When Is Immunotherapy Recommended in Bladder Cancer?
Bladder cancer immunotherapy is available, but which patients qualify for it? Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses who is eligible for immunotherapy, patient factors that contraindicate against immunotherapy, and proactive patient advice to learn about immunotherapy.
[ACT]IVATION TIP
“…ask about it just to ask your provider what’s going on with the immunotherapy? Any board-certified oncologist should be able to address it.”
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Transcript:
Lisa Hatfield:
Dr. Hasan, how do you determine which patients facing a bladder cancer diagnosis are suitable candidates for immunotherapy?
Dr. Shaakir Hasan:
Right now you don’t really want to be a suitable candidate for immunotherapy, because right now it’s indicated for those that have metastatic disease not curable disease. And they’re now doing, they’re doing clinical trials and to test immunotherapy in localized, curable disease. And I suspect we’re going to, it’s going to pan out. It’s going to be better than just classic chemo. But right now, you don’t want to be in that category. Now, if you do happen to be in that category, if you happen to have metastatic disease or incurable disease, there’s nothing that would stop you other than what we call contraindications, meaning specific conditions that prevent you from getting a treatment, because it can cause harm. But other than that, there’s nothing that should preclude you from getting immunotherapy.
And also the combination of an anti-drug, antibody drug conjugate to get the most optimal treatment. Sometimes because it does ramp up the immune system, you end up having, as a side effect, you can have what we call autoimmune conditions because the immune system is so ramped up, it can not only attack these cancer cells, but also attack your healthy tissue in a way we don’t want to. And that can adversely affect you.
So you can have what we call the itises, the inflammatory effects of different organs. Pneumonitis is inflammation of the lungs, colitis is inflammation of the colon, just to name a couple. And that can be problematic. So if you’re predisposed of these conditions, if you already have autoimmune conditions, then you might be more susceptible to what immunotherapy can cause and that might be a contraindication. But otherwise there really should be no reason you couldn’t get immunotherapy, and it’s definitely worth having a conversation with your oncologist.
Lisa Hatfield:
Okay. Thank you. So you talked about the contraindications for that, but are there any specific biomarkers of bladder cancer or characteristics of the cancer itself that influenced that decision for immunotherapy?
Dr. Shaakir Hasan:
So classically, we look at, what we call PD-L1, and that’s the ligand. It’s the protein on the cells that that’s expressed at a certain rate. That’s what the immunotherapy binds onto to initiate this cascade, which it heightens the immune system. And so some of these cancer cells have a higher expression of that protein, and therefore will be more susceptible to it. So we classically kind of look at that expression and then correlate that with your, how well you would do with immunotherapy. However, there are many instances, for example, lung, head, and neck and bladder, where it doesn’t even matter independently of the expression of the PD-L1. You can still benefit from it. Now you might benefit to a different degree, but in this case, we would recommend it regardless of your PD-L1 status.
Lisa Hatfield:
Okay. Great. Thank you, do you have any [ACT]IVATION tips for the immunotherapy question?
Dr. Shaakir Hasan :
I would just say, again, if it’s not mentioned at all, that’s a little strange. Particularly in the metastatic setting, you should always bring it up to your provider, at any stage. Like I said, right now it’s indicated FDA-approved in the metastatic stage, but in any capacity, it should be something that’s addressed by your oncologist. So I would simply, as an [ACT]IVATION tip, ask about it just to ask your provider what’s going on with the immunotherapy? Any board-certified oncologist should be able to address it.
