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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 more advanced and effective.
Immunotherapy is a form of treatment that uses the body’s own immune system to attack cancer cells. The Food and Drug Administration (FDA) approved the first immunotherapy for UBC in 1990. Since then, several more have been approved.
Here’s everything you need to know about how immunotherapy works on the body to fight cancer and the types of immunotherapy at UBC.
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 found on bacteria, viruses, tumors and even normal cells that alert your body to a foreign substance.
Your immune system is like a team of soldiers protecting your body.
Cancer cells are like enemies. These enemies carry “flags” called antigens.
Your immune system uses these “flags” to recognize what doesn’t belong. When the immune system detects something harmful, it mounts a reaction and creates antibodies that help destroy it. The immune system can also learn to recognize these threats and thus react more quickly in the future.
Think of it this way: When the body detects an enemy:
- It sends soldiers (immune cells)
- It makes weapons (antibodies).
- It remembers the enemy so it can fight faster next time
What different cells are there in the immune system?
The immune system is made up of different cells that work together to fight off infection and disease.
- B cells: Design and release antibodies to defend against each specific antigen.
- CD4+ helper T cells: Send signals to other immune cells to tell them where to go and which harmful cells to attack.
- CD8+ killer T cells: Destroys infected cells in the body.
- Dendritic cells: Eating and analyzing harmful cells so that other immune cells can recognize and destroy them.
- Macrophages: Similar to dendritic cells, macrophages eat and analyze harmful cells in large quantities so that other immune cells can recognize and destroy them.
- Regulatory T cells: Monitor and balance the immune system to ensure that it does not overreact or attack its own healthy cells, which is known as an autoimmune disease.
How does immunotherapy work?
Immunotherapy is a form of treatment that uses the body’s own immune system to fight diseases such as cancer. There are two main ways immunotherapy works:
- Strengthens and supports the immune system so it is better able 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: Checkpoints on immune cells can tell the immune system to start or stop an immune response. Cancer cells can influence the checkpoints and tell them to slow down the immune system, allowing the cancer cells to grow. Immune checkpoint inhibitors release the brakes and allow the immune system to stay active so it can attack cancer cells.
In UBC treatment, immune checkpoint inhibitors can target either PD-L1, a protein on cells that stops the immune system from attacking those 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 growth.
Intravesical therapy: These are therapies that are introduced directly into the bladder. They come in liquid form and are typically used for earlier, less invasive types of bladder cancer and include:
- Bacillus Calmette-Guerin (BCG)
- Nadofaragene firadenovec (adstiladrine)
- Nogapendekin alfa inbakicept (Anktiva)
Although each of these treatments consists of different substances, they all work by causing the immune system to attack cancer cells.
Antibody-drug conjugates (ADCs), also called targeted antibodies: These artificial antibodies are associated with chemotherapy drugs. They call the chemotherapy drugs directly into the cancer cells in order to fight them more efficiently.
Can multiple immunotherapies be used?
Yes. Depending on the type of tumor and the progression of the cancer, a combination of different immunotherapy drugs may be used for more effective treatment. Immunotherapy can also be used alongside more traditional therapies such as radiation, surgery or chemotherapy.
This educational resource was created with support from Merck.
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