Immunotherapy Timing Crucial for Advanced Bladder Cancer Treatment
For individuals battling advanced bladder cancer, initiating immunotherapy soon after initial chemotherapy treatment offers a better prognosis than taking a prolonged break from cancer treatment. This conclusion stems from a recent study where patients receiving the immunotherapy drug avelumab (Bavencio) before any signs of cancer recurrence experienced substantially longer survival times compared to those who only received supportive care until their cancer returned.
The study, presented at the 2020 American Society of Clinical Oncology Virtual Scientific Program, revealed that patients treated with avelumab as maintenance therapy had the longest overall survival ever documented in a clinical trial for metastatic bladder cancer. Dr. Elizabeth Plimack, a leading figure in bladder cancer research, emphasized the significance of these positive results, while Dr. Andrea Apolo pointed out the ongoing uncertainties regarding the optimal treatment sequence for advanced bladder cancer patients.
Metastatic bladder cancer patients face a grim prognosis, with a mere 5% surviving five years post-diagnosis. Despite the initial effectiveness of platinum-based chemotherapy in halting or reducing cancer growth, the disease often returns aggressively within weeks or months. Since 2016, the FDA has approved five immunotherapy drugs for treating metastatic bladder cancer, all belonging to the immune checkpoint inhibitors class. These drugs work by enabling the body's immune cells to attack cancer cells more effectively.
The JAVELIN Bladder 100 study, involving 700 participants with locally advanced or metastatic bladder cancer, demonstrated the substantial benefits of maintenance avelumab treatment post-chemotherapy. Participants receiving avelumab every two weeks until cancer progression or other reasons for leaving the study had a median overall survival of over 21 months, compared to about 14 months for those on supportive care alone. This survival improvement was consistent regardless of the PD-L1 protein levels in participants' tumors, a factor previously considered a predictor of treatment response.
However, the study also highlighted the need for careful consideration of several factors, including the rapid progression of bladder cancer and the accessibility of immunotherapy drugs. Dr. Apolo and Dr. Plimack both noted the challenges in ensuring all patients can benefit from second-line therapy, emphasizing the importance of not delaying immunotherapy after chemotherapy.
Looking ahead, ongoing research aims to determine the best strategies for incorporating immunotherapy into bladder cancer treatment, including its potential as a first-line treatment and its effectiveness in non-metastatic cases. The advancements in immunotherapy represent a significant leap forward in the fight against bladder cancer, offering hope for improved survival rates and quality of life for patients.