New Drug Spares Bladder Cancer Patients Life-Changing Surgery

Doctors are hailing a drug that spares bladder cancer patients “life-changing” surgery and stops tumours coming back.

Bladder cancer is the ninth most common cancer in the world. Advanced or aggressive forms are often treated with surgery to remove the entire bladder, with patients left having to find alternative ways to pass urine for the rest of their life.

Now an immunotherapy drug, durvalumab, has been found to destroy bladder cancer, prevent it from returning and remove the need for an operation.

A trial led by the Institute of Cancer Research, London, (ICR) found that adding the drug to chemotherapy and radiotherapy reduced the risk of the disease coming back while avoiding the need for surgery.

Results from the study were presented in Chicago at the world’s largest cancer conference, the American Society of Clinical Oncology’s annual meeting.

Nick James, professor of prostate and bladder cancer research at the ICR, said: “In 2012, my team showed that adding a low-cost chemotherapy drug to radiation provides good long-term benefit to bladder cancer patients.

“Now, we’ve shown that with the addition of immunotherapy, the combination of treatments has an even bigger improvement in outcomes – fewer cancers come back.

“Importantly, we’ve shown that it’s possible to achieve these outcomes without surgically removing the bladder. Keeping the bladder means people can avoid major, life-changing surgery and maintain more of their normal daily function and independence.

“I expect this approach to be practice-changing – offering bladder cancer patients improved outcomes whilst preserving their quality of life.”

In 2020, the artist Tracey Emin said she had been diagnosed with a “really aggressive” form of bladder cancer, and had undergone surgery to remove her bladder.

“Having a urostomy bag is quite a disadvantage for lots of reasons and it’s something that most people would want to keep a secret,” she said in 2021.

“It’s a very private thing because, basically, you’ve got part of your bodily function happening on the outside of your body. It leaks and things happen. I could be out somewhere public and it could happen – and people’d just think I’ve pissed myself or think I’ve been drinking.”

The phase-two trial, funded by AstraZeneca and the University of Birmingham, tested the drug in 54 patients, adding it to chemotherapy and radiotherapy while sparing them surgery to remove their bladder.

Cancer did not come back in 46 patients (85%), results showed. In previous trials, the combination of chemotherapy and radiotherapy, without immunotherapy, prevented it returning in 60% of patients.

Durvalumab is a PD-L1 inhibitor, which helps the body spot cancer cells hiding from the immune system, allowing it to target and destroy them.

The ICR’s chief executive, Prof Kristian Helin, said identifying smarter, kinder treatments was a priority in cancer research.

“These results are a significant step forward for people with aggressive bladder cancer. By adding immunotherapy to chemotherapy and radiotherapy, we may be able to spare patients the physical and psychological burden of having their bladder removed entirely – and after one year, we’re already seeing a meaningful reduction in the risk of the cancer returning.”

Michelle Mitchell, the chief executive of Cancer Research UK, who was not involved in the study, said: “Radical surgery can cause serious side effects for bladder cancer patients. Finding kinder ways to treat the disease is incredibly important, and this trial has done exactly that.

“Further research will be needed at a larger scale to know for sure, but these results have the potential to be life-changing for some bladder cancer patients. Breakthroughs just like this are essential to ensure people affected by cancer can live not just longer lives, but better lives.”