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Urothelial bladder cancer (UBC), the most common form of bladder cancer, is the sixth most common cancer in the United States. About 85,000 people are diagnosed each year in the United States, but the good news is that treatments for UBC are becoming increasingly advanced and effective.
Immunotherapy is a treatment that attacks cancer cells using the body’s own immune system. The Food and Drug Administration (FDA) approved the first immunotherapy treatment for UBC in 1990. Several more have been approved since then.
Here’s everything you need to know about how immunotherapy works with the body to fight cancer and the types of immunotherapy for UBC.
How does the immune system fight disease?
The immune system is made up of organs, cells, and proteins that recognize and protect the body from antigens – substances on bacteria, viruses, tumors, and even normal cells that warn the body of foreign substances.
Your immune system is like a team of soldiers protecting your body.
Cancer cells are your enemy. These enemies have “flags” called antigens.
The immune system uses these “marks” to recognize things that don’t belong. When the immune system detects something harmful, it triggers a response and creates antibodies that help destroy it. Additionally, your immune system can learn to recognize these threats so it can respond more quickly in the future.
Think of it like this: When the body finds an enemy:
- Send to soldiers (immune cells)
- Make weapons (antibodies)
- Remember your enemy so you can fight faster next time
What are the different cells of the immune system?
The immune system is made up of various cells that work together to fight off infections and diseases.
- B cells: We design and release antibodies that can protect against each specific antigen.
- CD4+ helper T cells: It sends signals to other immune cells, telling them where to go and which harmful cells to attack.
- CD8+ killer T cells: Destroys infected cells in the body.
- dendritic cells: Eats and analyzes harmful cells so that other immune cells can recognize and destroy them.
- macrophage: Similar to dendritic cells, macrophages ingest and analyze large amounts of harmful cells, so other immune cells can recognize them and destroy them.
- regulatory T cells: Monitors and balances the immune system to prevent it from overreacting or attacking healthy cells, known as autoimmune diseases.
How does immunotherapy work?
Immunotherapy is a type of treatment that uses the body’s immune system to fight diseases such as cancer. There are two main ways immunotherapy works.
- It strengthens and supports the immune system, making it better suited to seek out and fight cancer cells.
- It uses laboratory-created parts of the immune system to improve the body’s ability to find and fight cancer cells.
What types of immunotherapy are available for bladder cancer?
There are several types of immunotherapy used to treat bladder cancer.
Immune checkpoint inhibitors: Checkpoints in immune cells can instruct the immune system to start or stop an immune response. Cancer cells can influence checkpoints and tell them to put the brakes on the immune system, allowing cancer cells to grow. Immune checkpoint inhibitors release the brakes, allowing the immune system to remain active and attack cancer cells.
For UBC treatment, immune checkpoint inhibitors may target PD-L1, a protein on cells that prevents the immune system from attacking those cells, or PD-1, a protein that prevents the immune system from attacking other cells. PD-L1 and PD-1 inhibitors block these proteins, shrinking tumors or slowing their growth.
intravesical treatment: This is a treatment that is inserted directly into the bladder. This product is in liquid form and is usually used for early, less invasive types of bladder cancer and includes:
- Bacillus Calmette-Guérin (BCG)
- Norparagene Pyradenovec (Astiladrin)
- Nogapendekin Alfa Invakicept (Anktiva)
Although each treatment consists of different substances, they all work by triggering the immune system to attack cancer cells.
Antibody drug conjugates (ADCs), also known as targeted antibodies: These artificial antibodies are linked to chemotherapy drugs. They direct chemotherapy drugs to cancer cells, making them fight them more efficiently.
Can I use more than one immunotherapy?
yes. Depending on the type of tumor and the extent of cancer progression, various immunotherapy drugs may be used in combination for more effective treatment. Immunotherapy may also be used in conjunction with more traditional treatments such as radiation, surgery, or chemotherapy.
This training material was created with support from:m Merck.
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