Breaking the deadlock in bladder cancer treatment with targeted therapy

For many of us, bladder cancer might not sound as familiar as breast or lung cancer. Yet, it is relatively widespread. Statistics by the World Health Organization in 2018 show that cancer of the bladder is the 10th most common form of cancer globally. It is the 12th most deadly form of cancer. There is also a concerning trend that those likely to be visited by bladder cancer are getting younger and younger. Whereas it previously tended to affect those aged between 60 and 70 years, it is now a risk for those under 40 as well.

The survival rates five years post-diagnosis of bladder cancer are quite erratic. The type and the stage in which it was detected are crucial factors to survival. For those diagnosed with transition or urothelial cell carcinoma, the survival rate can be as high as 96%. Whereas for patients where the cancer has spread to surrounding tissue and organs, the survival rate drops to just 33%.

All of this underscores the importance of early detection in improving the chances of survival, in this case, up to threefold. Also, the fact that the medical establishment at large still lacks a truly effective means of treatment for bladder cancer in metastasis. Or does it? Let us look at how a scientific breakthrough in targeted therapy might arrive just in time to break the deadlock in metastatic bladder cancer treatment.


Brief look at current treatment paradigms

If the cancer is detected in its early stages, keyhole surgery is usually performed to remove the tumour. This will be followed by chemotherapy, which is given directly to your bladder via a catheter inserted through your urethra (an organ that carries urine to the outside of your body). But if the cancer has already spread, intravenous (systemic) chemotherapy and radiation therapy may be called for. In more extreme cases, the bladder itself may have to be removed and a urostomy (a bag to collect your urine) installed. The removal of the bladder is an incredibly complex and risky procedure. In men, it also necessitates both a prostatectomy and a vasectomy. In women, the womb, ovaries, and even parts of the vagina will have to be removed. However, the surgery may not even be viable in some cases.


Full speed ahead to the future

Thankfully, research and development in the field of bladder cancer treatment has been making continuous progress. Urothelial cell bladder cancer, which accounts for 90% of cases, is caused by abnormalities in the fibroblast growth factor cell receptor (FGFR) gene. Normally, this gene helps to regulate the healthy growth and multiplication of other cells. Malfunctioning of this gene may cause cells to grow and multiply abnormally, resulting in cancer.

One in five cases of metastasizing bladder cancer has this FGFR mutation and malfunction. This is where the medication that directly targets and shuts down this gene comes in. Just last year, bladder cancer patients received good news in the form of the USFDA’s approval of erdafitinib. This oral medication is a targeted therapy designed to inhibit the FGFR gene function. Given the urgent needs of patients who do not respond to chemotherapy and are not viable for surgery, it has been fast-tracked through the approval process. It is now available for adult patients with metastasizing bladder cancer.

Because its approval was fast-tracked, the number of patients involved in the clinical trials were limited. Nevertheless, the results were stunning. Even patients who previously showed no positive response to certain kinds of immunotherapy responded well to erdafitinib. Most promising is the fact that FGFR can be found in all kinds of cells all over the body. This means that the medication also has the potential to be effective in treating other forms of cancer too, such as the non-small-cell lung carcinoma (NSCLC), pancreatic cancer, breast cancer, or leukemia. It even shows promise for the treatment of glioma, a type of brain cancer that is one of the very hardest to treat. Clinical trials for the treatment of glioma using this medication have already commenced, both for adults and children, and includes relapsed patients.

Erdafitinib is now providing a light at the end of the tunnel for all those patients with metastasizing bladder cancer. It may even light the way to successful treatment of other forms of cancer too. However, patients must have their FGFR mutation confirmed first, and the side effects will have to be taken into careful consideration. This is all part and parcel of the care that our physicians provide to our patients, to ensure the highest possible chances of a safe and quick recovery to wellbeing.

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