A new study has shown for the first time that an injectable immunotherapy can reduce the risk of relapse of bladder cancer when combined with chemotherapy after organ removal surgery. The work was published in The New England Journal of Medicine, a leading global scientific journal, and presented last Sunday (15) at the European Oncology Congress in Barcelona, Spain.
THE studycalled NIAGRA, showed that incorporating Durvalumab, an injectable immunotherapy, into the treatment increased the chance of a complete pathological response by 34%, that is, the chance of the tumor disappearing when observed under a microscope after surgery. This leads to a 32% reduction in the risk of the patient experiencing recurrence, that is, the return of the cancer, after the end of treatment.
“The results obtained in this study are important and could lead to a change in the way patients with bladder cancer are treated, with a chance of cure and quality of life,” says Ariel Kann, coordinator of the Specialized Oncology Center at Hospital Alemão Oswaldo Cruz and co-author of the study.
According to the World Health Organization (WHO) and the American Cancer Society, 614,000 people are diagnosed with colon cancer every year, making it the ninth most common type of cancer. The disease is four times more common in men than in women and the main risk factor is smoking, as well as occupational exposure and exposure to certain chemicals.
The main symptom of bladder cancer is the presence of blood in the urine, which may be accompanied by pelvic pain and burning or pain when urinating. The tumor is diagnosed through imaging tests (ultrasound, tomography or resonance) and cystoscopy, a device with a camera inserted into the urethra, analyzing the bladder and collecting fragments to perform a biopsy.
Inclusion of immunotherapy may increase patients’ life expectancy
There are two types of patients with bladder cancer, as explained by Bruno Benigno, urologist and oncologist at Hospital Oswaldo Cruz and director of Clínica Uro Onco. “There are those who have a superficial tumor, that is, one that only affected the mucosa of the organ and did not infiltrate the muscular part, deeper in the bladder. And there is the group that had the tumor infiltrated the muscular part. When this happens, there is a lot of contact with the vascularization, which increases the chance of metastasis”, says the specialist.
Currently, treatment is given according to the stage of progression of the disease, and can range from partial removal of the bladder (partial cystectomy) to complete removal of the organ (radical cystectomy) — a procedure more indicated for those with a deeper tumor. In previous studies, it was found that performing chemotherapy before surgery could improve the cure rate of the disease by 7% to 15%, which made this the standard approach to treating advanced bladder cancers.
Although current treatment is effective, disease recurrence and life expectancy still present significant challenges, in Benigno’s view. The inclusion of immunotherapy in the therapeutic approach, suggested by the new study, may be a way to reverse this scenario, presenting a more effective solution for the survival of patients with bladder cancer.
“What is innovative about this study is that we now have a drug that favors an increase in cure rates and survival expectations. That is the gain,” comments Benigno, who was not involved in the study, but participated in the European Oncology Congress and saw the presentation of the work.
How was the study done?
To reach this conclusion, the study included 1,063 patients with bladder cancer who needed to undergo surgery. They were divided into two groups: those who would receive conventional chemotherapy — with the chemotherapy drugs Cisplatin and Gemcitabine — and those who would receive chemotherapy combined with the immunotherapy Durvalumab before and after surgery.
“Immunotherapy works by stimulating our immune system to recognize tumor cells as enemy cells. As a result, our own body begins to attack the tumor cells,” explains Kann. Study participants received chemotherapy with or without immunotherapy and then underwent surgery. Those who underwent treatment with immunotherapy had a lower chance of tumor recurrence.
The new therapeutic approach suggested by the study is indicated for patients with localized bladder cancer, that is, cancer that has not yet metastasized (has not spread to other organs), according to Kann.
Next steps for bladder cancer treatment
According to the study’s co-author, the discovery could change clinical practice for patients with bladder cancer. However, for this to happen, the results still need to be presented to regulatory agencies, such as, in Brazil’s case, the National Health Surveillance Agency (Anvisa). “But it’s just a matter of time,” says Kann.
Benigno believes that the study may have some limitations, especially in the Brazilian scenario. “This immunotherapy is a very expensive medication and is administered in approximately eight cycles, and this is far from being incorporated into the public health system. So, a major challenge is how to bring this to benefit a greater number of people,” says the urologist.
Another challenge is identifying the disappearance of the tumor before bladder removal surgery. “In the study, approximately 20 to 25% of patients who received chemotherapy with immunotherapy no longer had the tumor at the time of surgery, which is good because there was a complete response, but the big challenge is how to identify this complete disappearance of the tumor before removing the bladder,” says Benigno.
This prior identification — which, according to the specialist, could be done by developing blood or urinary markers — could guarantee the surgeon that there has been complete regression of the tumor, increasing the possibility of preserving the patient’s bladder. “We don’t have this marker yet. So, I believe that this could be the future direction of the next studies,” he says.
According to Kann, this is the researchers’ future goal. “The next step is to take advantage of this study and analyze which patients need to receive all doses, which patients need to increase the number of medication cycles. Circulating tumor DNA is being investigated in this same study. The patients’ quality of life is also being analyzed, and the future goal is to perhaps spare patients from bladder surgery, that is, treat them without surgery. That would be the ideal world,” he says.
This content was originally published in Bladder cancer: new treatment approach reduces chance of recurrence by 32% on the CNN Brasil website.
Source: CNN Brasil
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