Thousands of NHS patients with fatal bladder cancer are set to benefit from a drug that offers new hope for treatment.
In a landmark ruling, UK health chiefs approved nivolumab for people too weak to tolerate treatments such as chemotherapy.
Doctors usually give a course of chemotherapy after removing bladder tumors to kill any remaining cancer cells.
But there are no alternatives for patients who cannot have chemotherapy due to disabling side effects, so their cancer usually returns within a year.
However, trials have shown that the drug nivolumab, which helps the body’s immune system to find and destroy cancer cells, keeps the disease at bay twice this time.
Some patients do not show signs of cancer at least three years after they stop taking the drug.
‘Many of my bladder cancer patients cannot tolerate chemotherapy,’ said Professor Tobias Arkenau, consultant oncologist at the Sarah Cannon Research Institute in London. After we’ve removed what we can do with surgery they just have to keep their fingers crossed hoping it won’t come back.
It is believed that the new drug could give hope to patients who cannot undergo chemotherapy (stock image)
“But this drug works very well and the side effects are much less horrific.”
More than 10,000 Britons are diagnosed with bladder cancer each year. If caught early, patients are usually offered a minimally invasive surgery in which the tumor is cut out using instruments passed into the bladder through the urethra – the passage through which urine exits the body. A short course of chemotherapy is given to remove any remaining cancer cells.
But about a quarter of bladder cancer cases are diagnosed later, in stages two to three, when a tumor begins to grow in the muscle wall lining the bladder. These patients are offered either radiotherapy to shrink the cancer or invasive surgery to remove the organ as well as the surrounding tissue.
Artist Tracey Emin has spoken candidly about a major procedure in 2020 to treat bladder cancer, which involved removing several of her pelvic organs, including the bladder, which made her use a urostomy bag to hold urine.
In one in five bladder surgery patients, cancer cells remain. Chemotherapy can be given to destroy them, but a third of patients are old or in poor health and unable to tolerate the stressful side effects.
Instead, it is closely monitored and only treated when the cancer has returned. This occurs within two years for about half of patients, at which point it is more difficult to treat.
Dr Robert Hodart, professor of oncology at the Institute of Cancer Research in London, said: “Relying on screening to make sure small cancers are detected can go as far. It’s easy to miss a small tumor. This is why it is so important to have a treatment that can eliminate the cancer cells that may be lurking in each patient.
Nivolumab is the first treatment that gives this group hope of a cure. The drug, given as a drip every two weeks for up to a year, works by disrupting proteins called PD-L1 that are linked to tumors making them invisible to the immune system’s fighting cells. This “switching off” of the proteins allows the immune system to detect and attack cancer.
Actress Tracy Emin (pictured) has spoken candidly about having a major operation to treat bladder cancer in 2020.
Many other tumors have PD-L1 proteins attached to them, and nivolumab has been shown to work effectively on other cancers in the same way. NHS patients with skin cancer, kidney cancer and some head and neck cancers may be treated with this drug. Side effects are often mild, with the most common being itchy skin, diarrhea and tiredness.
Dr Syed Hussain, Professor of Oncology at the University of Sheffield, who was involved in the nivolumab trial, said: “I treated a 60-year-old man with nivolumab and there is still no sign of cancer even after two years.
Best of all, he had an excellent quality of life on medication, with virtually no side effects. It was so wonderful.
“It’s clear that patients who take nivolumab can happily go about their daily lives, which is even more difficult with chemotherapy.”
Weird science: boys who turn into boys at puberty
There is a village in the Caribbean where many boys do not develop sexual organs until they reach puberty.
Commonly known as Guevedoces, which translates to “penis at 12,” babies are born with what resemble female genitals due to a hormone deficiency.
Normally, babies in the womb are neither male nor female until after eight weeks of pregnancy, when the sex hormones begin to appear.
In boys, testosterone is converted into a powerful hormone called dehydro-testosterone that stimulates the growth of the sex organs.
But Guevedoces are deficient in the enzyme that triggers this process, so they appear as female when they are born and are raised that way.
Only when they reach puberty, and have a second boost in testosterone, does the body respond.
Your amazing body
Researchers think having wrinkled hands in water is an evolutionary advantage
Soaking too long in the shower makes fingers and toes wrinkle—but this weirdness in our bodies may once have served an important purpose.
Experts believe the spurs that form in the skin gave our ancestors an evolutionary advantage, helping them grip wet objects or surfaces by directing water away, much like the tread of a car tire.
Wrinkles appear when the brain sends signals to the blood vessels under the skin, telling them to contract.
This reduces blood flow to the fingers and toes, slightly reduces in size and forms sagging skin folds.