Will Pembrolizumab help me with my metastatic cancer?

Question

Hello doctor,

I am 62 and was diagnosed with bladder cancer eight months ago and had my bladder removed, but recent scans show the cancer has spread to my liver and lungs.

My oncologist mentioned this is now metastatic urothelial carcinoma and wants to start me on immunotherapy with Pembrolizumab after chemotherapy did not work as well as hoped. I am feeling overwhelmed by this progression and wondering what my prognosis really is with metastatic disease.

How effective is immunotherapy for this type of cancer?
What side effects should I expect?
Should I be thinking about palliative care options?
How do I discuss this with my family?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

I am truly sorry that you are going through this. Living with metastatic urothelial carcinoma, especially after bladder surgery and chemotherapy, is physically and emotionally exhausting. It is completely understandable to feel worried if a treatment does not seem to be working.

Metastatic urothelial carcinoma can be difficult to treat once it has spread. After chemotherapy, immunotherapy with Pembrolizumab is a standard option. It works by helping your immune system recognize and attack cancer cells. It is usually given as an IV (intravenous) infusion every three weeks.

Not everyone responds the same way. Around 20 to 30 percent of patients have durable responses with Pembrolizumab alone. In recent years, combining it with Enfortumab vedotin has shown better outcomes in many patients compared to getting chemotherapy alone. Some patients may experience meaningful tumor shrinkage or longer disease control, but results may vary depending on overall health and disease burden.

If immunotherapy is not giving you the desired response, it does not mean there are no options. Your oncologist may consider:

Combination immunotherapy approaches.
Targeted therapies (a type of cancer treatment that targets proteins that control how cancer cells grow, divide, and spread).
Clinical trials.
Symptom-focused (palliative) treatments to improve comfort and quality of life.

Palliative care does not mean giving up. It focuses on controlling pain, fatigue, breathlessness, and emotional distress, and it can be given alongside active cancer treatment.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.