New treatment for urothelial cancer available on the NHS

New treatment for urothelial cancer available on the NHS
© iStock/MJ_Prototype

Over 800 people with locally advanced or metastatic urothelial cancer will benefit from a new treatment – avelumab.

Urothelial cancer is a type of bladder cancer and is three to four times more common in men. Around one in 50 men and one in 133 women will be diagnosed with bladder cancer in their lifetime. Many cases occur in people aged over 60 and the main risk factor for urothelial cancer is older age; however, smoking and exposure to some chemicals can increase the risk.

New draft guidance by NICE recommends avelumab (also known as Bavencio and made by Merck Serono) as maintenance treatment for adults with locally advanced or metastatic urothelial cancer that has not got worst after platinum-based chemotherapy.

What is urothelial cancer?

The most common type of bladder cancer is urothelial cancer, also known as transitional cell bladder cancer. Around 90% of bladder cancer cases are the urothelial cancer form.

This cancer develops from the cells of the bladder lining and when the bladder is empty, these cells are all bunched together. Then, once the bladder fills with urine, the cells stretch out into a singular layer and come into contact with waste products in the urine that may cause cancer, such as chemicals from cigarette smoke.

Blood in the urine is the most common symptom of bladder cancer; however, less common symptoms include sudden urges to urinate and a burning sensation when passing urine. If bladder cancer reaches an advanced stage, symptoms such as pelvic and bone pain may occur.

Treatment for bladder cancers such as urothelial cancer typically is treated depending on how advanced the cancer is. However, treatment options will either be:

  • An operation to remove your bladder,
  • Radiotherapy with a radiosensitiser.

Avelumab immunotherapy

Avelumab is a type of immunotherapy known as a checkpoint inhibitor. This form of treatment stimulates the body’s immune system to fight cancer cells. Avelumab targets and blocks a protein called PD-L1 on the surface of certain immune cells. By blocking this protein, it activates the immune cells to find and kill cancer cells.

Clinical trial evidence showed that avelumab increases both how long people live and the length of time before their disease get worse compared with best supportive care alone.

Helen Knight, interim director for medicines evaluation at NICE, said: “People with locally advanced or metastatic urothelial cancer often have a poor quality of life and a poor prognosis. Avelumab is a promising drug that has the potential to extend life. The committee recognised there are few treatments available to people with this form of cancer, many of whom have to wait until their disease gets worse before they are able to have immunotherapy or further courses of chemotherapy.”


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