July 15, 2015 | by Sumanta Kumar Pal M.D.
In years past, Bladder Cancer Awareness Month has been a sobering reminder of a disease with few treatment options. For patients with metastatic disease (disease that has spread from the bladder to distant organs), average survival is typically just over one year. Fortunately, things are changing.
Academic institutions like City of Hope now have a wealth of clinical trials for patients with bladder cancer. These clinical trials are examining drugs that work through a number of mechanisms distinct from chemotherapy. Highlighted below are the top three research and treatment advances that I feel are the most promising:
1. Redirecting the immune system
We have several ongoing studies looking at a class of drugs called programmed death-1, or PD-1, inhibitors. In a patient with cancer, the immune system is often suppressed, making it challenging for the body to mount any response against cancer cells. PD-1 inhibitors (and a closely related class of drugs called PD-L1 inhibitors) cause dormant immune cells to reactivate, therefore overcoming this suppression.
Not every patient will respond to PD-1 or PD-L1 inhibitors, but those who do often have extremely prolonged responses, with existing studies documenting survival of up to several years.
2. Targeting the genes that protect cancer cells
For some time now, we have been involved in clinical trials exploring a specific class of “gene therapies." These treatments are composed of the same building blocks that form our own DNA – an extremely novel approach that until now has been met with only modest results. The agent we have utilized in the clinic, an intravenous treatment called OGX-427, eliminates proteins in the cancer cell that allow it to survive under conditions of heat or other stressors.
Przemyslaw Twardowski, M.D., clinical professor in the Department of Medical Oncology & Therapeutics, and my partner in the clinic, was a part of a small team of investigators around the country that reported the first results related to OGX-427 in patients with metastatic bladder cancer. Ironically, the treatment appeared to work best in the sickest of patients – those who were more weak or infirm, and those patients with liver metastases.
3. Personalizing therapy for metastatic bladder cancer
One inherent problem with chemotherapy is that it does not discriminate – along with targeting actively dividing cancer cells, it will attack actively dividing hair follicles or actively dividing cells lining the gut. It is in this manner that chemotherapy often drives loss of hair, nausea/vomiting and other side effects. We have opened up several clinical trials that attempt to avert this problem by using targeted therapies.
We believe these targeted therapies hone in on the cancer cell in a much more specific fashion – hopefully averting many side effects. We perform genetic testing in patients with metastatic bladder cancer to identify the “targets” of targeted therapy in individual patients. Some of the preliminary results from this approach appear to be extremely promising.
It’s incredibly important to highlight that the therapies I’ve mentioned are all currently in clinical trials; access to them is limited, and is principally confined to academic medical centers. For those reading this who have friends and family afflicted by bladder cancer, my advice is simple: Get a second opinion.
The standard treatments for bladder cancer have not changed in over three decades, but the treatments that we have now in clinical trials are nothing short of revolutionary.
** Sumanta Kumar Pal, M.D., is an assistant clinical professor in the Department of Medical Oncology & Therapeutics Research and co-director of the Kidney Cancer Program at City of Hope.
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