Achievements in Bladder Cancer Treatment Offer Hope for Cure

Advancements in bladder oncology open new horizons for patients. Modern research demonstrates significant progress in treatment, especially for aggressive forms of cancer. Thanks to a personalized approach based on precise identification of molecular characteristics of the tumour, doctors can choose the most effective therapeutic strategies for each patient.

For a long time, the standard treatment for metastatic and muscle-invasive bladder cancer remained platinum-based chemotherapy administered before surgery. However, with the development of immune checkpoint inhibitors capable of "releasing the brakes" on immune cells, they have been used to activate the immune attack on the tumour. In combination with chemotherapy and new drugs, such as the antibody-drug conjugate enfortumab vedotin, approved by the FDA in 2019 for the treatment of advanced bladder cancer, this combined therapy demonstrates significantly higher efficacy.

New approaches have also begun to be studied for combating bladder cancer at early stages, which may help reduce the risk of recurrences and save lives.

For instance, in the NIAGARA study, the use of the immune checkpoint inhibitor durvalumab in combination with chemotherapy was evaluated both before and after bladder removal surgery. The results showed that patients receiving the combined therapy had significantly higher two-year survival rates and lower recurrence rates compared to patients undergoing only chemotherapy. According to Professor Matthew Milowsky from the University of North Carolina, the NIAGARA study was the first randomized phase 3 trial that changes the standard approach to treating muscle-invasive bladder cancer.

Conclusions

Despite some limitations, the NIAGARA study opens new prospects for treating muscle-invasive bladder cancer. Thanks to this work, future studies will consider the contribution of durvalumab at different stages of treatment, which will help more accurately assess its effectiveness and reduce the risk of side effects.

In the future, according to Milowsky, the use of predictive biomarkers will allow for the most precise treatment. Identifying patients at high risk of recurrence will enable personalized therapy. One promising tool will be circulating tumour DNA, which can help identify patients who will benefit the most from perioperative therapy.

"Our goal is to prescribe treatment only to those who truly need it. By applying prognostic biomarkers, we can focus on those patients who are most likely to benefit from additional therapy, sparing others from unnecessary side effects," emphasized Milowsky.