Details determine your best treatment options

Which type of bladder cancer do you have? Is it the most common — urothelial carcinoma — or something more unusual?

Depending on the type, grade and stage of the bladder cancer, your treatment options here at UT MD Anderson could range from something as simple as intravesical therapy (in which the walls of the bladder are repeatedly bathed in cancer-fighting drugs) to something as complex as a radical cystectomy, or the complete surgical removal of your bladder.

Bladder-preserving options are sometimes available, but not every patient is eligible for them.

“More patients are realizing the opportunity to keep their bladders as we develop better treatment strategies,” Campbell says. “But some are better candidates than others. If you’re having to urinate every hour on the hour, for instance, or waking up at night and having to urinate frequently, the chances of that improving with a bladder preservation strategy are quite low.”

“Sometimes, radiation therapy is also an option for bladder cancer,” adds Kamat, “but it is not appropriate for every patient. That’s why personalizing cancer care is extremely important.”

New treatment strategies are yielding better results

The standard of care for bladder cancer used to be a cisplatin-based regimen of chemotherapy, followed by surgery. Unfortunately, only about half of all bladder cancer patients were eligible to receive that drug, because it’s so hard on the kidneys, nerves and ears (hearing). Of those who could receive it, only about 30% to 40% saw a complete pathologic response (pCR) — or the total absence of living cancer cells — by the time they had surgery.

“But this has dramatically shifted in just the last year,” notes Campbell. “There’s a treatment now combining an antibody drug conjugate called enfortumab vedotin with an immune checkpoint inhibitor called pembrolizumab that has dramatically increased the chances of eradicating cancer by the time of surgery. Those pCR numbers are now pushing closer to the mid-50% and even the mid-60% range, depending on how you do your calculations. And, that includes patients who were historically cisplatin-ineligible. So, this has been a huge game-changer for the bladder cancer patients we treat here at UT MD Anderson.”

To hear the full conversation between Campbell and Kamat, listen to UT MD Anderson’s Cancerwise podcast.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.