FDA Approves “Game Changer” Immunotherapy Drug for Bladder Cancer

Bladder cancer survivor and his wife on a sailboat.

Craig Brown and his wife, Lynda, sailing on the Hudson River. Mr. Brown’s bladder cancer disappeared after he received atezolizumab as part of a clinical trial at MSK.

People with advanced bladder cancer have not traditionally had effective treatment options. Although chemotherapy can temporarily hold the disease at bay, it often comes roaring back within months.

Now these patients have a new reason for hope. Today, the FDA approved the immunotherapy drug atezolizumab (Tecentriq®) for patients with metastatic urothelial carcinoma, the most common form of the disease. The drug’s approval stemmed largely from results of a phase II clinical trial led by Memorial Sloan Kettering medical oncologist Jonathan Rosenberg.

The drug represents the first new treatment for this type of bladder cancer in more than 20 years and could have a major impact on the disease, which is the fifth most common form of cancer and the fourth most common in men. The drug is specifically approved for urothelial carcinoma arising in the urinary tract. (The FDA occasionally approves drugs showing great promise in phase II studies, whereas most drugs typically aren’t approved until after completing phase III.)

It is also the latest success story in the burgeoning field of immunotherapy, treatments that exploit the power of the immune system to fight cancer.

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“We’re seeing people get lasting responses with atezolizumab after chemotherapy has stopped working,” says Dr. Rosenberg. “That’s a game-changer for these patients, and it represents a huge breakthrough.” 

Results from the trial, which were published in The Lancet, showed that atezolizumab shrank tumors in a significant portion of patients. The benefit appeared to be lasting in many people. Among patients in the clinical trial who had anticancer responses, 84 percent were still responding after about one year.

Although the approval is for use in certain bladder cancer patients only — those with metastatic disease who previously have received chemotherapy — Dr. Rosenberg says this approval might later expand to others with the disease.

“These patients have few options and the existing treatments that are available are very toxic — and none of them are known to prolong life,” he says.

“A Whole New Spin on Your Life”

For Craig Brown, who participated in the clinical trial, atezolizumab has been nothing short of a miracle. In early 2014, he was diagnosed with stage IV bladder cancer that had spread to his ribs. He began receiving platinum-based chemotherapy (the most common type) once a week for nearly six months, but the treatment proved to have limited benefit and brought severe side effects.

“The chemo made me extremely tired, and it took a while to wear off,” he says. “At some points I could barely get out of bed after receiving it. There was some improvement with the cancer, but not complete remission, and as soon as I stopped taking the chemo, it came back almost immediately.”

I'm able to live now with a far better picture of the future.
Craig Brown patient

MSK medical oncologist Dean Bajorin enrolled Mr. Brown in the atezolizumab trial in October 2014. Mr. Brown says the change to his health was immediate and dramatic. Not only did the new drug begin shrinking the cancer immediately, it also has caused no noticeable side effects during the 19 months he has been on it. He is still receiving atezolizumab once every three weeks under the care of Dr. Bajorin.

“It’s been tremendous,” he says. “I’m a CPA, and I’ve been able to work from early in the morning to late at night six days a week like I did before the cancer. The doctors tell me I’m in complete remission. It puts a whole new spin on your life to be this fortunate.”

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Providing Lasting Potency

Atezolizumab is one of a new group of immunotherapy drugs called checkpoint inhibitors. These drugs take the brakes off the immune system, allowing it to attack the cancer. The braking molecule targeted by atezolizumab is called PD-L1, which is expressed on the surface of some cancer cells and immune cells and prevents the immune system from recognizing that the cancer cells pose a threat. Other checkpoint inhibitors have already been approved for the treatment of several other cancers, including melanoma, lung, and kidney cancers.

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Dr. Rosenberg says that the most impressive benefit of atezolizumab may be its lasting effectiveness.

“That is not something we have seen before with bladder cancer,” he explains. “There are some patients whose cancer disappeared completely, even after spreading to other sites. You never saw that on a regular basis with chemotherapy-resistant bladder cancer.”

He says upcoming clinical trials will test atezolizumab in additional bladder cancer patients — either alone or in combination with chemotherapy, angiogenesis inhibitors (drugs that choke off tumor blood supply), or other targeted agents. There also is a great deal of interest in seeing whether atezolizumab can be an effective and safe treatment earlier in the disease process.

Mr. Brown is delighted at the thought of more patients having atezolizumab as a treatment option. “I’m able to live now with a far better picture of the future,” he says. “This approval is a wonderful thing so that other people may also share in the benefits of this drug.”

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Commenting is disabled for this blog post.

I have been diagnosed with Transitional Cell Carcinoma. I'm in the midst of Radiation treatment and my medical oncologist wants me to start the old school platinum based chemo.

I've been praying for the opportunity to be treated by an immune therapy, but I did not qualify for any trails.

I'm excited to learn more.

Dear Bill, we are sorry to hear about your diagnosis. We recommend that you follow up with your oncologist to see if the newly approved immunotherapy drug is an option for you. We continue to study immunotherapy and other novel treatments for people with bladder cancer. Those studies can be found here: https://www.mskcc.org/cancer-care/types/bladder/clinical-trials. If you have specific questions about any of our clinical trials or would like to make an appointment for a second opinion regarding the next steps in your care, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

I am a bladder cancer patient, have treated with Dr Machelle Donat of MSKCC (a world class doctor and wonderful person) since 2011. My bladder cancer is T-1 and has recurred several times after BCG, Mytomicin and Gemcitabene. Dr Donat referred me to NY Pres/Columbia Urology (Dr James McKiernan) and I am in a 6 week chemo protocol (clinical trial) involving a combination of chemotherapy combinations. I am interested to know if Tenecentriq is available for someone like me (non metastatic, non muscle invasive but recurrent bladder cancer). Thank you- A. Michael Furman

Thank you for reaching out.

Michael, thank you for reaching out. Tenecentriq is currently FDA-approved for platinum-refractory locally advanced or metastatic urothelial carcinoma, not localized disease.

It also is in clinical trials for other situations. Here is information about one such trial:


We suggest you discuss this with your current care team.

Thank you for your comment.

My sister was diagnosed with metastatic transitional cell cancer. After 3 months of chemo scans revealed that the cancer in the lung area had worsened. The tumors had grown and additional tumors have surfaced. She begins her first treatment with tencentriq tomorrow. Your research states that the data revealed a statistical relevant success rate in patients. What percentage of patients have typically shown improvement after a 3 month period on Tencentriq? Thank you for your time!

Diane, thank you for reaching out. We consulted with MSK oncologist Jonathan Rosenberg, who responds:

Overall, the major shrinkage rate is about 15% (“response”) with a significant additional proportion of patients having the cancer stop growing, at least temporarily. The majority of responses happened by 3 months, though there some patients where major shrinkage occurred more slowly over time (i.e. later than 3 months).

Urothelial carcinoma metasis

Dear Jagat, we are studying new treatments for people with urothelial carcinoma. To view these clinical trial listings, please visit https://www.mskcc.org/cancer-care/types/bladder/clinical-trials. If you have any questions about these studies or would like to make an appointment with one of our specialists about your treatment options, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

Thanks to Dr. Gopa Iyer I have a new lease on life. The people at MSKCC are compassionate and knowledgeable. I started an immunotherapy trial last year and after only 2 of 7 treatments my metastasized cancer has been shrinking even without additional treatments. Again I want to thank Dr Iyer and his wonderful staff and MSKCC for giving me my life back.

Dear Eliot, we are very glad to know that you have felt well-cared for by your MSK treatment team. Thank you for sharing your thoughts and experience on our blog!

Is there any immunotherapy for bile duct cancer

Dear Joe, to learn more about how people with bile duct cancer are treated (including investigational approaches such as the use of biologics) please visit https://www.mskcc.org/cancer-care/types/gallbladder-bile-duct/treatment. If you would like to make an appointment to discuss possible treatment options, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

I am a 64 year old male diagnosed with high grade urothelial carcinoma of the bladder and prostrate urethra with invasion into the prostrate, clinically staged at T4a NO. I curious if I would be a possible candidate for this new treatment?

In mid-October I had surgery in Thailand to remove my bladder due to high grade uretheral cancer with invasion in nearby tissues removed. A follow up PET Scan revealed non small cell lung cancer which was removed with the lower lung lobe in mid November. I will be returning to Seattle area in January for further treatment. I have EGFR MUTATIONS, and I am selecting a drug to take before coming home in January. Looking at Opdivo and Tecentric, any thoughts to share?

Dear Jeffrey, we’re sorry to hear about your diagnosis. Unfortunately we are not able to offer medical advice on our blog, but if you would like to have a consultation with one of our doctors when you return to the US you can cal 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. If you are not able to travel to New York, we recommend that you discuss this with your doctors in Seattle. Thank you for your comment, and best wishes to you.

Hello, My Mother has Stage IV metastatic (to liver and lung) invasive bladder cancer with HER-2. She had her bladder removed in Dec 2017 and afterward found that it had spread to her liver and lungs. She also found out she had breast cancer (unrelated but ER+). She received chemo, but not cisplatin because she was ineligible for that. That did not work on the liver tumors so she is now receiving nivolumab every two weeks. She has had 3 treatments at this point. She is very tired, her stomach is swelling, & anemic, but otherwise fairly well considering. She is/was an otherwise healthy 84 year old. Is this the best option for her? Are there other options?

Dear Janet, we’re sorry to hear about your mother’s diagnosis. We recommend that you discuss her treatment options with her medical team. If she would like to come to MSK for a consultation with one of our experts, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment, and best wishes to you and your mother.