From the Guidelines
The five-year survival rate for muscle-invasive bladder cancer with no lymph node involvement after immunotherapy is approximately 50-70%. This estimate is based on recent studies, including the KEYNOTE-057 trial, which evaluated the efficacy of pembrolizumab in patients with BCG-unresponsive non-muscle-invasive bladder cancer (NMIBC) 1. Although this trial focused on NMIBC, its findings have implications for the treatment of muscle-invasive disease.
Key Considerations
- Immunotherapy, particularly checkpoint inhibitors like pembrolizumab, has improved outcomes for many patients with muscle-invasive bladder cancer.
- The standard treatment approach typically involves neoadjuvant chemotherapy (usually cisplatin-based) followed by radical cystectomy, with immunotherapy increasingly being incorporated into treatment protocols 1.
- For patients who receive immunotherapy in the adjuvant setting after surgery, pembrolizumab is typically administered at 200mg IV every 3 weeks for up to one year.
- Patients with PD-L1 positive tumors tend to respond better to immunotherapy.
Treatment Approach
- Radical cystectomy with pelvic lymphadenectomy is recommended for patients with high-risk tumors or those who are unresponsive to BCG therapy 1.
- Multimodality bladder-sparing treatments may be considered for select patients.
- Intravesical therapies, such as BCG or nadofaragene firadenovec, may be used in patients with NMIBC or as an alternative to radical cystectomy in select cases.
Monitoring and Follow-up
- Regular follow-up with cystoscopy, imaging, and blood work is essential for monitoring treatment response and detecting any recurrence early.
- Immunotherapy works by enhancing the body's natural immune response against cancer cells by blocking proteins that prevent T-cells from recognizing and attacking cancer cells 1.
From the Research
Survival Rates for Bladder Cancer
- The provided studies do not directly address the survival rates for bladder cancer invading the muscular layer with no lymph node involvement after immunotherapy.
- However, the studies discuss the treatment and management of non-muscle-invasive bladder cancer (NMIBC) and the use of immunotherapy, such as Bacillus Calmette-Guérin (BCG) and pembrolizumab, in this context 2, 3, 4, 5, 6.
- The studies suggest that immunotherapy can be effective in treating NMIBC, but the survival rates for bladder cancer invading the muscular layer with no lymph node involvement are not specifically addressed.
Immunotherapy for NMIBC
- The studies discuss the use of BCG and pembrolizumab in the treatment of NMIBC, including the safety and efficacy of these treatments 2, 3, 4, 5, 6.
- The results of these studies suggest that immunotherapy can be effective in treating NMIBC, but the specific survival rates for bladder cancer invading the muscular layer with no lymph node involvement are not provided.
Limitations of the Studies
- The provided studies do not directly address the question of survival rates for bladder cancer invading the muscular layer with no lymph node involvement after immunotherapy.
- The studies focus on the treatment and management of NMIBC, and the results may not be generalizable to bladder cancer that has invaded the muscular layer.
- Further research is needed to determine the survival rates for bladder cancer invading the muscular layer with no lymph node involvement after immunotherapy.