Interview with Urologic Oncologist About Treatment Options
Dr. Friedlander is a urologic medical oncologist specializing in cancers of the bladder and prostate. His interests are in developing novel therapies, particularly immunotherapies, to treat urologic cancers, and studying biomarkers predictive of response and resistance to therapy. The Editorial Team at BladderCancer.net was fortunate enough to be able to interview him about new, exciting treatment options, and we are excited to share his insight with you!
There are a number of exciting developments in immunotherapy for bladder cancer. The recent approval of PD-1/PD-L1 checkpoint inhibitors has been a major development as we are seeing some patients with metastatic bladder cancer have very dramatic and durable responses, lasting months to years, including patients with very advanced cancer that had progressed despite chemotherapy.
Current research is looking for answers about immunotherapy
The major questions facing the field are how to identify potential responders ahead of time in order to prioritize them for immunotherapy and avoid the toxicity of chemotherapy, how to manage the autoimmune toxicity that can happen with these agents (and that can rarely be severe), and whether we should be using these types of therapy earlier in the disease course, for example, in patients without metastatic disease. A number of ongoing trials are aiming to address these questions.
Bladder cancer combination therapies
Additionally, for the patients who do not respond to PD-1/PD-L1 checkpoint immunotherapy, a number of studies are trying to understand why these cancers don't respond, whether it is due to the intrinsic makeup of the cancer, the body's immune system, or some component of both. A number of trials are therefore combining PD-1/PD-L1 checkpoint inhibitors with other agents, including with chemotherapy, with other novel immunotherapies, with radiation, and with genetically targeted therapies, to see if we can help improve the chance of responding to the immunotherapy.
Online resources for bladder cancer
I always present a number of options to patients and make sure that they have time to process the information during the visit. I encourage them to come to visits with family and friends, to write down questions ahead of time, to reach out to me if new questions or problems arise, and to look for reliable sources of information online. The Bladder Cancer Advocacy Network (BCAN) in particular is a great resource, as well as BladderCancer.net. I do counsel patients not to simply read Google or other blogs as there is a lot of erroneous information on the internet about how to treat cancer that raises patient's anxiety but does nothing to actually help the patient understand their disease or think through treatment options. At the same time, I do encourage patients to ask me about treatments they have heard of that may not be part of the medical mainstream, and I try to give an honest answer each time about the value of any particular treatment, so patients are best informed.
There is a saying that "sunlight is the best antiseptic," meaning that opening up about a cancer diagnosis and talking to family and trusted friends can dramatically help patients understand their diagnosis and think through treatment options. Seeking input from cancer survivors is important as a patient can get a real-world understanding of the impact of different therapies.
Asking for help
Bladder cancer has a stigma because it is associated with cigarette and tobacco use for some, it involves the urinary tract, and some treatments, like bladder removal, require the placement of a urostomy and raise a number of cosmetic and quality of life issues. This is where having a team of folks helping with decisions, like family or friends, in addition to the medical providers, is crucial. I have found that many patients who are reluctant to "burden" their loved ones with news of their cancer diagnosis find that their family and friends want to help, that it's in most people's human nature, and I encourage patients not to come to doctors’ visits alone, but to enlist their family and friends to help understand the diagnosis, take notes and ask questions, and help the patient think through the options.