In two groundbreaking studies, two novel treatments are emerging as the most effective interventions in decades for individuals grappling with bladder cancer, according to trial results that have marked a transformative shift in the treatment landscape. In both trials, patients administered a combination of immunotherapy drugs demonstrated prolonged survival compared to those undergoing standard chemotherapy, signifying an unprecedented advancement in managing advanced bladder cancer.
Considered “monumental” in urology, Dr. Andrea Apolo of the National Cancer Institute’s Genitourinary Malignancies Branch expressed optimism in a press release, stating, “The future looks bright for our patients.”
A notable treatment involves the combination of enfortumab vedotin (Padcev) and the immunotherapy drug pembrolizumab (Keytruda). Referred to as an antibody-drug conjugate, this combination showcased significant efficacy in diminishing cancer progression and extending the lives of patients. In the EV-302 trial, participants were randomly assigned to receive either the antibody-drug conjugate or standard chemotherapy as an initial treatment. Astonishingly, tumors regressed or halted growth in about 67 percent of those treated with the antibody-drug conjugate, surpassing the 44 percent response observed in the chemotherapy group.
Furthermore, a “complete response,” where cancer disappeared entirely, occurred in almost 30 percent of patients on the antibody-drug conjugate, compared to 12 percent in the chemotherapy group. Dr. Thomas Powles, the lead investigator on the EV-302 study, highlighted the unprecedented nature of so many patients experiencing a complete response. Following participants for approximately 18 months, the study revealed that individuals treated with the antibody-drug conjugate lived nearly twice as long as those in the chemotherapy group, with an average of 31 months versus 16 months.
A parallel trial, CheckMate-901, involving standard chemotherapy alone or in combination with the immunotherapy drug nivolumab, demonstrated a similar trend. The addition of nivolumab extended a patient’s life by about 22 months, surpassing the 19 months observed in those treated with chemotherapy alone.
Bladder cancer treatment options have traditionally been limited, with platinum drugs like cisplatin being the standard initial treatment. However, the outcomes have often led to worsening conditions for most patients. Bladder cancer ranks as the fourth most common cancer in men, primarily affecting older individuals. The innovative antibody-drug conjugate enfortumab-pembrolizumab is poised to become the new standard of care for advanced bladder cancer patients, ushering in a transformative era. Nonetheless, questions regarding cost and treatment response sustainability linger as considerations for these groundbreaking drugs.