.
