Even though as many American women will die of bladder cancer this year as from cervical cancer, most people haven't given much thought to the disease. Make no mistake: It is the eighth most common cancer in the U.S., affecting almost 400,000 people worldwide.

Treating then and now

“Bladder cancer is often a smoking-related cancer, and it's not rare by any means,” says Dr. Charles Ryan, bladder cancer expert, American Society of Clinical Oncology. “But metastatic bladder cancer was not paid a lot of attention by the public, so progress in the treatments available has been significantly slower than progress in the treatments for breast and prostate cancer. To see a new therapy is very exciting.”

That therapy is anti-PD-L1 immunotherapy, a new treatment currently available to patients with advanced bladder cancer. Combined with new, more accurate diagnostic tools like blue light cystoscopy, bladder cancer is looking more treatable than ever.

“It used to be conventional wisdom that bladder cancer was the most expensive cancer to treat, because people had repeated urological procedures,” says Ryan. “Many patients have localized treatments that can be effective, but when bladder cancer becomes deadly is when the cancer has metastasized. Historically, this cancer has a very poor response to chemotherapy and can be very toxic for patients.”

“Along with fewer side effects, immunotherapy may present a longer-term fix than chemotherapy when it comes to bladder cancer.” 

Troubles for the elderly

That bladder cancer is so frequently tied to cigarette smoking is part of the reason that, once it has spread beyond the bladder it can be very hard to treat. “The reasons for the poor response are because the cancer requires a more aggressive chemotherapy, and people who get bladder cancer often have other illnesses related to poor general health,” explains Ryan. “The elderly especially have a hard time handling therapies that might do damage to the kidney or other organs. So, helping older bladder cancer patients was an unmet medical need.”

What anti-PD-L1 immunotherapy does is focus specifically on the cancer. “The immune system in our bodies will be trying to fight the cancer, but cancer will suppress the immune system by shutting down our defenses against it,” says Ryan. “Remember the movie ‘Independence Day’? Imagine the big spaceship as a tumor. It had a big force field around it. When the humans tried to attack the ship, they hit the force field. What the anti-PD-L1 immunotherapy does is allow the force fields to come down and give the immune system access to fight the cancer. If you have bladder cancer, the cancer is preventing your immune system from penetrating and destroying it.”

A permanent fix?

Along with fewer side effects, immunotherapy may present a longer-term fix than chemotherapy when it comes to bladder cancer. “Chemotherapy tends to only be effective while we’re giving it to the patient,” says Ryan. “When we stop the treatment, it comes back. This offers the promise of controlling the cancer long-term.”

While only 25 to 30 percent of bladder cancer patients in trials have responded to immunotherapy, Ryan adds these results are still reason to be excited. “The responses from anti-PD-L1 immunotherapy can be quite profound, achieved quickly and with fewer side effects,” he says. “It's opened the door to a new treatment and it's proof of concept that people with bladder cancer can be treated with more success.

“Now we just need to research further," he says. With anti-PD-L1 immunotherapy having been approved by the FDA in May, that shouldn’t be a problem. “There are ways to modify this treatment,” Ryan contends. “We're still learning and modifying our approach.”