Immunotherapy Nivolumab received its break-through therapy designation in June as a possible treatment for individuals with locally advanced or metastatic urothelial carcinoma after an unfavorable outcome from platinum-based chemo. The FDA gave atezolizumab accelerated approval in May after encouraging Phase II findings in the IMvigot210 study. As with nivoumab, atezolizumab is indicated for individuals with locally advanced or metastatic urothelial carcinoma whose cancer was not responsive to platinum-based chemo prior to or after surgery.

Before we get too far ahead of ourselves, let’s talk a bit about immunotherapy. Both drugs are part of a new wave of cancer treatment — immunotherapy — but these drugs do not necessarily “fight” cancer. These drugs act on your immune system so that it can fight the cancer. Earlier attempts at utilizing the immune system to fight cancer were based in “super-charging” the immune system, but results were spotty and side effects could be very unpleasant.

A more successful approach has been to “train” specific immune system cells to recognize and attack a patient’s specific tumor (cancer) or identifying and then magnifying a patient’s own tumor-specific immune cells. The difference in these new drugs is they work directly on the immune cells — the cells designated to attack tumors. These drugs used for immunotherapy are called “Checkpoint Inhibitors,” and they impede or stop a cancer cell’s ability to evade attack from immune cells.

Let’s focus on Atezolizumab (TECENTRIQ).

In studies involving patients with advanced bladder cancer, TECENTRIQ was found to stop tumor growth by 24% and shrank existing tumors by 30%. Researchers report that 21 of the original 119 patients which began treatment in 2014 have gone into remission and continue to use TECENTRIQ.

Currently, the treatment option of advanced bladder cancer involves platinum-based cisplatin, which is a chemotherapy agent designed to bind to DNA causing the DNA strands to crosslink, which triggers cells to die in a programmed manner. But platinum-based cisplain can lead to nephrotoxicity and neurotoxicity — kidney and nerve damage. Cisplatin is also an agent that causes one of the highest incidence of vomiting in patients.

It has been reported that patients who received TECENTRIQ had manageable side effects. The reported effects were fatigue, itchy skin, and diarrhea. One concern is that other research has suggested that checkpoint inhibitors can trigger attacks on perfectly healthy organs; so a cautious approach is being taken and all patients and results closely monitored. As a caveat, other research is suggesting that by screening patients with genetic tests, it will be easier to see which patients will be helped by these kinds of drugs.

These advances are twofold, though. The American Cancer Society reports that over 76,000 new cases of bladder cancer will be diagnosed this year. Most of them being in men. More than 16,000 Americans will die from bladder cancer this year. The majority of patients diagnosed at Stage 0 will be able to fight and live through the disease, but 85% of advanced bladder cancer patients die. So TECENTRIQ is a welcome alternative. The problem is TECENTRIQ has a monthly price tag of $12,500.00 per month, a cost prohibitive to many patients.

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