Understanding the range of medication-based therapies for bladder cancer in cases where treatments beyond surgery are required.
If you’ve been diagnosed with bladder cancer, you may undergo several different therapies including a surgical procedure to remove the tumor. Sometimes surgery, along with surveillance to ensure the disease hasn’t returned, is all that is required to treat bladder cancer. But in more aggressive or invasive cases of disease, treatment may also involve medication-based options such as chemotherapy.
“Treatment options really have been expanding even in just the last year,” said Dr. Katy Eby Beckermann, a medical oncologist at Vanderbilt-Ingram Cancer Center. “The Food and Drug Administration has given approvals for agents that target bladder cancer specifically. So that’s been really exciting to see and opened up additional options for our patients.”
Vanderbilt’s urology team offers intravesical therapy for some cases of early-stage cancer. Intravesical therapy involves instilling a medication directly into the bladder. Bacillus of Calmette and Guérin (BCG) is a bacteria that can be placed into the bladder where it will encourage the immune system to attack cancer cells.
Traditional chemotherapy drugs administered through an IV is one of the tried-and-true methods for bladder cancer. “Sometimes we use them in what we call the frontline setting or as the very first treatment that a patient would get for bladder cancer,” Beckermann said, “because we know that those are still some of the most effective therapies that we have.”
Over the last five years, immune-based therapies have been developed to help target various types of tumors. “The goal is to activate the body’s immune system against the cancer,” Beckermann explained. “We use immune-based therapy as either the first line or the second line treatment option for bladder cancer, depending on the patient and various side effects or benefits.”
Beckermann said these treatments have shown promise for patients’ long-term prognosis. “It’s a minority, but we do have a number of patients who get a long-lasting, durable benefit from these immune-based medicines,” she explained.
The FDA has recently granted approval for two novel medications to treat bladder cancer. “One is an antibody,” Beckermann said. “It targets a protein expressed mostly on the bladder cancer cells and then it delivers the chemo directly to the bladder cancer.” This medication, called Padcev (enfortumab vedotin-ejfv), targets a cell adhesion molecule common to the disease.
Balversa (erdafitinib), the other medication, targets genetic changes. Fibroblast growth factor receptors (FGFRs) are cell proteins that help cells grow and divide. But some people have gene mutations that encourage cells to make these proteins, which in turn can promote cancer cell growth. Balversa is for patients with advanced-stage bladder cancer who have an FGFR3 or FGFR2 gene mutation. Beckermann said about 10 to 15 percent of patients fall into this category and might be a good candidate for this treatment.
The newest therapies available were approved by the FDA after clinical trials showed them to be effective. For eligible patients, clinical trials are another treatment option for bladder cancer. Beckermann said the team at Vanderbilt tries to have one or more trials available to offer patients. In some cases a clinical trial can be initiated before a patient has had other treatments, she added. In other cases, a clinical trial might function as a second or third line defense against cancer if other treatments haven’t been effective.
In addition to clinical trial options and medical teams that specialize in urologic cancers, Vanderbilt’s cancer tumor board, made up of multiple experts, meets weekly. “During that time we review our patients,” Beckermann said. “And I think that level of expertise is very helpful to get multiple opinions all at one time.” The combined experience and knowledge of the board helps physicians determine the best treatments for their patients who have bladder cancer.