After being detected with bladder cancer, some patients must make an almost difficult choice: have their bladder removed or bear the chance that the disease may spread if the bladder is left intact.
Bladder Removal Is One Option To Get Rid Of Bladder Cancer
But according to some researchers, there is an alternative. David Cabelis, 68, had a simpler decision than most since he had a one-of-a-kind opportunity to participate in a clinical trial exploring a combination of chemotherapy and immunotherapy as a potential substitute for bladder resection.
Cabelis is among a tiny number of patients who have benefited from the experimental medication more than two years after the study began. Cabelis is now cancer-free, even though his bladder remains in situ.
While the experiment is still ongoing, the preliminary findings indicate that some individuals with his stage of bladder cancer may be able to avoid bladder removal in the future with favorable outcomes.
When cancer cells have gone into the deeper layers of the bladder wall and can soon spread outside the bladder, surgical removal of the bladder, known as cystectomy, is part of the usual treatment regimen for persons with muscle-invasive bladder cancer. At this stage, approximately one in every four persons is diagnosed.
However, the cure rate following bladder removal is far from flawless.
According to Dr. Matthew Galsky, an investigator in the experiment, even when patients receive surgical resection of the bladder for muscle-invasive bladder cancer, the probability of metastatic recurrence is roughly 50%. He is the co-director of The Tisch Cancer Institute’s Center of Excellence for Bladder Cancer at Mount Sinai Health System in New York City.
Of course, the thought of losing one’s bladder is terrifying. Urine must still leave the body even if the bladder is not there. An ileal conduit, which allows urine to pass via a tube constructed of intestinal tissue, is one alternative. The tube is attached to a tiny orifice in the abdomen, and urine is collected in an external bag.
Other patients may be able to get a neobladder, which mimics the function of the original bladder. According to Dr. Jonathan Rosenberg, chief of bladder cancer service at Memorial Sloan Kettering Cancer Center in New York City, a neobladder can imitate a pretty normal urine function in the best-case scenario, but they occasionally don’t perform well or come with consequences.
A reputable urologist said that the best bladder is the one people are born with, and if they can preserve it, that would be excellent.
Cabelis, who is originally from Greece, has lived in the United States for more than three decades, working as a cab driver in New York City. After seeing blood in his urine and visiting the emergency department in May 2017, he was directed to a doctor at Mount Sinai. He was diagnosed with muscle-invasive bladder cancer and offered two options: have his bladder removed or participate in the research experiment.
Cabelis said that they asked him if he wanted to have his bladder removed or go through a cycle of treatments with a scientific study. He stated that he does not wish to live a half-life. He wants to live a full life; therefore he’d gladly participate in the experiment rather than have his bladder removed.
The clinical study, which began in 2018, is the first to use a combination of chemotherapy and immunotherapy as the initial treatment for patients with muscle-invasive bladder cancer. Chemotherapy alone is often used to treat these tumors, followed by surgery to remove the bladder.
The inclusion of immunotherapy, as well as the concept of not always required to remove the bladder, is innovative.
The trial comprised 76 people who received four rounds of chemotherapy as well as a dosage of the immunotherapy medication nivolumab on the first day of each cycle. Patients were subjected to extensive testing after three months of treatment to see how their malignancy reacted to treatment.
After the three months, 31 of the 64 individuals for whom data is currently available looked to be cancer-free. They were allowed to continue treatment, getting four months of immunotherapy alone.
The other 33 patients were advised to have their bladders removed immediately if they did not appear to profit from the experimental therapy based on different testing.
More study, however, is required before this strategy may become a standard practice in the future.