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Dr. Terence Friedlander Answers Questions on Bladder Cancer and Immunotherapy from the CRI Virtual Immunotherapy Patient Summit

January 18, 2021

At the CRI Virtual Immunotherapy Patient Summit in December, patients and caregivers were eager to further their understanding of immunotherapy for bladder cancer.

Terence Friedlander, M.D., chief of hematology-oncology at Zuckerberg San Francisco General and an associate professor of medicine at the UCSF Helen Diller Family Comprehensive Cancer Center, led the Bladder Cancer and Immunotherapy Breakout Session.

We followed up with Dr. Friedlander after the event to discuss several more questions from attendees.

CRI:  Is there any success treating people who have bladder cancer recurrence? 

Dr. Friedlander: Yes. PD-1 immunotherapies are approved for patients whose cancer recurs despite surgery or radiation therapy. There are a number of other treatments available for patients who have had the cancer recur despite PD-1 immunotherapies (as detailed below).

CRI: Are there any treatment strategies if I develop resistance to an immunotherapy?

Dr. Friedlander: It is less well known if other types of immunotherapy are still effective after resistance to the approved PD-1 checkpoint inhibitors. There are a number of studies underway to develop different immunotherapeutic strategies (often combining a new agent with an existing PD-1 checkpoint inhibitor) to address this. I encourage patients to seek out clinical trials if they have received PD-1 therapy that is no longer working.

CRI: How is COVID-19 impacting clinical research? Is it still safe to enroll in a clinical trial?

Dr. Friedlander: This varies by institution. Here at UCSF we have weathered the storm fairly well and have been accruing patients to our studies all year long. We have had to modify some of the study procedures to minimize the number of visits and try to reduce COVID exposure. It is not clear that participating in a study, or receiving an immune stimulant, raises your risk of getting COVID or having a worse outcome if you contract COVID, so I encourage patients to take part in trials even during the pandemic.

I also encourage patients to receive the recently approved vaccine(s) if they are available in your area. 

CRI: What are the major areas that need working on, from a research perspective?

Dr. Friedlander: While immune therapy is very effective for some patients, there are still a majority of patients who don't have durable (long lasting) responses, so understanding why these patients don't respond to any therapy is a major area of research. Additionally there are a number of other strategies (chemotherapy, targeted therapy, and others) that have promise even if they are unlikely to cure a patient of bladder cancer, as they may significantly prolong patients’ lives and prevent morbidity.

The drug enfortumab vedotin recently received FDA approval and is being tested in multiple areas in bladder cancer. The FGFR (fibroblast growth factor receptor) inhibitors are showing activity for patients with FGFR2 and FGFR3 mutations, and other targeted therapies are being investigated. 

CRI: Do I need to travel to a major medical center to enroll in a bladder cancer immunotherapy trial?

Dr. Friedlander: Most clinical trials take place at large academic medical centers; however many community oncology practices have clinical trials. It is reasonable to ask your oncologist to see if there are studies nearby. Sometimes it is worth having a one-time visit at a nearby academic center to get the lay of the land. Many of these can be done as a video visit to save you the travel and reduce the COVID risk. 

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*Immunotherapy results may vary from patient to patient.

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