For patients with locally advanced or metastatic cancer, after chemotherapy, a new drug delays progression and increases survival, along with a good quality of life
After 30 years without great progress, there are important innovations in the treatment of bladder cancer which, with 25,500 new diagnoses every year in Italy, is the fifth most widespread form of cancer in our country. It is especially striking after the age of 70, in 80 per cent of cases men and the most recent advances mainly concern the most “difficult” patients: those with a tumor that has reached locally advanced or metastatic stage, for which until now there was no ” maintenance therapy “. Now, however, the Italian Medicines Agency (Aifa) has approved the reimbursement of a new immunotherapy drug that has demonstrated effective disease control, significantly increasing the survival of treated patients, together with a good quality of life.
What changes for patients
For more than three decades, bladder cancer has been treated in much the same way: surgery if possible, sometimes radiotherapy and different types of chemotherapy in the presence of an advanced cancer. In recent years, new immunotherapy and molecular target drugs have arrived that are able to stop the advance of the neoplasm. “For patients in an advanced or metastatic stage, however, there was no maintenance therapy that aims to maintain the result achieved by the first line of chemotherapy, delay the progression and slow down the evolution of the neoplasm – explains Roberto Iacovelli , medical director at the Medical Oncology of the Agostino Gemelli IRCSS University Polyclinic Foundation of Rome-. Until now, standard first-line treatment of advanced urothelial carcinoma was characterized by platinum-based chemotherapy alone, usually for up to six courses. In patients in whom at least a stable disease was observed at the end of chemotherapy, then followed a period of observation (clinical and instrumental) to identify early the new disease progression which was followed by a new treatment, this time second line “. Today, however, Aifa has approved a new treatment: the immunotherapy drug avelumab for the first-line maintenance treatment of adult patients with locally advanced or metastatic urothelial cancer without progression after platinum-based chemotherapy.
Symptoms not to be overlooked
In over 90% of cases, bladder cancer originates in the inner lining of the bladder (urothelium), but in the remaining 10% of patients it also affects other organs of the urinary tract (such as the renal pelvis, ureter and urethra) and is therefore defined, more generically, urothelial carcinoma. In a locally advanced or metastatic stage it can then spread to the muscle wall surrounding this area and reach the lymph nodes or other organs such as lungs, liver, bones. “For this reason, timely diagnosis is fundamental, because it influences future survival, as well as the therapeutic approach which, depending on the stage of the tumor, involves combined interventions between surgery, chemotherapy, radiotherapy and immunotherapy” adds Iacovelli. It is therefore important not to overlook some potential signs such as blood in the urine (or hematuria) and other symptoms (even if vague and common to other disorders) such as the need to urinate more frequently, recurrent infections, urgency, pain or difficulty when urinating.
It improves the quality of life of the sick
The approval of the new treatment came after the results obtained with the trial (phase three) JAVELIN Bladder 100 and the most updated data of the study, presented at the American conference dedicated to genitourinary neoplasms (Asco GU, held in San Francisco in February 2022 ) demonstrated a significant benefit (8.8 months) in the survival of patients receiving it as maintenance after the first line of therapy compared to observation alone. With a relevant addition: the patient’s condition is maintained or improved, thanks to the limited toxicity of the drug. “Avelumab not only proved to be effective in controlling the disease, and with increased survival results compared to those previously reported, but it is also well tolerated – explains Sergio Bracarda, director of the Department of Oncology and Medical and Translational Oncology of the Santa Maria di Terni Hospital -. This latter element is extremely important, in light of the type of patients treated, often elderly and suffering from various other pathologies. Avelumab is a monoclonal antibody that binds to the so-called PD-L1 checkpoint protein, a specific target that allows some cancer cells to evade the activity of the immune system. The drug – concludes Bracarda, who is also incoming president of SIUrO (Italian Society of Uro-Oncology) – inactivates PD-L1, present on the surface of tumor cells, blocking this protective effect and allowing our immune system to fight the tumor ” .
May 12, 2022 (change May 12, 2022 | 09:34)
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