“When Bladder Cancer Metastasizes, the survival rate is 10%”

“When bladder cancer metastasizes, the survival rate is 10%… “Immunotherapy drugs are very effective in preventing progression.”

Bladder cancer is a disease in which cells proliferate abnormally and a tumor forms on the inner wall of the bladder. In Korea, approximately 5,000 new patients are diagnosed with bladder cancer every year.

Bladder cancer has a very poor prognosis when distant metastasis occurs, with a 5-year survival rate of less than 10%. The most common symptoms of bladder cancer include hematuria, urgency, abdominal pain, and a feeling of residual urine when urinating. Hematuria is the main symptom, but the presence of hematuria does not necessarily mean it is bladder cancer. Other than that, there are actually no noticeable symptoms.

“When Bladder Cancer Metastasizes, the survival rate is 10%”
“When Bladder Cancer Metastasizes, the survival rate is 10%”

In the field of advanced and metastatic bladder cancer treatment, where there has been no alternative to platinum-based chemotherapy for a long time, it has recently become possible to provide first-line maintenance therapy with Bavencio (ingredient name: avelumab). Accordingly, we asked Kim In-ho, professor of oncology at Seoul St. Mary’s Hospital, in detail about bladder cancer prognosis and treatment methods.

―Advanced and metastatic bladder cancer is known to have a poor treatment prognosis.

“It is important to check whether bladder cancer invades the detrusor muscle. Bladder cancer that does not invade the detrusor muscle is stage 1. 60-70% of all bladder cancer patients are discovered in stage 1. The possibility of metastasis is low,

so additional tests are not needed and in many cases, the disease is completely cured through surgery. The recurrence rate of bladder cancer is classified based on muscle invasion, and the recurrence rate for patients with cancer that invades the muscle layer reaches 50%. Of these, approximately 10% are inoperable or have metastasized, and the prognosis is very poor. For this reason, patients who have metastasized or relapsed require maintenance therapy immediately after the first chemotherapy.”

“Before the advent of immunotherapy, chemotherapy was the standard treatment method. Even in metastatic patients, if the hematuria is not too severe, chemotherapy should be started first. In Korea, platinum-based chemotherapy, such as gemcitabine and cisplatin combination therapy and gemcitabine and capoplatin combination therapy, is most commonly used for the first treatment of metastatic bladder cancer. 

Chemotherapy is performed every 4 to 6 weeks during the 3 to 4 month treatment period. Although treatment is effective in 7 out of 10 patients, most patients have no choice but to take a drug holiday due to drug toxicity. 

However, the disease often progresses again after 6 to 9 months of treatment. Even with treatment, it was difficult to completely cure the disease due to recurrence, and the 5-year survival rate was only 5%. “Recently, as first-line maintenance therapy using the anti-cancer immunotherapy drug avelumab has been reimbursed, positive clinical results, including increased survival rates, are being reported.”

―I wonder what the difference is from existing treatments.

“Starting in August, health insurance coverage for avelumab has been applied as first-line maintenance therapy for adult patients with locally advanced or metastatic urothelial cancer whose disease has not progressed on platinum-based chemotherapy. This means that rather than simply watching for recurrence after chemotherapy, treatment can now be continued through maintenance therapy. “Immunotherapy drugs have little toxicity, so they have the advantage of improving the quality of life for patients.”

-What is the effect of the treatment?

“Avelumab was confirmed to increase the survival period of patients with metastatic and advanced bladder cancer by 2 to 3 years. Although there are slight differences between clinical studies, the risk of death and cancer progression was reduced by approximately 30% compared to the placebo group when compared to the risk standard. “This is a more positive result than the combination of immunotherapy and chemotherapy, or the use of immunotherapy in primary treatment.”

―Is there a case in which you treated a patient that was most memorable?

“There are two cases. One patient had no noticeable improvement despite chemotherapy treatment. 

However, as first-line maintenance therapy with avelumab was performed, the cancer size decreased and a good response was observed. Another patient has been receiving first-line maintenance therapy with avelumab for almost two years, and the cancer is maintaining well with no further progression. 

Patients who had a very poor prognosis with existing platinum-based chemotherapy, with a 5-year survival rate of less than 10%, are experiencing an increasing survival rate through maintenance therapy in clinical practice. “In particular, as avelumab treatment has been ongoing for about two years, some patients do not see their condition worsening during the treatment period, and some patients are saying to stop taking anticancer drugs and monitor their condition.”

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