Immunotherapy for Urological Cancers

Over the past decade our understanding of the biology of tumors has advanced significantly, thanks to medical research. This increased knowledge has allowed for the development of immunotherapies. Immunotherapies are drug-treatments that help the immune system attack cancer and other diseases. Some types of immunotherapy work to stimulate the body’s immune system to work harder and smarter against cancer cells. Other types provide immune–system components, such as specific proteins, that help the body fight disease.

Immunotherapy works on some types of cancer better than others. Usually, it works best when combined with other types of cancer treatment, such as surgery or chemotherapy.

Several types of urological cancer respond well to immunotherapy. These include non-muscle-invasive bladder cancer, renal cell carcinoma (kidney cancer), metastatic castrate-resistant prostate cancer and certain types of testicular cancer.

Bladder cancer

Bacillus Calmette-Guérin (BCG) was the first FDA-approved immunotherapy for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). It continues to be one of the most effective immunotherapies in cancer treatment. Studies have shown that BCG reduces NMIBC disease progression by 27%. Immunotherapy agents are also being tested in clinical trials for the treatment of muscle-invasive bladder cancer.

Renal cancer

In the 1990s, immunotherapy agents were developed to treat renal cancer. Over the past 10 years, new checkpoint inhibitor-type immunotherapies have made rapid progress. Studies show that current immunotherapies for renal cancer have between a 25 and 40% response rate in patients.

Prostate & Testicular cancer

Immunotherapy is used to enhance treatment of certain types of prostate and testicular cancers. In the case of prostate cancer, it may be used to treat patients with advanced metastatic disease.

Types of Cancer Immunotherapy

The main types of immunotherapy now being used to treat cancer include:

Monoclonal antibodies: These are man-made versions of immune system proteins. Antibodies can be very useful in treating cancer because they can be designed to attack a very specific part of a cancer cell.
Immune checkpoint inhibitors: These drugs basically take the ‘brakes’ off the immune system, which helps it recognize and attack cancer cells.
Cancer vaccines: Vaccines are substances put into the body to start an immune response against certain diseases. We usually think of them as being given to healthy people to help prevent infections, but some vaccines can help prevent or treat cancer.
Other, non-specific immunotherapies: These treatments boost the immune system in a general way, but this can still help the immune system attack cancer cells.

(source: American Cancer Society)

Side Effects of Immunotherapy

The side effects of immunotherapy depend on the type of drug given, the dose and the patient’s overall health. Your doctor will discuss with you the possible adverse reactions to the drug you are considering. Below are the most common side effects.

Side effects of BCG (for bladder cancer):

Frequent and/or urgent urination
burning during urination
Fever
Fatigue
Body aches or chills
Loss of appetite

Side effects of other immunotherapy drugs:

Fatigue
Diarrhea
Skin rash or itch
Nausea and vomiting
Loss of appetite
Cough
Difficulty breathing
Inflammation
Low blood pressure

Your urologist or oncologist will monitor your reactions to the drug by taking frequent blood tests. All reactions should be reported to your physician.

Conclusions

Immunotherapy for treatment of urological cancers is a rapidly developing area of study. In the years to come, we can expect many more treatment options in this area.

Resources

Immunotherapy in Urological Tumors
Anand Sharma, Narin Suleyman, Oliver Jones, Nikhil Vasdev
Rev Urol. 2019; 21(1): 15–20.
American Cancer Society

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