Immunotherapy is a new form of cancer treatment that uses the immune system to attack cancer cells. A form of immunotherapy called bacillus Calmette-Guérin therapy is typically given after surgery for bladder cancer that hasn’t grown into the muscle.
In recent years, a new class of immunotherapy drugs called checkpoint inhibitors has emerged. If the bladder cancer has spread, doctors may suggest one of these drugs instead of chemotherapy. In people who respond to checkpoint inhibitors, the drugs can have a more lasting effect than chemotherapy, with fewer side effects.
Checkpoint inhibitor drugs release a natural brake on the immune system. This allows the immune cells called T cells to recognize and attack tumors. The drugs work by blocking the interaction of a molecule called PD-1 on the surface of immune cells with a molecule called PD-L1 on the surface of cancer cells.
Beginning in 2014, five checkpoint inhibitor drugs became available for the treatment of bladder cancer:
- atezolizumab (Tencentriq®)
- pembrolizumab (Keytruda®)
- nivolumab (Opdivo®)
- avelumab (Bavencio®)
- durvalumab (Imfinzi®)
Your doctor may give you pembrolizumab or atezolizumab if you are not able to take chemotherapy. If you have already had chemotherapy and the cancer returned, you may receive any of the five checkpoint inhibitor drugs.
MSK researchers are currently conducting research to determine which people with bladder cancer are more likely to respond well to these immunotherapy drugs based on the genetic makeup of their tumors. We continue to look for ways to make these immunotherapy drugs work better and be effective in more people. This includes combining a checkpoint inhibitor with chemotherapy and testing combinations of checkpoint inhibitors with each other.