Duke Cancer Institute Center for Prostate and Urologic Cancers offers patients with bladder cancer many of the newest and most promising treatments. This includes new medical therapies, advanced surgical capabilities, and minimally invasive ablative techniques. 

“Our team is on the forefront of the latest treatments for both muscle-invasive and non-muscle-invasive bladder cancer,” says Duke urologic oncologist Jeffrey Gahan, MD. “We have breakthrough therapies and technology available to personalize treatment for once hard-to-treat bladder cancers, which is revolutionary,” he adds.

“One technology we’re excited about offering patients is thulium laser for tissue vaporization, ablation, and en bloc resection,” says Michael R. Abern, MD, urologic oncologist. 

With this procedure, bladder tumors can be ablated with a more controlled depth of tissue penetration. This minimizes potential damage to healthy bladder tissue. Other benefits include better control of bleeding during the procedure and cleaner margins with tumor removal. 

“For patients with small bladder tumors, this option can be beneficial because it can avoid more invasive surgical procedures under general anesthesia. We can complete the ablation in our clinic,” says Abern.

Another new treatment evolving the standard of care for muscle-invasive bladder cancer (MIBC) is the drug combination enfortumab vedotin with pembrolizumab (EV+P). EV+P is now a first-line perioperative treatment showing promising results.

“Muscle-invasive bladder cancer has been a lethal disease for quite some time. With EV+P, we’re seeing meaningful results with disease control compared to chemotherapy alone,” says Gahan. 

Gahan explains that patients receive at least three cycles of EV+P before surgery. Of the patients treated, nearly 60% are disease-free pre-surgery. “This is now a disease we can manage effectively in many cases,” he says.

Enfortumab vedotin is an antibody-drug conjugate. The antibody finds and binds to a protein found on the surface of bladder cancer cells. When it attaches, it releases a toxic chemotherapy payload directly into the cancer cell. This targeted therapy destroys the cancer cells while sparing healthy tissue. Pembrolizumab is an immune checkpoint inhibitor that works by blocking the PD-1 protein on T-cells, enabling the immune system to recognize and attack cancer cells. The combination offers two mechanisms of action to target and kill the cancer cells.

Gahan and team are utilizing AI diagnostic tools that aggregate thousands of pathology data points to help predict favorable treatment response for each patient. “Using these advanced diagnostic tools, we can individually tailor our treatments based on the patient’s imaging and pathology reports,” says Gahan. 

Additionally, technology is being implemented to monitor patients for treatment effectiveness or cancer recurrence. With a blood draw, the team can detect distinct bladder cancer cells with high sensitivity and specificity. “This helps us understand if the patient is a candidate for escalating or de-escalating treatment,” Gahan notes. “It’s an exciting time because we have personalized real-time data telling us how a patient is responding to treatment, so we can identify early indicators of response or recurrence and adjust treatment accordingly,” he adds.

Effective treatments for non-muscle invasive bladder cancer (NMIBC)are expanding and now offered at Duke. This has been an unmet need, but more first- and second-line treatment options are rapidly being developed. 

“Patients and referring providers can trust that Duke is examining and offering treatments for all types of bladder cancer, including new trials,” says Gahan. 

The program also offers clinical trials for novel therapies to treat NMIBC, including new treatments for patients with high-grade tumors that recur after Bacillus Calmette-Guérin (BCG) therapy, as well as treatments for recurrent low-grade tumors.

“We have experts in every discipline to offer the best possible care,” says Gahan. “And we communicate and coordinate patients’ care well as a team.” Patients can expect a multidisciplinary assessment at their first appointment, with multiple specialties present. This can include medical oncologists, radiation oncologists, surgeons, and more. 

Gahan concludes, “We offer patients the best experience and timely care. We want to understand each patient’s wishes and goals, so we can develop a cohesive and comprehensive treatment plan to support them.”