Treatment Strategy Helps People With Advanced Bladder Cancer Retain the Organ
“Listen, I'm not a Pollyanna,” New Yorker David Cabelis makes clear. “I'm a cab driver.”
“But I was diagnosed with this cancer,” the 72-year old said. “Bladder cancer, that's what I had, and then I had this treatment, and it was the most amazing experience. And thank God, now I'm clean, I'm cancer-free. So, if you're asking me about this treatment, I'll tell you one thing: I'm not objective -- it's great!”
Cabelis' self-declared bias has to do with his years-long involvement in testing a first-of-its kind treatment for bladder cancer. The experimental treatment is now the subject of ongoing studies at multiple U.S. medical centers.
It aims to address a key downside of the current standard of care -- the life-changing impact that removing a patient's bladder can have on quality of life, even when doing so successfully treats the cancer.
“Muscle-invasive bladder cancer refers to bladder cancer that has invaded into the muscle layer of the bladder,” said study leader Dr. Matthew Galsky, co-director of the Center of Excellence for Bladder Cancer at Tisch Cancer Institute and a professor at Icahn School of Medicine at Mount Sinai in New York City. "Once this layer is penetrated, there is a high risk for bladder cancer spreading to other parts of the body."
Until now, removing the entire bladder has been the standard treatment. But when the bladder removed, urine needs to be drained from the body in a different way. That means undergoing a procedure to attach an external storage bag to the lower abdomen.
“Given that removing the bladder can have these life-changing consequences, there has been an attempt to develop treatments that might get rid of bladder cancer without having to remove the bladder,” Galsky said.
Enter researchers from Mount Sinai, the City of Hope, the Universities of Pennsylvania, Wisconsin, Southern California and Utah, and Oregon Health & Sciences University.
Several years back, they launched a study focused on 76 bladder cancer patients.
The goal was to evaluate a combination chemotherapy/immunotherapy treatment while leaving the bladder itself intact.
“Immunotherapy is a medication that helps to get the body's immune system to fight cancer,” Galsky noted. The new approach added it to standard chemo.
After three months of treatment, the study showed that 43% of patients had no detectable cancer.
In turn, those patients were invited to continue immunotherapy treatment for two more years, without bladder removal.
Two years out, 70% of patients who chose to continue treatment had no signs of recurrent cancer.
The findings were reported Oct. 2 in Nature Medicine.
Among these patients is Cabelis, who was first diagnosed in April 2017. He started the trial at Mount Sinai that fall.
"I was in it for maybe about eight months. I'm not going to lie. It was intense," said Cabelis, who emigrated from Greece to New York City decades ago. "I mean, initially they went in and they 'cleaned' me up, in a high-tech way. What I mean is that they went through my urethra and bombarded the cancer growth. The cysts. Then we went to chemo. I had several sessions, initially every two weeks, if I remember correct. For about six months.”
During that time, Cabelis struggled with fatigue, weakness and intense anxiety attacks. At one point, his sodium levels plummeted so low, he collapsed. But he bounced back.
The treatment was never painful, he said, adding that the nurses and doctors made the experience "as pleasant and nice" as possible.
“A few months later they went back with a camera to see what was happening, and I was clean," Cabelis said. "Then they asked me if I wanted to continue with the trial. And of course, I said yes! I took my chances. I went all the way.”
Six years out, Cabelis remains cancer-free. What was initially a cancer screening every three months is now a yearly checkup.
“I asked them if I'm cured,” Cabelis said. “Galsky said, 'That's a big word. But at this point it's unlikely you'll get sick again.'"
Galsky said side effects of the experimental treatment appear to be in line with those of standard chemo and/or immunotherapy treatment when bladder cancer has spread.
While the findings are encouraging, “longer follow-up and additional studies are needed to determine if this should be a mainstream treatment,” Galsky said.
That caution was strongly seconded by Dr. Daniel Petrylak, chief of genitourinary oncology at Yale School of Medicine.
“So far this finding is certainly intriguing-- and exciting,” said Petrylak, who wasn't part of the study. “And it makes sense. But this is work with just a little more than 70 patients. That's a small group. So this will definitely need to be reconfirmed, in a longer and larger randomized trial.”
But in the meantime, nothing is going to dampen Cabelis' enthusiasm. For him, at least, the jury is already in.
“Listen, it's not very pleasant to live without a bladder,” he shared with a knowing and hearty laugh. “But they're trying to figure this out so that people don't have to. And they've already made sure that I don't have to. So … I couldn't be happier!”
Based on results of this Phase 2 trial, one follow-up study has already begun and another is scheduled to open in six months.
There's more about standard bladder cancer treatment at the U.S. National Cancer Institute.
SOURCES: Matthew Galsky, MD, co-director, Center of Excellence for Bladder Cancer, Tisch Cancer Institute, New York City, and professor, medicine, Icahn School of Medicine at Mount Sinai, New York City; Daniel Petrylak, MD, chief, genitourinary oncology, and professor, medicine (medical oncology) and urology, Yale School of Medicine, New Haven, Conn.; David Cabelis, cancer patient, New York City; Nature Medicine, Oct. 2, 2023
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