Keytruda Enhances Bladder Cancer Outcomes Post-Op

On Wednesday, September 18, 2024, a new study revealed that Keytruda, when administered post-organ removal surgery, can significantly extend the cancer-free period for patients with advanced bladder cancers. This promising development offers new hope for individuals diagnosed with "high-risk" bladder cancers—tumors that have already invaded the surrounding muscles.

The study demonstrated that patients who received Keytruda (pembrolizumab) after their surgeries experienced a doubling in the duration they remained cancer-free compared to those who did not receive the drug. Lead researcher Dr. Andrea Apolo highlighted the significance of these findings, noting that extending the time patients remain cancer-free greatly enhances their quality of life. Dr. Apolo serves as a senior investigator in the Genitourinary Malignancies Branch of the Center for Cancer Research at the National Cancer Institute (NCI).

Funded by the NCI and published in the New England Journal of Medicine on September 14, the study sheds light on the treatment of high-risk bladder cancers, which are generally addressed through surgeries involving complete bladder removal. To eliminate any remaining cancer cells in the surrounding tissue, many patients undergo a round of cisplatin chemotherapy prior to their surgeries. However, due to the severe side effects of cisplatin, some patients cannot tolerate this treatment and are instead closely monitored for signs of cancer recurrence post-surgery.

In recent years, the use of immunotherapy drugs post-surgery has gained traction among healthcare providers. In 2021, the U.S. Food and Drug Administration approved Opdivo (nivolumab), another immunotherapy drug, for post-surgical use in treating high-risk bladder cancers. The recent trial explored a similar approach using Keytruda, enrolling 702 patients with high-risk bladder cancers who had undergone bladder removal surgeries. Approximately two-thirds of these patients had also received pre-operative cisplatin.

The trial divided the patients into two groups: one received post-surgery Keytruda every three weeks for a year, while the other group was only monitored. Over a follow-up period of four years, researchers observed that patients treated with Keytruda remained cancer-free for an average of nearly 30 months. In contrast, those who did not receive the drug remained cancer-free for just over 14 months.

The effectiveness of Keytruda also appeared to vary depending on the type of bladder tumor. For tumors that were PD-L1-positive—meaning they produced a significant amount of the PD-L1 protein—the average cancer-free period was nearly 37 months. This was a substantial increase compared to the 21 months for patients with the same tumor type who were only monitored after surgery. For PD-L1-negative tumors, the average cancer-free survival time was 17.3 months, still a notable improvement over the 9 months for patients who did not receive Keytruda.

These findings underscore the potential of Keytruda as a vital post-surgical treatment option for high-risk bladder cancer patients, offering them a significantly longer period free from cancer and thereby improving their overall quality of life.