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Urothelial bladder cancer (UBC), the most common type 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 urothelial bladder cancer are becoming more advanced and effective.
Immunotherapy is a treatment that uses the body’s immune system to attack cancer cells. The Food and Drug Administration (FDA) approved the first immunotherapy for urothelial bladder cancer in 1990. Since then, several more have been approved.
Here’s everything you need to know about how immunotherapy helps the body fight cancer and what types of immunotherapy are available for urothelial bladder cancer.
How does the immune system fight disease?
The immune system consists of organs, cells and proteins that recognize and protect the body from antigens. These are substances from bacteria, viruses, tumors and even normal cells that alert your body to the presence of a foreign substance.
Your immune system is like a team of soldiers protecting your body.
Cancer cells are like enemies. These enemies have “flags” called antigens.
Your immune system uses these “flags” to recognize what shouldn’t be in the body. When the immune system detects something dangerous, it triggers a reaction and produces antibodies to destroy the threat. The immune system can also learn to recognize these threats so that it can react more quickly in the future.
Imagine it works like this: When the body detects an enemy:
- Send soldiers (immune cells)
- Produces weapons (antibodies)
- Remember the enemy so you can fight them faster next time
What are the different cells of the immune system?
The immune system is made up of several cells that work together to fight infection and disease.
- B lymphocytes: They develop and secrete antibodies to protect the body from certain antigens.
- CD4+ T helper lymphocytes: They send signals to other immune cells to tell them where to go and which harmful cells to attack.
- CD8+ cytotoxic T lymphocytes: They destroy infected cells in the body.
- Dendritic cells: They eat harmful cells and break them down so other immune cells can recognize and destroy them.
- Macrophages: Similar to dendritic cells, macrophages eat and break down harmful cells so that other immune cells can recognize and destroy them.
- Regulatory T lymphocytes: They monitor and balance the immune system to make sure it doesn’t overreact or attack healthy cells, which are known as autoimmune diseases.
How does immunotherapy work?
Immunotherapy is a form of treatment that uses the body’s own immune system to fight diseases such as cancer. Immunotherapy works in two main ways:
- Strengthen and promote the immune system so that it is better prepared to find and fight cancer cells.
- Using lab-made parts of the immune system to improve the body’s ability to find and fight cancer cells
What types of immunotherapy are there for bladder cancer?
There are a few types of immunotherapy used to treat bladder cancer.
Immune checkpoint inhibitors: Immune cell checkpoints can signal the immune system to start or stop an immune response. Cancer cells can influence checkpoints and tell the immune system to stop, which allows cancer cells to spread. Immune checkpoint inhibitors turn off the brakes and allow the immune system to stay active so it can attack cancer cells.
To treat urothelial bladder cancer, immune checkpoint inhibitors can target PD-L1, a cellular protein that stops the immune system from attacking these cells, or PD-1, a protein that stops the immune system from attacking other cells. PD-L1 and PD-1 inhibitors block these proteins to shrink tumors or slow their spread.
Intravesical therapies: These are therapies that are introduced directly into the bladder. They have a liquid form and are often used for less invasive, early-stage types of bladder cancer and include:
- Bacilo Calmette y Guérin (BCG)
- Nadofaragen firadenovec (adstiladrine)
- Nogapendekin alfa inbacicept (Anktiva)
Although each of these treatments contains different substances, they all activate the immune system to attack cancer cells.
Antibody-drug conjugates (CAFs), also known as targeted antibodies: These artificial antibodies are associated with chemotherapy drugs. They target chemotherapy drugs directly to cancer cells in order to fight them more efficiently.
Can multiple immunotherapies be used?
Yes. Depending on the type of tumor and the stage of the cancer, a combination of several immunotherapy drugs may be used for more effective treatment. Immunotherapy can also be used alongside more traditional treatments such as radiation therapy, surgery or chemotherapy.
This educational resource was created with support from Merck.
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