At 62, can immunotherapy cure my urothelial carcinoma?

Question

Hello doctor,

I am a 62-year-old man and was diagnosed with metastatic urothelial carcinoma originating from the bladder. It is now spread to the pelvic lymph nodes and one lesion in the liver. I just completed my first cycle of Gemcitabine and Cisplatin. My creatinine is up to 1.8 now, and I am exhausted all the time. My oncologist mentioned switching to immunotherapy if kidney function worsens. Please tell me,

Can you explain in plain words what the treatment roadmap looks like at this stage?
Is immunotherapy more effective or just less toxic?
How do I know if treatment is working or just delaying things?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

You have metastatic urothelial carcinoma that has spread to the pelvic lymph nodes and one spot in the liver. Gemcitabine (a nucleoside metabolic inhibitor) plus Cisplatin (platinum-based chemotherapy medication) is the standard first step for your treatment. It can shrink the cancer quickly and control the spread. However, Cisplatin is known to be harsh on the kidneys, and a creatinine of 1.8 suggests that your kidneys are starting to get strained. This is a common reason for switching to a different type of treatment.

If the kidneys cannot tolerate more Cisplatin, the next step is usually immunotherapy. The commonly used medications are Pembrolizumab (a PD-1 inhibitor), Nivolumab (a PD-1 inhibitor), or Atezolizumab (a humanized IgG1 monoclonal antibody). These medicines work by helping your own immune system recognize and attack the cancer cells. Many people move to immunotherapy after only one or two cycles of chemotherapy if side effects make chemotherapy unsafe.

Immunotherapy is often both less toxic and sometimes more effective long-term, depending on how your body responds. It causes far fewer kidney issues compared to Cisplatin and generally does not cause hair loss or severe nausea. The main limitation is that it takes time, usually several weeks, before you start seeing results. Not everyone responds, but patients who do respond can experience long-lasting control of the disease, sometimes for years.

To understand whether treatment is working, you will have regular scans every eight to twelve weeks. These will show whether tumors are shrinking, stable, or growing. You will also notice an improvement in the following symptoms;

Fatigue.
Appetite.
Pain and energy levels.

Blood tests help monitor organ function and how well your body is tolerating the therapy. Oncologists categorize response as complete response, partial response, stable disease, or progression, and even stable disease can be meaningful because it prevents further spread.

At this stage, the goal of treatment is to control the cancer, slow down progression, extend life, and maintain the best possible quality of life. Your next steps are to closely monitor kidney function and stay in communication with your oncologist. If your creatinine continues to rise, it is appropriate to transition early to immunotherapy.

I hope this information helps you.

Feel free to ask further queries.

Thank you.