Recent developments in the treatment of bladder cancer may bring promise of effective care to a larger group of patients, particularly those with high-risk localized, muscle-invasive forms of the disease, as highlighted in a recent editorial.
Recent developments in the treatment of bladder cancer may bring promise of effective care to a larger group of patients, particularly those with high-risk localized, muscle-invasive forms of the disease, as detailed in an editorial featured in the New England Journal of Medicine.
Dr. Matthew Milowsky, a bladder cancer specialist at the UNC School of Medicine and the UNC Lineberger Comprehensive Cancer Center, emphasized that integrating new treatment options and predictive biomarkers for selecting the most suitable patients will enhance future treatment strategies for bladder cancer.
Traditionally, platinum-based chemotherapy has been the go-to treatment for metastatic bladder cancer and muscle-invasive cases, where neoadjuvant chemotherapy is administered before surgery. However, the introduction of immune checkpoint inhibitors, which help immune cells actively target cancer cells, has begun to transform treatment protocols. These newer therapies show remarkable effectiveness, especially when paired with chemotherapy and innovative drug formulations like enfortumab vedotin, which gained FDA approval in 2019 for advanced bladder cancer. This combination strategy is now being tested for earlier stages of bladder cancer with hopes of improving survival rates and lowering recurrence risks.
Recent findings from the NIAGARA trial, which assessed the immune checkpoint inhibitor durvalumab alongside chemotherapy before and after bladder removal surgery, indicated that patients receiving the combination treatment had a notably higher survival rate over two years compared to those who only received chemotherapy. Additionally, these patients encountered fewer instances of cancer recurrence and had better disease-free progression rates.
According to Milowsky, NIAGARA is the first randomized phase 3 trial to challenge the current neoadjuvant treatment methods for muscle-invasive bladder cancer.
Despite its promising results, the NIAGARA trial faced notable limitations, particularly as it was not structured to evaluate the specific effects of durvalumab treatment before and after surgery.
“Future research needs to be designed to overcome this limitation, as we often find that more treatment does not always equal better outcomes, and it could potentially lead to more side effects that affect quality of life,” Milowsky warned.
Looking forward, Milowsky anticipates that incorporating predictive biomarkers will further enhance bladder cancer treatment. These biomarkers can identify patients who are at an elevated risk of recurrence, aiding doctors in personalizing their treatment approaches. One promising example is circulating tumor DNA, which can indicate which patients may gain the most from perioperative therapies.
“The aim is to provide treatment only to those who truly require it,” Milowsky explained. “By utilizing predictive biomarkers, we can concentrate on the patients most likely to respond favorably to additional therapy, thus avoiding unnecessary side effects in others.”
