Patient education and Resources about Immunotherapy.

From last 3 decades survival is advanced urinary bladder cancer remained poor and cisplatin was the only effective drug, but now with the advent of immunotherapy and other targeted therapies we are looking at prolonged survival for such patients and responses.

Urinary bladder cancer if diagnosed early and treated in time is a curable disease and different modalities involved are described below

Surgical treatment consists of following modalities

Transurethral bladder tumor resection (TURBT)

Radical cystectomy and lymph node dissection

Urinary diversion.

Therapies using medication

The types of systemic therapies used for bladder cancer include:

  • Chemotherapy
  • Immunotherapy
  • Targeted therapy

Intravesical chemotherapy- Bacillus Calmette-Guerin (BCG)

Systemic chemotherapy. Used in the treatment of urinary bladder cancer

  • Cisplatin and gemcitabine
  • MVAC, which combines 4 drugs: methotrexate (Rheumatrex, Trexall), vinblastine (Velban), doxorubicin, and cisplatin
  • Dose-dense (DD)-MVAC with growth factor support: This is the same regimen as MVAC, but there is less time between treatments and has mostly replaced MVAC
  • Docetaxel or paclitaxel (available as a generic drug)
  • Pemetrexed (Alimta)

Immunotherapy

Bacillus Calmette-Guerin (BCG)

Interferon (Roferon-A, Intron A, Alferon)

Immune checkpoint inhibitor

Advanced stage urinary bladder cancer are very aggressive and survival is poor . Chemotherapy was the only option for such patients and there has been a lot of research in last decade and now we are seeing more and more patients survive longer with better quality of life. Immunotherapy can be combined with radiation as well or can be given after radiation therapy.

Check point inhibitors used in the treatment of urinary bladder cancer

Atezolizumab (Tecentriq)

Avelumab (Bavencio)

Nivolumab (Opdivo)

Pembrolizumab (Keytruda).

Response to immunotherapy in stage 4 urinary bladder cancer.

Recently very important drugs which showed phenomenal responses and survival in urinary bladder cancer in Enfortumab vedotin and sacituzumab govitecan

Enfortumab vedotin (Padcev)

Enfortumab vedotin is an antibody-drug conjugate (ADC), which is a monoclonal antibody linked to a chemo drug.

Bladder cancer cells usually have the Nectin-4 protein on their surface. Enfortumab vedotin is an anti-Nectin-4 antibody attached to a chemo drug. The antibody part acts like a homing signal, bringing the chemo drug to the bladder cancer cells with Nectin-4 on them. The chemo enters the cancer cells and kills them.

This drug may be used to treat people with advanced bladder cancer who have already been treated with a platinum chemo drug (such as cisplatin) and immunotherapy (specifically, a PD-1 or PD-L1 inhibitor).

Enfortumab vedotin is infused into a vein (IV), once a week for 3 weeks with one week off.

Common side effects include fatigue, peripheral neuropathy (a type of nerve damage), nausea, taste changes, decreased appetite, diarrhea, rash, hair loss, dry eye, dry skin, itching, and high blood sugar levels.

Sacituzumab govitecan (Trodelvy)

Sacituzumab govitecan is also an antibody-drug conjugate (a monoclonal antibody joined to a chemo drug).

In the case of this ADC, the monoclonal antibody part attaches to the Trop-2 protein on bladder cancer cells and brings the chemo directly to them. (Some bladder cancer cells have too much Trop-2, which helps them grow and spread.)

This ADC can be used in people with advanced bladder cancer who have already been treated with a platinum chemo drug (such as cisplatin) and immunotherapy (specifically, a PD-1 or PD-L1 inhibitor).

This drug is infused into a vein (IV) once a week for two weeks, followed by one week off, then restarted.

Some common side effects of this drug include nausea, vomiting, diarrhea, constipation, feeling tired, rash, loss of appetite, hair loss, low red blood cell counts, and belly pain.

More serious side effects can include very low white blood cell counts (with increased risk of infection) and severe diarrhea, as well as reactions when the drug is infused. Medications to lower the chances of an allergic reaction are normally given before treatment with this drug.

 

Lot of research is happening and we are excited that after so many years newer drugs have shown amazing results.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel feels during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after an advanced cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, report that they are more satisfied with treatment, and they may live longer.

Research

https://www.cureus.com/articles/17222-harnessing-the-immunomodulatory-effects-of-radiation-in-urinary-bladder-cancer#:~:text=Extensive%20preclinical%20data%20supports%20the,the%20systemic%20anti%2Dtumor%20effect.

https://www.ojionline.org/article.asp?issn=2589-1871;year=2020;volume=4;issue=3;spage=110;epage=114;aulast=Patil

https://ijmio.com/cardiotoxicity-in-patients-on-trastuzumab-in-her2-positive-breast-cancer-a-retrospective-analysis-from-a-center-in-north-india/

https://www.crstonline.com/article.asp?issn=2590-3233;year=2020;volume=3;issue=1;spage=146;epage=147;aulast=Abbas

https://www.researchgate.net/publication/343512692_Predictors_of_Occult_Neck_Metastasis_and_Extra_Capsular_Spread_in_Early_Oral_Cancers

https://pubmed.ncbi.nlm.nih.gov/30050778/

https://pubmed.ncbi.nlm.nih.gov/31607695/

https://pubmed.ncbi.nlm.nih.gov/31807489/

https://www.proquest.com/openview/d26bb79fb4948a5db6724295f88156a5/1.pdf?pq-origsite=gscholar&cbl=226512

https://pubmed.ncbi.nlm.nih.gov/31489291/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498714/

https://www.journalofcurrentoncology.org/article.asp?issn=2589-8892;year=2018;volume=1;issue=2;spage=97;epage=100;aulast=Patil

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348784/

https://www.researchgate.net/publication/334632035_Cancer_Awareness_amongst_Nurses_in_a_Tertiary_Care_Hospital_in_North_Delhi_India

https://www.crstonline.com/article.asp?issn=2590-3233;year=2021;volume=4;issue=1;spage=55;epage=60;aulast=Abbas

https://www.crstonline.com/article.asp?issn=2590-3233;year=2020;volume=3;issue=1;spage=146;epage=147;aulast=Abbas

 

Dr. Waseem Abbas

Director research @MAX institute of cancer care.

Senior consultant medical and Hemato-oncology @MAX cance centre shalimarbagh.

Clinical lead in Medical oncology from MAX cancer centre shalimarbagh.

This has encouraged dr Abbas to dedicate himself to research in the field of immunotherapy. He has treated so far 500 patients with immunotherapy and has published research in International and National journals. Apart from that dr Abbas has done some breakthrough research in this field. Dr abbas have dedicated his life to immunotherapy research and is the pioneer of immunotherapy in India.