Dr Henderson on Incorporating Immunotherapy Agents into Practice in Bladder Cancer

R. Jonathan Henderson, MD, oncologist, Arkansas Urology; member, the American Urologic Association, Shreveport Medical Society, Louisiana State Medical Society, and the Society of Laparoscopic Surgeons; president, LUGPA Board of Directors, discusses incorporating immunotherapy agents into practice in patients with bladder cancer.

Henderson believes that when integrating immunotherapy into clinical practice, the primary step for urologists is to ensure alignment and collaboration within the entire practice. He goes on to state that it's crucial to recognize that including immunotherapy in clinical practice introduces a new range of potential complications, or adverse effects (AEs), particularly autoimmune AEs such as pneumonitis, pancreatitis, and organ inflammation, which are well-defined but not typically managed in routine practice. These AEs occur in approximately 50% of patients who receive immunotherapy agents, he says. Therefore, it's essential for everyone involved in the treatment of patients receiving immunotherapy to connect with specialized professionals in their community before venturing into this domain, Henderson notes. Notifying these specialists beforehand allows for a network of support for managing AEs when they arise. Although these complications are likely to occur, it is often unclear when they will manifest, he adds. As the adoption of immuno-oncology agents increases, urologists are likely to encounter immunotherapy-associated AEs more frequently, Henderson notes.

Looking to the future, the most significant development in bladder cancer treatment may manifest in the ability to reduce the frequent recurrence of superficial bladder cancer, he expands. Although invasive cancers requiring chemotherapy or cystectomy are costly, the recurring superficial cases, which demand repetitive procedures, pose the greatest burden to the healthcare system, he emphasizes. Patients with recurrent superficial bladder cancer often undergo multiple surgeries, causing financial strain for themselves and the healthcare system, Henderson states.

The emergence of newer agents that operate through immune mechanisms may address these challenges, Henderson continues. This advancement arrives at an opportune moment, especially considering the long-standing shortage of Bacillus Calmette-Guérin, the most effective intravesical therapy available for patients with superficial bladder cancers, he states. The introduction of new treatment options is timely and significantly enriches the available medical resources for managing this condition, Henderson concludes.