Checkpoint inhibitors- Emerging Immunotherapy for bladder cancer.
The “concept” of using immunotherapy to treat bladder cancer has been around for many years. In 1990, the Food and Drug Administration approved the use of BCG (Bacillus Calmette-Guerin) for the treatment of early stage or superficial bladder cancer. Today this remains the standard of care for noninvasive high-grade bladder cancer. This medication is instilled into the bladder to encourage the patient’s immune system to attack any cancer cells in the bladder and greatly reduces the risk of bladder tumor recurrence. We provide this treatment to many qualifying patients in our practice.
What is new however is the recent introduction of checkpoint inhibitors (CPIs) for the management of more advanced forms of bladder cancer. Until recently, all that was available aggressive chemotherapy regimens. Checkpoint proteins are molecules that slow down the immune system to protect the body from autoimmune illness. Cancer cells can use these checkpoint proteins to protect themselves from attack by the immune system, allowing spread and growth. A checkpoint inhibitor is a medication that reactivates the immune response to cancer cells. Urologists and oncologist consider these new medications an exciting and significant tool for the management of advanced bladder cancer.
Current medications include:
Immunomodulators
- Atezolizumab (Tecentriq®): targets the PD-1/PD-L1 pathway; approved for advanced bladder cancer and as a first-line treatment for patients who are ineligible for cisplatin chemotherapy
- Avelumab (Bavencio®): targets the PD-1/PD-L1 pathway; approved for advanced bladder cancer
- Durvalumab (ImfinziTM): targets the PD-1/PD-L1 pathway; approved for advanced bladder cancer
- Nivolumab (Opdivo®): targets the PD-1/PD-L1 pathway; approved for advanced bladder cancer
- Pembrolizumab (Keytruda®): targets the PD-1/PD-L1 pathway; approved for advanced bladder cancer