Bladder Cancer: New Treatment Approach May Help Patients Avoid Life-Altering Surgery

A combination treatment approach with gemcitabine, cisplatin, and nivolumab in muscle-invasive bladder cancer (MIBC) patients resulted in a clinical complete response (cCR) rate of 43%, enabling bladder preservation without immediate cystectomy. The study published in Nature Medicine revealed a cCR rate of 43%, with 97% positive predictive value for cCR, signaling a potential paradigm shift in the treatment of MIBC.

While cystectomy is a major surgery, until now it has been the best chance for patients with MIBC to be cured of the cancer. MIBC is often located in a deep part of the bladder. It can be difficult to completely remove the cancer without removing the entire bladder.

In addition to these findings, the study shed light on the safety profile of this approach, with common adverse events primarily consisting of manageable side effects such as fatigue, anemia, neutropenia, and nausea. Importantly, the study also explored the role of specific genes and tumor mutational burden in predicting treatment outcomes.

Further analyses delved into peripheral blood mass cytometry and soluble protein analytes, revealing intriguing associations between the immune contexture and clinical outcomes. These findings emphasize the significance of personalized medicine and the potential to revolutionize MIBC treatment strategies, offering patients the opportunity for bladder preservation instead of radical surgery.

Ref: Galsky, M.D., Daneshmand, S., Izadmehr, S. et al. Gemcitabine and cisplatin plus nivolumab as organ-sparing treatment for muscle-invasive bladder cancer: a phase 2 trial. Nat Med (2023). https://doi.org/10.1038/s41591-023-02568-1