Bladder cancer: new therapy increases chance of cure – 09/30/2024 – Balance and Health

The combination of immunotherapy with chemotherapy before and after surgery increased the probability of curing bladder cancer by 34%, according to a global study in which Brazil also participated.

Furthermore, treatment with the immunotherapy drug durvalumab led to a 32% reduction in the risk of relapse after the end of treatment.

“About 40 years ago it was established that bladder cancer should not be operated directly. The patient had to undergo chemotherapy first. This is the first study that showed that adding immunotherapy before and after surgery brings better results, which means a lower risk of the disease returning and a greater chance of a cure”, says Ariel Kann, coordinator of the Specialized Oncology Center at Hospital Alemão Oswaldo Cruz and co-author of the study.

The Niagara survey was carried out from November 2018 to July 2021, with 1,063 people who needed surgery. The article was published in the scientific journal The New England Journal of Medicine on the 15th of this month.

Participants, of both sexes, aged 18 or over, are from 22 countries in Europe, Asia, North America, Australia and South America. Brazil was represented by 30 patients, aged 40 to 80 years (average age of 65 years old), cared for by the SUS (Unified Health System) at Hospital Alemão Oswaldo Cruz.

The 1,063 participants were divided into two groups: one received conventional chemotherapy and the other received chemotherapy combined with durvalumab. According to Kann, in this group, there were four doses of the medication along with chemotherapy three months before surgery and eight doses after the procedure.

The medication stimulates the immune system to recognize tumor cells as enemies. As a result, the body starts attacking them. The new approach is aimed at patients with bladder cancer with invasion of the muscular layer, without metastasis.

According to the specialist, tumors that invade the muscular layer of the bladder are always aggressive. When the disease is diagnosed at this stage, the patient needs to be treated more radically, either with surgery to remove the bladder or with radiotherapy.

“The results obtained could lead to a change in the way patients with bladder cancer will be treated, with a chance of cure and quality of life”, says the study’s co-author.

The patients studied will continue to be under medical follow-up for at least another three years. They will undergo consultation and tomography every six months. The objective is to see if the disease will not return during this period.

Durvalumab —initially indicated for the treatment of lung cancer— was incorporated into the SUS (Unified Health System) in May this year. The combination with chemotherapy is not yet approved by Anvisa (National Health Surveillance Agency).

Bladder tumors are, in the vast majority, asymptomatic. When there are initial symptoms, they are mild: irritation, pain, burning, discomfort and difficulty urinating; weak urine flow, frequent urination and urgency to urinate, even when the bladder is not full. The main sign is bleeding, which cannot be overlooked.

“Sometimes we see patients looking for health services and the doctors themselves underestimate the symptom, as if it were a small infection, a kidney stone and they don’t do an exam, an ultrasound, a tomography to see what it really is”, alert the doctor.

According to the WHO (World Health Organization) and the American Cancer Society, every year, 614,000 people are diagnosed with bladder cancer, the ninth most common type. The disease is four times more common in men than women. Smoking and occupational exposure to some chemicals are the main risk factors.

According to Inca (National Cancer Institute), estimates for each year of the 2023-2025 triennium are that just over 11,300 people will be diagnosed with bladder cancer in Brazil, 7,800 men and 3,500 women.

_{This project is a partnership with Umane, an association that supports public health initiatives.}