Bladder cancer drug durvalumab may spare patients life-changing surgery

A new combination treatment that includes the immunotherapy drug durvalumab has been reported to deliver a notable advance in the care of patients with advanced bladder cancer. According to The Guardian, the results of a Phase III clinical trial led by the London-based Institute of Cancer Research significantly reduced the rate at which cancer returned, without requiring full removal of the bladder.

Bladder cancer is recognised as the ninth most common form of cancer worldwide. Advanced or aggressive cases of the muscle-invasive type have until now been treated with a surgical method called 'radical cystectomy'. The procedure involves complete surgical removal of the bladder and leaves patients reliant on a permanent medical arrangement for urinary diversion.

The clinical trial included 1,058 patients; the test arm received chemotherapy with the addition of durvalumab, while the control arm received chemotherapy alone. After three years of follow-up, the cancer had not returned in 64 percent of the patients in the durvalumab arm; in the control arm the figure was 53 percent.

The study's lead investigator, Professor Robert Huddart, is a specialist in radiotherapy and oncology at the Institute of Cancer Research. Huddart told The Guardian that 'we have not seen an advance of this scale in bladder cancer for decades; this could make a real difference to the quality of life, bodily integrity and mental health of patients'.

Durvalumab is a PD-L1 inhibitor developed by AstraZeneca. It blocks the mechanism by which immune cells fail to recognise tumour cells, allowing the immune system to fight cancer more effectively. The drug has already been approved for various oncology indications, principally lung cancer and urinary-tract cancers.

National Health Service (NHS) approval depends on the National Institute for Health and Care Excellence (NICE) review, expected in September 2026. The treatment is currently available within hospital-based clinical trials free of charge, but a positive cost-effectiveness analysis will be required for wider implementation. AstraZeneca said it was open to offering 'a competitive package' on NHS pricing for the drug.

Sarah Quinlan, director of Action Bladder Cancer UK, an organisation representing bladder cancer survivors, described the trial results as 'extremely encouraging'. Quinlan said 'cystectomy fundamentally transforms patients' day-to-day lives; having an alternative treatment on the table could influence the future decisions of thousands of families'.

The study's potential side effects were also shared. Side effects of the durvalumab combination include autoimmune reactions, fatigue, skin rashes and, in rare cases, pneumonitis. Eleven percent of the patients in the trial had to discontinue treatment. That figure is slightly higher than expected for an immunotherapy treatment but did not exceed the thresholds for approval.

Professor Charles Swanton, of University College London Cancer Institute, told The Guardian the study 'confirms that immunotherapy is significantly more effective when used in combination rather than on its own'. Swanton added that the approach was worth trialling in solid tumours beyond the bladder.

Following the durvalumab combination work, the Institute of Cancer Research team is now planning a new Phase II study that will measure the effectiveness of individualised drug dosing in patients with a high tumour mutation burden. Funding to launch the work is still in review. This article is not medical advice; bladder cancer patients should discuss their treatment options with their own oncologist.