Drug hope for bladder cancer patients too frail for chemo
THOUSANDS of NHS patients with deadly bladder cancer are set to benefit from a drug that offers fresh hope of a cure.
In a milestone ruling, UK health chiefs have approved nivolumab for sufferers who are too frail to withstand treatments such as chemotherapy.
Doctors usually give a course of chemotherapy after removing bladder tumours to kill off any remaining cancer cells.
But there are no alternatives for patients who can’t have chemo because of the crippling side effects, so their cancer usually returns within a year.
However, trials have shown that nivolumab, which helps the body’s immune system to seek and destroy cancer cells, keeps the disease at bay for twice this time. Some patients have no signs of cancer at least three years after they have stopped taking the drug.
Professor Tobias Arkenau, consultant oncologist at the Sarah Cannon Research Institute in London, said: ‘Many of my bladder cancer patients can’t tolerate chemotherapy. After we’ve removed what we can with surgery, they just have to keep their fingers crossed and hope it doesn’t return.
‘But this drug works phenomenally well and the side effects are far less gruesome.’
More than 10,000 Britons are diagnosed with bladder cancer every year. If it’s spotted early, patients are usually offered a minimally invasive operation where the tumour is cut away using instruments that are passed up to the bladder via the urethra – the passage through which urine leaves the body. A short course of chemotherapy is given to clear any remaining cancer cells.
But about a quarter of bladder cancer cases are diagnosed later, at stage two to three, when the tumour has started to grow into the muscle wall lining the bladder. These patients are offered either radiotherapy to shrink the cancer or invasive surgery to remove the organ as well as surrounding tissues.
Artist Tracey Emin has spoken candidly about the major procedure in 2020 to treat her bladder cancer, which involved the removal of multiple pelvic organs, including her bladder, which left her using a urostomy bag for urine.
In one in five bladder surgery patients, cancer cells remain. Chemotherapy can be given to destroy them, but a third of patients are elderly or in poor health and unable to withstand the gruelling side effects. Instead, they are closely monitored and treated only when the cancer comes back. This happens within two years for roughly half of patients, at which point it is more difficult to treat.
Dr Robert Huddart, Professor of Oncology at The Institute of Cancer Research in London, said: ‘Relying on scans to make sure we spot small cancers can only go so far. It is easy to miss a tiny tumour. This is why it’s vital we have a treatment that can obliterate the cancer cells that may be lurking around for every patient.’
Nivolumab is the first treatment to offer this group the hope of a cure. The drug, given as a drip every two weeks for up to a year, works by disabling proteins called PD-L1 attached to the tumour which make it invisible to fighter cells in the immune system. This ‘turning off’ of the proteins allows the immune system to spot the cancer and attack it.
MANY other tumours have PD-L1 proteins attached to them, and nivolumab has been shown to work effectively on other cancers in the same way. NHS patients with skin cancer, kidney cancer and some head and neck cancers may be treated with the drug. Side effects are mostly mild, with the most common being itchy skin, diarrhoea and fatigue.
Dr Syed Hussain, Professor of Oncology at the University of Sheffield, who was involved with the nivolumab trial, said: ‘I treated a 60-year-old man with nivolumab and there’s still no sign of cancer even two years later.
‘Best of all, he had an excellent quality of life on the drug, with virtually no side effects. It was quite remarkable.
‘It is clear that patients on nivolumab can happily continue with their day-to-day lives, which is far more tricky with chemotherapy.’