My aunt has urothelial cancer. Can clinical trials help her?

Question

Hello doctor,

My aunt is 62 and has metastatic urothelial carcinoma with lung and liver spread. She finished six cycles of Cisplatin and Gemcitabine, but her latest PET CT showed two new liver lesions, and alkaline phosphatase is 312 now. So, my concerns are -

Does this mean chemo has stopped working already? Should we ask oncologists about switching to immunotherapy like Pembrolizumab, and what is its success rate at this stage?
Also, are there ongoing clinical trials for advanced bladder cancer worth exploring?
How often should we repeat scans to track the disease, since progression seems to be happening quite quickly despite treatment?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I know it is difficult to see the disease progress despite treatment. Let me try to explain what this means and suggest the next steps.

1. The PET (positron emission tomography) scan showing new liver lesions after six cycles of Cisplatin and Gemcitabine suggests that the chemotherapy is no longer controlling the cancer. The rise in alkaline phosphatase (312) also fits with liver involvement.

2. At this stage, oncologists often consider switching to immunotherapy, and Pembrolizumab (Keytruda) is one of the standard options. Its success rate is not as high as chemotherapy in the beginning, but for some patients, it can give durable, longer-term control. Roughly 20 to 25 % of patients respond well, and those who do may benefit for months to years.

3. Clinical trials are definitely worth asking about. For advanced urothelial carcinoma, there are ongoing trials with combinations of immunotherapy and new targeted drugs (like Enfortumab vedotin or FGFR (fibroblast growth factor receptor) inhibitors in selected patients). Large centers or university hospitals are more likely to have access.

4. Usually, scans are done every two to three months to assess response, but if symptoms worsen, doctors may advise earlier imaging. Since your aunt’s disease progressed quickly, her oncologist may want to keep a closer watch.

Most importantly, even though the first-line chemotherapy has stopped working, there are still options ahead (immunotherapy, trials, supportive care). The key is to discuss with her oncologist soon about switching treatment rather than continuing the same chemotherapy.

I hope this helps.

Thank you and take care.

Regards.