Bladder cancer: an obvious symptom should lead you to consult

“Too little known to the general public, bladder cancer is a real public health issue. It is essential to make the general public aware of the warning signs. The primary objective of Bladder Cancer Month is to make the general public aware of the seriousness of this cancer but also of the very good prognosis if it is diagnosed early.” declares Dr. Benjamin PRADERE, Urologist and member of the cancerology committee of the French Association of Urology (AFU). On the occasion of the 4th edition of Bladder Month, the AFU is mobilizing to deploy throughout the month of May, a large awareness and information campaign on this still very little-known cancer.

Improve early diagnosis

Although largely unknown, bladder cancer is devastating: 13,000 to 20,000 additional people affected each year, 5,000 deaths per year, 4 times more cases in men than in women, 2nd urological cancer and a rate of remission ranging from 80% to 5%… Metastatic bladder cancer is one of the cancers with the poorest prognosis and one of the great challenges of urology in the 2020s. In France, smoking would be responsible 53% of cases of bladder cancer in men and 39% in women.

However, in 80 to 90% of cases, it is easy to spot: the first symptom is the presence of visible blood in the urine. But the general public still needs to know this… This is why the AFU (and therefore 90% of French urologists) is mobilizing for Bladder Month through a major awareness campaign, a series of meetings information, a Patient day and various events. Because time is the most important factor for survival:

• When cancer is caught in time, survival is 80% at 5 years;
• If the diagnosis is made later, only 50% survival is observed,
• And more than 5% survival at the metastatic stage.

It is therefore essential that people can consult as quickly as possible when the first symptoms appear.

New therapies soon available

The challenges of this bladder month are twofold: improving early diagnosis but also access to therapeutic innovations. “In terms of therapeutic innovations, the new treatments that were presented at ESMO are at the heart of this Bladder Month. It is the challenge for urologists and patients to have, as soon as possible, these new treatments at their disposal” declares Professor Yann Neuzillet, urological surgeon and member of the AFU oncology committee.

There are indeed numerous therapeutic innovations:

• Immunotherapies At the top of the list, immune checkpoint inhibitors targeting PD-1 have changed the prognosis of metastatic cancers for 10 years. Over the past year, the development of their use in earlier phases of the disease has made it possible to demonstrate the benefit of prescribing nivolumab in the adjuvant situation, that is to say in all cases. first months after surgery (cystectomy) to treat cancers with a high risk of recurrence.
• In more advanced stages of the disease, the delivery of chemotherapy in combination with antibodies targeting specific surface molecules of cancer cells (Antibody Drug Conjugates or ADC) makes it possible to treat bladder cancer more effectively while reducing the collateral effects of chemotherapy. Enfortumab vedotin is the first ADC to demonstrate benefit in prolonging the lives of patients after they have received conventional chemotherapy and immunotherapy.
• Very recently, this ADC in combination with immunotherapy with pembrolizumab has demonstrated the ability to halve the risk of death in patients newly diagnosed with locally advanced or metastatic disease. This immunotherapy had already demonstrated a benefit for patients who received chemotherapy and for those who cannot receive optimal chemotherapy. It is therefore to be hoped that health authorities will quickly validate their use in this new indication for the benefit of patients.
• Finally, new levers of action against cancer cells are being developed. Concretely, patients whose cancer presents genetic alterations of a protein called FGFR can benefit from treatment with an inhibitor of this molecule, erdafitnib, when the disease progresses the administration of conventional chemotherapy and immunotherapy. Other proteins, such as HER2, offer similar prospects.