The Emotional Impact of New Treatment Developments

It was just 5 years from the time my first husband died of bladder cancer in 2014 until 2019. It’s difficult to express just how dramatically the metastatic bladder cancer treatment landscape has changed since then. I can cite new developments (which I will below), but it is the emotional impact of having more options – something we didn’t have – that really resonates with me. I hope that today’s patients won’t face interactions with doctors as bleak as some of the ones we had.

Chemotherapy was our only option

We got opinions from multiple medical oncologists in late 2013 and they were all basically the same: “platinum-based chemotherapy is the only FDA-approved option to treat metastatic disease.” Second-line treatment at the time was taxane-based drugs, another type of chemotherapy.

It was shocking how few options we had

And when these stop working – or if they don’t work at all (as was the case for my husband), medical science has nothing left to offer in its standard-protocol toolkit, we were told. We ended up with an innovative and cutting-edge doctor who sought the newest options and was willing to explore possibilities. But even with a willing doctor, there wasn’t much to explore.

Too sick to participate in clinical trials

Immunotherapy drugs were still in their clinical trial phase. None had yet been approved. And my husband was too sick to even get into one of those trials. The first approval wouldn’t come until 2016, 2 years after his death.

I feel bittersweet but also hopeful

And so, I feel a sense of bittersweetness but also a sense of hope and relief about recent developments. Make no mistake, metastatic bladder cancer can still kill. We are a long way off from it becoming a chronic condition. But the fact that there are some new options will hopefully make those oncology visits not quite as bleak for today’s patients.

2 new targeted therapies for bladder cancer

Consider what happened just last year. In 2019, the F.D.A. approved 2 different targeted therapies for metastatic bladder cancer.

Padcev

In December, the F.D.A. approved Padcev (enfotumab-vedotin) as a third-line treatment for people who had already been treated with platinum-based chemotherapy as a first-line treatment and immunotherapy as a second-line treatment.

Here’s what the National Cancer Institute (NCI) said about the trial:“All patients in the trial received enfortumab-vedotin. Overall, 55 participants (44%) had their cancers shrink or stop growing during the treatment. Fifteen of these had their tumors disappear entirely, known as a complete response. Responses to treatment lasted for a median of 7.6 months.”¹

Not one but two new options approved in 2019

And this was the second targeted therapy approved in 2019. The first was Balversa, a treatment that targets certain mutations in one of several genes called FGFR. However, per NCI, “Only about 20 percent of bladder cancers harbor an FGFR alteration.”

So much has changed

It is still is challenging for me to mentally process how much has changed and how fast with bladder cancer treatments. I was told over and over again by doctors during my husband’s illness, that there had been no new treatments for metastatic disease since 1978.

People are still dying of bladder cancer. But it seems momentum is picking up in new drug approvals and I like to believe that hope is picking up, too.