Backed by pioneering research, Hackensack University Medical Center provides innovative kidney, bladder, and prostate cancer care using the latest medications and treatment combinations
The urologic oncology experts at Hackensack Meridian Hackensack University Medical Center’s John Theurer Cancer Center are at the forefront of genitourinary cancer treatment, using the latest immunotherapy medications and protocols to treat kidney, bladder and prostate cancer.
What is immunotherapy?
Immunotherapy treatment works by stimulating the body’s immune system to fight cancer. Immunotherapy can be used in combination with other treatments, such as surgery, targeted therapy, chemotherapy or radiation. It can also be used as a second-line therapy if cancer does not respond to or returns after traditional treatment, or if conventional treatments cause intolerable side effects.
“Immunotherapy is usually a tolerable therapy that provides patients with an excellent quality of life,” said Robert Alter, M.D., co-chief of Urologic Oncology at the John Theurer Cancer Center. “We certainly want to add years to each patient’s life, but we also want to add life to those years.”
Immunotherapy is typically well-tolerated by patients because it does not cause the nausea and hair loss sometimes associated with chemotherapy. However, immunotherapy can still be toxic and needs to be administered properly following guidelines established by the U.S. Food and Drug Administration (FDA). Patients who receive immunotherapy must be carefully monitored for signs of toxicity, such as an overactive immune response that can lead to inflammation in the body.
“Our clinical care providers, including our nurse navigators, nurse practitioners and medical assistants, are tuned in to each of our patients and are constantly watching for side effects due to immunotherapy,” said Dr. Alter. “Cancer care is a team effort.”
The oncologists at the John Theurer Cancer Center are now using next-generation sequencing to identify specific tumor markers resulting from gene mutations, enabling them to select immunotherapy and targeted treatments that will deliver the most cancer-fighting benefit. Next-generation sequencing is most often performed on tumor tissue taken during a biopsy.
“Next-generation sequencing allows us to choose treatments that can selectively target a patient’s tumor with limited toxicity, achieving a better response and enabling the patient to have a better quality of life,” said Dr. Alter. “It’s not only about the cancer; it’s also about the patient who has the cancer.”
Immunotherapy for Kidney Cancer
Immunotherapy has been shown to be effective at shrinking kidney tumors and helping patients to live longer — often with an improved quality of life.
Interleukin-2 (IL-2) and interferon-alpha use cytokines, a type of immune-stimulating chemical, to treat kidney cancer. However, these therapies are most often used as a second-line treatment due to an increased risk of serious side effects.
Newer medications, called immune checkpoint inhibitors, target specific proteins and restore the ability of immune cells to fight cancer. These medications can be used alone or in combination to target specific proteins that make up the tumor.
For example, a study called CheckMate 214 showed that 11 percent of patients with stage IV kidney cancer who used nivolumab combined with ipilimumab — two immune checkpoint inhibitor medications — were able to achieve complete remission.
Immunotherapy medication pembrolizumab combined with targeted drug axitinib is often used as the first treatment for advanced kidney cancer, and a study showed that 59 percent of patients experienced shrinkage of their tumor.
Immunotherapy medications can also be used as a maintenance treatment for kidney cancer, which can prevent cancer from spreading or returning.
“Patients with advanced kidney cancer are receiving the benefit of multiple types of therapies that can be used in combination and offer increased convenience, tolerability and effectiveness,” said Dr. Alter. “Now, in addition to discussing convenience, tolerability and effectiveness, we are also able to discuss curability and survival, which we weren’t able to do 15 years ago.”
Immunotherapy for Bladder Cancer
Immunotherapy can be an option for patients with bladder cancer who are unable to tolerate chemotherapy, or when chemotherapy is ineffective. Similar to kidney cancer, bladder cancer is treated with immune checkpoint inhibitors that are given via intravenous (IV) infusion every 2-3 weeks.
Patients may also receive immunotherapy as a maintenance treatment. The JAVELIN Bladder 100 trial showed a 50 percent improvement in overall survival for patients who received maintenance immunotherapy with the drug avelumab.
“Having the ability to switch treatment mechanisms if one treatment isn’t working gives patients reassurance,” said Dr. Alter. “We are taking science and moving cancer care forward.”
Immunotherapy for Prostate Cancer
Immunotherapy and targeted therapies are also used to treat prostate cancer, but hormone therapy — also called androgen suppression therapy — is also an option. Hormone therapy reduces the number of male hormones called androgens so they can no longer fuel prostate cancer cells.
Hormone therapy can be delivered as an injection administered in the doctor’s office, or as a daily oral medication. Studies have shown that injectable medication results in hormone suppression in 4-6 weeks, while oral medication achieves a similar result in just one week.
“In addition to exploring new, effective treatment options, we are also looking at how we administer medications and the impact that may have on a patient’s quality of life,” said Dr. Alter.
Access to Advanced Clinical Trials
The John Theurer Cancer Center routinely participates in leading-edge clinical trials, providing genitourinary cancer patients with access to some of the most promising therapies years before they receive FDA approval and become available to the public.
Dr. Alter shared a story about a patient who had cancer that continued to recur despite surgery and standard chemotherapy treatment. After participation in a Phase I clinical trial, the patient’s cancer has been in complete remission for four years. The patient finished treatment with the clinical trial drug one year before the medication received FDA approval.
“Our patients are like family, and I always encourage them to participate in clinical trials,” said Dr. Alter. “These studies can give patients a running start on treatment before a drug receives FDA approval.”
Dr. Alter said data from clinical trials also allows oncologists to expand the horizons of cancer treatment and continue to offer new, effective therapies that will enable patients to maintain quality of life.
“When I do my charting at the end of the day, I often find myself smiling because my patients are doing so well,” said Dr. Alter. “I feel like every day is going to be a rewarding day, and I am always excited about the next patient success story.”