What are the types of therapy for bladder cancer? Dr. Piyush Agarwal shares an overview of treatment options available – including the role of clinical trials – and details how the classification of bladder cancer affects therapy choices.
Dr. Piyush K. Agarwal is the Director of the Bladder Cancer Program at the University of Chicago Medicine Comprehensive Cancer Center (UCCCC), where he also serves as Professor of Surgery, Vice Chief of Urology, and Fellowship Director of Urologic Oncology. Learn more about Dr. Agarwal.
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Transcript
Katherine Banwell:
What options are currently available for people diagnosed with bladder cancer?
Dr. Piyush Agarwal:
There are kind of different states of bladder cancer, so if I refer to localized bladder cancer – so cancer that’s just in the bladder and not deep within the wall of the bladder – we have a standard drug called BCG, and we have another set of drugs, a type of chemotherapy regimen, that many of us use that is a doublet of gemcitabine (Gemzar) and docetaxel (Taxotere).
And then if patients don’t respond to that, and they have high-grade BCG, unresponsive tumor, there are some novel agents that have been approved in the past couple of years for use in those patients. There’s a product called nadofaragene firadenovec-vncg (Adstiladrin). Another one used to be called N803.
The trade name is Anktiva, and that is combined with BCG. And then there’s another, newer product called gemcitabine intravesical system (Inlexzo) that used to be called TAR200 that was also recently approved. These three agents are available now for patients.
And then if you think about muscle invasive, or a locally advanced, or maybe an early metastatic bladder cancer, there’s a novel combination which has really shown some – really has changed the paradigm for how we manage locally advanced disease there. It’s a combination of two drugs.
One is called enfortumab vedotin-ejfv, known by the trade name Padcev, and then combined with an immunotherapy called pembrolizumab, known by the trade name of Keytruda.
And this combination has been really amazing. In fact, it’s been shown to be superior to standard chemotherapy with gemcitabine (Gemzar) and cisplatinum for locally advanced and metastatic bladder cancer. This has really changed the way we manage these patients. And so, it’s an exciting time in bladder cancer for us as investigators, because we now have more tools to offer our patients and potentially can achieve better outcomes.
Katherine Banwell:
Dr. Agarwal, how do clinical trials fit into a bladder cancer care plan?
Dr. Piyush Agarwal:
There’s certainly a large amount of clinical trials going on in the bladder cancer space. And thankfully, those have led to the recent EV-pembro combination that I referred to.
That was discovered to be the superior regimen after the culmination of a bunch of clinical trials. And recently, the most recent one was presented at the GU ASCO meeting recently in San Francisco. I would say a lot of the advancements we’ve seen are the direct results of clinical trials. Those three novel agents that I mentioned that were approved for BCG unresponsive disease also were the results of clinical trials.
And at any given moment, there’s a large amount of clinical trials. There’s still ongoing clinical trials in the BCG unresponsive state for bladder cancer. There’s also clinical trials for those patients who have been exposed to BCG, but comparing another round of BCG versus a novel agent. There’s clinical trials for even BCG-naive patients, trying to treat them with a novel regimen that may or may not be done in conjunction with BCG.
There are some great resources on clinicaltrials.gov, and other organizations also have websites devoted to clinical trials. And that’s one thing I should have mentioned earlier when you had asked, “What can patients do?” Patients can go to these clinical trial websites and then ask their provider, “Hey, am I eligible for this clinical trial?”