I saw a 67-year-old gentleman who noticed blood in his urine. He did not have a UTI, or urinary tract infection.
He was referred to a urologist. He underwent cystoscopy (passing a lighted instrument in the bladder). It showed cancer of the bladder. Unfortunately, his cancer was involving muscle of the bladder.
In the United States, 84,000 new cases are diagnosed with bladder cancer every year. Almost half of those cases are in smokers. Almost one third of bladder cancers are diagnosed when it is involving muscle.
Other than smoking, chemicals used in the textile, rubber, leather, dye, paint and print industries; some naturally occurring chemicals; and chemicals called aromatic amines and others can also increase the risk of bladder cancer.
Common presentation of bladder cancer includes blood in urine, frequent urinary tract infections, pain while urinating, or feeling the need to urinate but cannot urinate. Usually, patients with any one of these symptoms undergo cystoscopy. That helps to make a diagnosis.
Once bladder cancer involves muscle, it needs surgery to remove the bladder or, occasionally, part of the bladder. Studies have shown that giving chemotherapy before surgery improves the chance of cure. My patient underwent surgery after receiving chemotherapy. Until now, there was no further therapy available.
Recently, the FDA approved Opdivo for this group of patients. Opdivo is an immunotherapy and is approved by the FDA for many years for different cancers, including advanced bladder cancer.
In the CheckMate-274 trial, 353 patients were randomly assigned to receive nivolumab or Opdivo after surgery, and 356 others were assigned to receive a placebo.
Nivolumab was administered at 240 milligrams by intravenous infusion every two weeks until recurrence or unacceptable toxicity for a maximum duration of one year. Patients who received Opdivo did a lot better. Their progression-free survival, or time without cancer recurrence, doubled.
This treatment is usually well tolerated, and it does not cause hair loss, nausea, vomiting or lowering of blood count. Immunotherapy works by boosting the immune response of a patient’s own human body. It is changing the management of cancer patients drastically.
My patient would benefit from Opdivo therapy for one year. This will increase the chance of cure in him. Advances like this are helping patients with different kinds of cancer.
The goal of cancer care is eventually making cancer a chronic disease, like diabetes or high blood pressure. We are not there yet, but getting closer daily.
Dr. Sunil Gandhi is a hematologist and oncologist. He is the volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email email@example.com or call 352-746-0707.