From the Guidelines
The life expectancy for patients with muscle-invasive bladder cancer (MIBC) without lymph node involvement who have undergone immunotherapy and local resection is approximately 60-70% five-year survival rate, as suggested by recent guidelines 1. When considering the management of MIBC, it is essential to take into account the patient's overall health status, the completeness of the resection, tumor grade, and specific molecular characteristics of the cancer.
- The standard immunotherapy for bladder cancer includes checkpoint inhibitors such as pembrolizumab (200mg IV every 3 weeks), atezolizumab (1200mg IV every 3 weeks), or nivolumab (240mg IV every 2 weeks), which are often administered before surgery (neoadjuvant) or after surgery (adjuvant) for approximately one year 1.
- Following treatment, patients require regular surveillance with cystoscopy every 3-6 months for the first two years, then every 6-12 months thereafter, along with imaging studies (CT urogram annually) and urine cytology.
- Factors that can influence individual prognosis include the patient's age, overall health status, the completeness of the resection, tumor grade, and specific molecular characteristics of the cancer.
- The combination of immunotherapy with local resection represents a bladder-sparing approach that aims to preserve quality of life while targeting the cancer, though some patients may eventually require radical cystectomy if the disease recurs or progresses 1. The most recent guideline from 2024 1 provides a risk-stratified, clinical framework for the management of muscle-invasive urothelial bladder cancer, emphasizing the importance of multidisciplinary collaborative efforts that take into account survival and quality of life concerns.
From the Research
Life Expectancy for Bladder Cancer
- The life expectancy for bladder cancer invading the muscular layer with no lymph node involvement after immunotherapy and local resection is a complex topic that requires consideration of various factors, including the effectiveness of treatment and patient outcomes.
- According to a study published in 2022 2, neoadjuvant atezolizumab with gemcitabine and cisplatin in patients with muscle-invasive bladder cancer showed promising results, with 69% of patients achieving non-muscle-invasive downstaging to < pT2N0.
- Another study published in 2021 3 reported a successful case of gemcitabine-cisplatin re-challenge after pembrolizumab therapy in a patient with metastatic bladder cancer, suggesting that re-administration of chemotherapy after immune checkpoint inhibitors may be a effective treatment option.
- A review of pembrolizumab for the treatment of bladder cancer published in 2018 4 found that the checkpoint inhibitor improved overall survival in patients with locally advanced or metastatic urothelial carcinoma who progressed after or during cisplatin-containing therapy.
- However, it's worth noting that a study published in 2005 5 is not relevant to the topic of bladder cancer treatment and life expectancy, as it discusses the effects of low-dose DDT on hepatocarcinogenesis in male rats.
Treatment Outcomes
- The studies suggest that immunotherapy and chemotherapy can be effective in treating bladder cancer, with some patients achieving significant downstaging or complete response.
- However, the outcomes of treatments after second-line treatment have not been well established, and more research is needed to determine the best course of treatment for patients with bladder cancer.
- The use of checkpoint inhibitors such as pembrolizumab and atezolizumab has shown promise in improving overall survival and response rates in patients with bladder cancer, and further study is warranted to fully understand their potential benefits and limitations.