Age Influences Response to Bladder Cancer Immunotherapy
Among patients with superficial bladder cancer, response to intravesical immunotherapy (immunotherapy drugs administered directly into the bladder) appears to decline with age. These results were published in The Journal of Urology.
Bladder cancer is a common cancer; approximately 55,000 new cases are diagnosed in the United States each year. Superficial bladder cancer refers to cancer that remains localized within the outermost (most superficial) layers of the bladder and has not spread to deeper layers.
Patients with superficial bladder cancer are routinely treated with surgical removal of the cancer and may also receive additional treatment to decrease the risk of cancer recurrence or progression to more invasive disease. This additional treatment often involves intravesical therapy (placement of medication directly into the bladder). This often consists of mitomycin C or Bacille Calmette-Guérin (BCG). BCG, an immunotherapy agent, is derived from a weakened form of a bacterium related to bacteria that cause tuberculosis.
Immunotherapy acts by stimulating the body to produce an immune response. Thus, it’s possible that immunotherapy will be less effective in patients who have depressed immune systems (such as the very elderly).
To evaluate whether the response to immunotherapy varies by age, researchers evaluated information from a phase II clinical trial. Patients in the trial received intravesical therapy with BCG and interferon alfa.
- Response to treatment was highest in patients between the ages of 61 and 70. Among patients in this age group, 61% were alive and cancer-free after two years.
- Response to treatment was lowest among patients over the age of 80; only 39% of these patients were alive and cancer-free after two years.
- Although there were few patients under the age of 50, response also appeared to be worse in this age group. Forty-five percent of young patients were alive and cancer-free after two years. The reason for the relatively low response in these patients is unclear.
The researchers concluded that aging appears to be linked with a decreased response to intravesical immunotherapy. This decreased response was most apparent among patients over the age of 80.
Reference: Joudi FN, Smith BJ, O’Donnell MA et al. The Impact of Age on the Response of Patients with Superficial Bladder Cancer to Intravesical Immunotherapy. The Journal of Urology . 2006;175:1634-1640.