Thousands of NHS patients with deadly bladder cancer will benefit from a drug that offers new hope for a cure.
In a landmark ruling, UK health chiefs have approved nivolumab for patients who are too weak to withstand 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 can’t get chemo because of the crippling side effects, so their cancer usually returns within a year.
However, trials have shown that nivolumab, which helps the body’s immune system search for and destroy cancer cells, keeps the disease at bay for twice as long.
Some patients have no signs of cancer for at least three years after they stop taking the drug.
Professor Tobias Arkenau, consultant oncologist at the Sarah Cannon Research Institute in London, said: ‘Many of my bladder cancer patients cannot tolerate chemotherapy. After we remove what we can with surgery, they just have to keep their fingers crossed and hope it doesn’t come back.
The new drug is thought to offer hope to patients who cannot undergo chemotherapy (stock image)
“But this drug works phenomenally well and the side effects are much less severe.”
More than 10,000 Britons are diagnosed with bladder cancer every year. If caught early, patients are usually offered minimally invasive surgery in which the tumor is excised using instruments that are passed through the urethra to the bladder — 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 the tumor begins to grow in the muscle wall lining the bladder. These patients are offered either radiation therapy to shrink the cancer or invasive surgery to remove the organ and surrounding tissues.
Artist Tracey Emin has spoken candidly about the major procedure in 2020 to treat her bladder cancer, which involved the removal of multiple pelvic organs, including her bladder, forcing her to use a urostomy bag for urine.
Cancer cells remain in one in five patients with bladder surgery. Chemotherapy can be given to destroy them, but a third of patients are elderly or in poor health and cannot withstand the debilitating side effects.
Instead, they are only closely monitored and treated if the cancer comes back. This happens within two years for about half of the patients, at which point it is more difficult to treat.
dr. Robert Huddart, professor of oncology at the Institute of Cancer Research in London, said: ‘We can only go so far as relying on scans to ensure that we detect small cancers. It’s easy to miss a small tumor. That’s why it’s vital that we have a treatment that can destroy the cancer cells that lie in wait for every patient.”
Nivolumab is the first treatment to offer this group hope for a cure. The drug, given as an infusion every two weeks for up to a year, works by turning off proteins called PD-L1 attached to the tumor, making it invisible to fighting cells in the immune system. This ‘shutdown’ of the proteins allows the immune system to track down and attack the cancer.
Artist Tracey Emin (pictured) has spoken candidly about a major procedure to treat her bladder cancer in 2020
PD-L1 proteins are attached to many other tumors, and nivolumab has been shown to be similarly effective in other cancers. NHS patients with skin cancer, kidney cancer and some head and neck cancers can be treated with the drug. Side effects are usually mild, the most common being itchy skin, diarrhea and fatigue.
dr. Syed Hussain, a professor of oncology at the University of Sheffield who was involved in the nivolumab study, said: ‘I treated a 60-year-old man with nivolumab and even two years later there is still no sign of cancer.
Best of all, he had an excellent quality of life with the drug, with virtually no side effects. It was quite remarkable.
“Clearly, patients taking nivolumab can continue to enjoy their daily lives, which is much more difficult with chemotherapy.”
Strange science: boys who turn into boys during puberty
There is a village in the Caribbean where many of the boys do not develop sexual organs until they reach puberty.
Known as Guevedoces, which translates as ‘penis at 12’, the children are born with what appears to be female genitalia due to a hormone deficiency.
Normally, babies in the womb are neither male nor female until about eight weeks after conception, when sex hormones kick in.
In boys, testosterone is converted into a powerful hormone called dihydrotestosterone, which triggers the development of sex organs.
But Guevedoces are deficient in an enzyme that initiates this process, so they appear feminine when born and are raised this way.
It’s only when they reach puberty and have a second wave of testosterone that the body responds.
Your amazing body
Researchers believe getting wrinkly hands in the water is an evolutionary advantage
If we spend too long in the tub, fingers and feet get wrinkly — but this quirk of our bodies may have once served an important purpose.
Experts believe that the ridges that form in the skin gave our ancestors an evolutionary advantage, allowing them to grip wet objects or surfaces by diverting water, much like the tread of a car tire does.
The 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 feet, making them marginally smaller and forming loose skin folds.