In this educational webinar from 2022, Dr. Aly-Khan A. Lalani explains how immunotherapy uses the body’s immune system to identify and attack bladder cancer cells. The session covers treatment options for advanced, metastatic, and post-surgery patients, as well as guidance for managing side effects.
For the most up-to-date information on immunotherapy, please visit our immunotherapy page.
Understanding Immunotherapy
Immunotherapy works by “training” the immune system to recognize cancer cells, helping it attack them more effectively. Common approaches include PD-1 / PD-L1 inhibitors like pembrolizumab and nivolumab, which remove the “cloak” cancer cells use to hide from the immune system, and CTLA-4 inhibitors, which enhance immune activity. Immunotherapy may be used alone or alongside other treatments such as chemotherapy.
Immunotherapy for Advanced and Metastatic Bladder Cancer
Historically, platinum-based chemotherapy was the standard. Immunotherapy emerged as a second-line option, providing improved survival with fewer side effects. Key clinical trials include:
- KEYNOTE-045: Showed improved survival after platinum chemotherapy
- JAVELIN Bladder 100: Demonstrated benefits of maintenance immunotherapy immediately post-chemotherapy
These therapies can improve both survival and quality of life for patients with advanced and metastatic bladder cancer.
Immunotherapy After Surgery (Adjuvant Setting)
For patients with muscle-invasive bladder cancer, radical cystectomy (bladder removal) is standard. Adjuvant immunotherapy is now an option for high-risk patients, with drugs like nivolumab helping to reduce the risk of recurrence.
Managing Side Effects Safely
Immunotherapy can trigger immune-related side effects, affecting organs like the skin, liver, lungs, or thyroid. Management includes:
- Baseline assessments and regular monitoring
- Education on early warning signs
- Prompt communication with healthcare teams
- Treatment of side effects, often with steroids or other medications
Most side effects are manageable when monitored closely.
Looking Ahead with Bladder Cancer Canada
Research continues into immunotherapy for earlier-stage bladder cancer, combination treatments, and potential biomarkers for better targeting. Clinical trials in Canada and internationally are expanding access and options for patients.
Key Takeaways:
- Immunotherapy is a standard of care for advanced/metastatic bladder cancer
- Maintenance therapy after chemotherapy provides significant survival benefits
- Adjuvant therapy post-surgery is emerging for high-risk patients
- Side effects are generally manageable with careful monitoring
Bladder Cancer Canada continues to provide resources and support to help patients understand their treatment options and navigate their cancer journey with confidence.
