Can new targeted drugs help my wife, 58, with bladder cancer?

Question

Hi doctor,

My 58-year-old wife was diagnosed with metastatic urothelial carcinoma six months ago, and treatments are not working like we hoped. It started as bladder cancer, but now has spread to her liver and bones in the spine. She has been through four cycles of Cisplatin and Gemcitabine, but the last CT scan showed progression of disease. Her creatinine is up to 2.1, so the oncologist cannot use Cisplatin anymore because of kidney damage. The doctor tried immunotherapy with Pembrolizumab, but after three infusions, her tumors are still growing. The bone metastases are causing severe back pain, and she needs OxyContin just to get through the day.

Her appetite is gone, and she has lost 25 pounds in the past three months, which makes her look so frail. The urothelial carcinoma has also caused kidney obstruction, and she has to have stents changed every three months. The radiation oncologist did some palliative radiation to the spine, but the pain is still bad. I am really running out of options and not sure what else can be tried for metastatic urothelial carcinoma. Are there clinical trials or newer targeted therapies that might help? also wondering about the quality of life versus continuing aggressive treatment at this point.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

I am sorry to hear about what your wife is going through, and I can feel how overwhelming and exhausting this must be for both of you. When urothelial carcinoma becomes metastatic and stops responding to both platinum chemotherapy and immunotherapy, treatment options become more limited, but there are still some possibilities worth discussing with her oncologist.

Newer targeted therapies, such as Erdafitinib, which work against tumors with FGFR2 (fibroblast growth factor receptor) or FGFR3 genetic alterations, can be effective in selected patients, but this requires testing the tumor for those mutations. Antibody drug conjugates like enfortumab vedotin and sacituzumab govitecan have also shown benefit in patients whose disease progressed after chemotherapy and immunotherapy, and these are being used more widely, though availability may depend on location and eligibility.

Clinical trials are another option and often give access to cutting-edge treatments, including combinations of immunotherapy with targeted agents. At the same time, given her kidney function decline, weight loss, pain, and overall frailty, it is important to weigh the potential benefits of aggressive treatments against the risks and side effects they may bring.

Supportive and palliative care should not be seen as “giving up” but rather as focusing on her comfort, pain control, nutrition, emotional well-being, and quality of life. A palliative care team can work alongside oncology to manage pain, appetite loss, fatigue, and other symptoms while still leaving the door open for additional cancer-directed therapy if she is a candidate.

It may help to have an open conversation with her oncologist about realistic goals of care at this stage and whether a clinical trial, a targeted drug, or a shift toward primarily supportive care would best align with her wishes and priorities.

I hope this information will help you.

Thanks.