From the FDA Drug Label
KEYTRUDA may be used with the medicine enfortumab vedotin in adults when your bladder or urinary tract cancer has spread or cannot be removed by surgery (advanced urothelial cancer) KEYTRUDA may be used alone when your bladder or urinary tract cancer: has spread or cannot be removed by surgery (advanced urothelial cancer), and you are not able to receive chemotherapy that contains platinum (medicines called either cisplatin or carboplatin), or you have received chemotherapy that contains platinum, and it did not work or is no longer working Cisplatin Injection is indicated as a single agent for patients with transitional cell bladder cancer which is no longer amenable to local treatments, such as surgery and/or radiotherapy.
Newer modalities of treatment for bladder cancers include:
- Immunotherapy with KEYTRUDA (pembrolizumab), which may be used alone or in combination with other treatments for advanced urothelial cancer
- Combination therapy with enfortumab vedotin and KEYTRUDA for advanced urothelial cancer
- Chemotherapy with cisplatin as a single agent for patients with transitional cell bladder cancer that is no longer amenable to local treatments. [1] [2]
From the Research
The most effective treatment for bladder cancer involves the use of immunotherapy with checkpoint inhibitors, such as pembrolizumab, which has shown superior event-free survival rates compared to traditional chemotherapy and upfront radical cystectomy, as demonstrated in the most recent study from 2024 3. The treatment of bladder cancer has undergone significant advancements in recent years, with a focus on personalized medicine and the incorporation of newer modalities. Some key points to consider in the treatment of bladder cancer include:
- The use of immunotherapy with checkpoint inhibitors, such as pembrolizumab and atezolizumab, which have revolutionized the treatment of advanced and metastatic disease, offering durable responses with fewer side effects than traditional chemotherapy 3.
- The evolution of intravesical therapies for non-muscle invasive bladder cancer (NMIBC) beyond BCG, including nadofaragene firadenovec and novel drug delivery systems like TARIS 4.
- The efficacy of enfortumab vedotin, an antibody-drug conjugate, in previously treated advanced disease, which has shown remarkable efficacy and is given at 1.25 mg/kg on days 1, 8, and 15 of a 28-day cycle 4.
- The use of enhanced surgical approaches, including robot-assisted radical cystectomy, which offers improved precision and potentially faster recovery compared to open surgery 4.
- The viability of bladder-sparing trimodal therapy, combining maximal TURBT with concurrent chemoradiation, as a viable alternative to cystectomy for selected patients with muscle-invasive disease, typically using cisplatin with 60-66 Gy radiation 4. These newer modalities work through diverse mechanisms, providing oncologists with multiple options to personalize treatment based on disease stage, patient characteristics, and molecular features of the tumor, as supported by the most recent and highest quality study from 2024 3.