Thousands of Britons with incurable bladder cancer will find new hope thanks to an immune-boosting drug therapy that gives years of extra life.
Patients whose cancer has spread to other areas live a third longer on the drug than those who receive standard chemotherapy, according to the findings of a recently published groundbreaking study.
Some survived more than three years after starting treatment – more than double the average prognosis.
Artist Tracey Emin, pictured, has revealed she has an aggressive form of bladder cancer and at one point expected to be ‘dead by Christmas’
A new form of immunotherapy, developed by British researchers, is expected to give patients with the aggressive form of cancer extra hope
The discovery, made by British researchers, comes when noted artist and Turner Prize nominee Tracey Emin revealed she had an aggressive form of the disease – and at one point expected to be ‘dead by Christmas’. She had to undergo major surgery.
The drug, avelumab, is a form of immunotherapy, which means it helps the immune system find and destroy cancer cells. Scientists at St. Bartholomew’s Hospital and Queen Mary’s Hospital in London found that the treatment, given via an IV, could shrink tumors and keep them microscopic for twice as long as chemotherapy.
One of the 700 patients involved in the study who had five tumors in his neck, lung, leg, abdomen, and bladder saw them shrink so much that they were no longer visible on scans.
Diagnosed in more than 10,000 Britons each year, bladder cancer has a notoriously gloomy outlook when noticed after it has spread, which it often does.
According to studies, early symptoms, such as blood in the urine or burning, are often mistaken for common urinary tract infections. About two-thirds of patients with late-stage bladder cancer will not survive much longer than a year.
Major surgery can be performed to stop the disease from spreading, completely removing the bladder and surrounding organs, including part of the bowel and, in women, their uterus and part of the vagina.
Patients, who are then forced to use ostomy pouches to remove waste from the body, often feel maimed.
Chemotherapy and radiation therapy can target secondary tumors, slowing the progression of the disease, but eventually it stops working as cancer cells adapt and get better at fighting off the drugs. But avelumab can double the time spent in remission – when tumors stop growing or get smaller and smaller.
Professor Thomas Powles, oncologist at Barts Cancer Center and lead investigator on the trial, said, “Such a dramatic drop in the death rate is normally unheard of in such patients. But because this drug works by stimulating the body’s natural defense system, instead of attacking the cancer itself, it still works even if the tumor itself changes. As a result, it works much longer than chemotherapy. ‘
A protein on the surface of most bladder cancer cells called PD-L1 helps it hide from the body’s immune system, preventing it from being destroyed.
Avelumab, a so-called PD-L1 inhibitor, attaches to the protein and causes a reaction that warns the body’s fighters of the invader.
PD-L1 inhibitors are already used to treat advanced kidney, lung and skin cancers, among others, with similar remarkable effects.
For bladder cancer patients, they are most effective when given after chemotherapy – when the cancer cells are less active. In the latest study, patients with the most common form of bladder cancer received the drug within weeks of completing chemotherapy and further doses every two weeks.
In the US, avelumab has received approval for use in late-stage bladder cancer from the country’s drug watchdog, the Food and Drug Administration. In the UK, late-stage bladder cancer patients can access the treatment through an early access scheme at specialist cancer centers, but experts predict it won’t be long before the NHS watchdog NICE approves it for wider use.
Two-thirds of patients who are late diagnosed with bladder cancer having metastasized die within a year
“It’s expensive, but unlike many drugs that have been tried in the past, we’ve shown clear results,” says Prof. Powles. “I expect it to pass through NICE easily.”
One trial participant benefiting from this is 70-year-old Andrew Younger, a graphic designer from North London. In March 2017, six months after chemotherapy to destroy a tumor in his bladder, doctors released the damning news that the cancer had returned and was no longer limited to one organ. Scans showed lesions on his neck, lung, leg, and abdomen.
‘I was told there could be more tumors too. But at that moment I didn’t want to know, ‘says the father of two. “The doctors told me I probably wouldn’t survive the year.”
Andrew’s oncologist, Prof. Powles, introduced him to the avelumab trial. And today – more than three years later – his tumors have virtually disappeared.
“Every few months I had a scan and doctors told me my tumors were shrinking,” he says. “My last scan showed that they shrunk by almost 100 percent.”
He will continue to receive avelumab infusions for one hour and will continue to do so until scans show it is no longer working.
He says the side effects are nothing compared to what he went through with chemotherapy, which caused tinnitus – a debilitating ringing in the ears – and a permanent loss of sensation in his hands and feet. ‘With avelumab, I had no illness or anything other than slightly loose bowels. And that side effect was easily remedied by changing what I ate. ‘
He adds: ‘This drug was my last chance – there were no two ways. And thankfully, there is no sign that it will stop working anytime soon. ‘
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