Immunotherapy treatment for bladder cancer in Germany
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Immunotherapy is considered the fourth most important cancer treatment after surgery, radiotherapy, and chemotherapy. This treatment option is used for most cancers. Bladder cancer (BC) is one of the oncological diseases for which immunotherapy is highly effective. It may be used in different variants. Depending on the goal of treatment and the stage of the cancer, medications to enhance the antitumor immune response may be injected intravenously or directly into the bladder.
Content
- Immunotherapy options
- Intravesical immunotherapy
- Systemic immunotherapy
- Where can I undergo immunotherapy?
Immunotherapy options
Immunotherapy for bladder cancer may be as follows:
- Intravesical
- Systemic
Intravesical immunotherapy is used mainly in the first stage. Less commonly, it may be used as an option for immunotherapy for muscle invasive bladder cancer. As for intravesical treatment, doctors may use the BCG vaccine or virotherapy.
Systemic bladder cancer immunotherapy is used after the spread of metastases, and less often, it may be an option for patients with a high risk of relapse of muscle invasive bladder cancer. The two standard options for metastatic bladder cancer immunotherapy are PD-L1/PD-1 inhibitors and antibody-drug conjugates.
Intravesical immunotherapy
Intravesical administration of drugs is mainly used for adjuvant immunotherapy for bladder cancer. This means that drugs are injected into the cavity of this organ after surgery in order to reduce the risk of recurrence of a malignant neoplasm.
It goes without saying that intravesical therapy implies that a person still has a bladder after surgery. This procedure can be performed after transurethral resection of a bladder tumor (TURBT), an operation during which doctors remove the tumor along with adjacent areas of the mucous membrane.
The following two methods can be used for adjuvant therapy: intravesical chemotherapy and immunotherapy. These treatment options are interchangeable. However, success rates are higher with immunotherapy, so this method is considered the main treatment option for more aggressive tumors when the risk of cancer recurrence after surgery is higher.
Less commonly, intravesical immunotherapy can be used at stages 2-3 of bladder cancer. This is possible if surgery is contraindicated for a person and radiotherapy and chemotherapy become the main treatment methods. Local immunotherapy is becoming an additional way to control tumor growth.
Doctors use one of the following two drugs:
BCG is the main drug for immunotherapy treatment for bladder cancer. This is a microbe close to the causative agent of tuberculosis. It activates immune cells, which then attack the tumor and destroy the remaining cancer cells. The administration of the BCG vaccine may cause side effects such as burning sensations, frequent urination, and, less commonly, the appearance of blood in the urine. Symptoms of general inflammation often appear, as with the flu, so a person may have an increase in body temperature, chills, and fatigue. These side effects disappear within 2-3 days.
Adstiladrin is an innovative drug for immunotherapy for bladder cancer, created on the basis of a virus. This type of treatment is also referred to as gene therapy. The technique was introduced into clinical practice at the end of 2022. A virus is injected into the bladder. It carries the gene responsible for the production of interferon alpha-2b. This virus invades the cells of the mucous membrane. Interferon production in the bladder increases dramatically, and this protein helps the immune system attack cancer cells. The treatment method is used in patients at high risk and in cases of the ineffectiveness of BCG. The drug is administered every three months. There are usually no common side effects. Local reactions may include burning sensations and a frequent urge to urinate.
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Systemic immunotherapy
Systemic immunotherapy is mainly used for end-stage cancer. Less commonly, it is used as part of adjuvant treatment. This is possible after a cystectomy (bladder removal surgery) in patients with an increased risk of recurrence. They receive immunotherapy for one year.
Stage 4 bladder cancer is usually treated with chemotherapy and radiation therapy. Immunotherapy is not considered a first-line treatment option for metastatic tumors. It may be used:
- If the tumor did not completely regress after the completion of chemoradiation therapy
- If relapse is detected after chemotherapy
- If a patient has contraindications for platinum-based drugs
- As maintenance treatment after chemotherapy
Immune checkpoint inhibitors are the mainstay of systemic immunotherapy. Three drugs in this group are used to block the PD-L1 or PD-1 proteins. They prevent the tumor from evading the immune response. However, these drugs themselves are not toxic to cancer cells. They also do not damage normal tissue, so they rarely cause any severe side effects.
Drugs in this group cause the immune system to more actively attack the tumor. They cannot completely cure cancer, but they can slow down or stop tumor growth and even shrink the size of malignant tumors.
Antibody-drug conjugates are innovative drugs that are antibodies combined with chemotherapy drugs. Antibodies target molecular targets in cancer cells, so they deliver chemotherapy drugs directly to the tumor.
Two drugs in this group have been approved for clinical use. One of them targets the Nectin-4 protein. It is used as a third-line drug if platinum-based drugs fail or are contraindicated, as well as when the effect of immune checkpoint inhibitors is insufficient. Another drug targets the Trop-2 protein. The indications are generally the same, but an important condition for the effectiveness of this drug is increased expression of Trop-2 in cancer cells. Not all types of bladder cancer produce this protein in large quantities.
Where can I undergo immunotherapy?
You can undergo immunotherapy in Germany. Doctors at German hospitals use innovative treatments, successfully combining them with other cancer treatment methods.
You are welcome to make an appointment for your treatment through the Booking Health service. On the website, you can see the best clinics in Germany, find out the prices of medical care programs, and compare the average cost of treatment in different medical centers. The Booking Health specialists will help you choose the most suitable hospital and take care of organizing your trip.
Choose treatment abroad and you will for sure get the best results!
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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Sources:
Read:
New Effective Treatments for Stage 4 Cancer (oncology)
Cancer immunotherapy in Germany
Dendritic cell therapy in cancer treatment in Germany - Vaccination against cancer
Adaptive Cell Therapy: CAR T-Cell Therapy