Urothelial bladder cancer (UBC), the most common form of bladder cancer, is the sixth most common cancer in the U.S. About 85,000 people are diagnosed in the U.S. each year, but the good news is that treatments for UBC are getting more advanced and more effective.
Immunotherapy is a type of treatment that uses the body’s own immune system to attack cancer cells. The Food and Drug Administration (FDA) approved the first immunotherapy treatment for UBC in 1990. And since then several more have been approved.
Here’s everything you need to know about how immunotherapy works with the body to fight cancer and types of immunotherapy for UBC.
How does the immune system fight diseases?
The immune system is made up of organs, cells and proteins that recognize and protect the body from antigens, which are substances on bacteria, viruses, tumors and even normal cells that alert your body to a foreign substance.
Your immune system is like a team of soldiers protecting your body.
Cancer cells are like enemies. These enemies have “flags” on them called antigens.
Your immune system uses these “flags” to recognize what does not belong. When the immune system detects something harmful, it triggers a response and makes antibodies to help destroy it. The immune system can also learn to recognize these threats, so it can respond faster in the future.
Think of it like this: When the body spots an enemy:
- It sends in soldiers (immune cells)
- It makes weapons (antibodies)
- It remembers the enemy, so it can fight faster next time
What are the different cells in the immune system?
The immune system is made up of different cells that work together to fight off infection and disease.
- B cells: Design and release antibodies to defend against each specific antigen.
- CD4+ helper T cells: Send signals to other immune cells to let them know where to go and which harmful cells to attack.
- CD8+ killer T cells: Destroy infected cells in the body.
- Dendritic cells: Eat and analyze harmful cells so other immune cells can recognize and destroy them.
- Macrophages: Similar to dendritic cells, macrophages eat and analyze harmful cells in large amounts so other immune cells can recognize and destroy them.
- Regulatory T cells: Monitor and balance the immune system to make sure it doesn’t overreact or attack its own healthy cells, which is known as an autoimmune disorder.
How does immunotherapy work?
Immunotherapy is a type of treatment that uses the body’s immune system to fight diseases like cancer. There are two main ways immunotherapy works:
- Strengthening and supporting the immune system so it’s better suited to find and fight cancer cells
- Using lab-made parts of the immune system to enhance the body’s ability to find and fight cancer cells
What types of immunotherapy are available for bladder cancer?
There are a few types of immunotherapy used to treat bladder cancer.
Immune checkpoint inhibitors: Checkpoints on immune cells can tell the immune system to start or stop an immune response. Cancer cells can affect the checkpoints, telling them to put the brakes on the immune system, which allows the cancer cells to grow. Immune checkpoint inhibitors release the brakes, allowing the immune system to stay active so it can attack cancer cells.
For UBC treatment, immune checkpoint inhibitors can either target PD-L1, a protein on cells that stops the immune system from attacking those cells, or PD-1, a protein that stops the immune system from attacking other cells. PD-L1 and PD-1 inhibitors block these proteins to shrink tumors or slow their growth.
Intravesical therapy: These are therapies that are inserted directly in the bladder. They are in liquid form and are typically used for earlier, less invasive types of bladder cancer and include:
- Bacillus Calmette-Guerin (BCG)
- Nadofaragene firadenovec (Adstiladrin)
- Nogapendekin alfa inbakicept (Anktiva)
Although each of these treatments are made up of different substances, they all work by triggering the immune system to attack cancer cells.
Antibody drug conjugates (ADCs), aka targeted antibodies: These manmade antibodies are linked to chemotherapy drugs. They call the chemotherapy drugs directly to the cancer cells to fight them more efficiently.
Can more than one immunotherapy be used?
Yes. Depending on the type of tumor and how advanced the cancer is, a combination of different immunotherapy medications may be used for a more effective treatment. Immunotherapy may also be used with more traditional therapies like radiation, surgery or chemotherapy.
This educational resource was created with support from Merck.
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