possible recurrence

2 months 1 week ago #60691 by Cariboy72
possible recurrence was created by Cariboy72
Hello everyone.  My partner who is 79 was diagnosed with squamous cell bladder cancer stage 4 last year which resulted in the removal of the bladder and 7 lymph nodes.  A week ago we received some distressing news.  The PET scan revealed a possible recurrence of the cancer only after 6 or 7 months.  There were  a couple of masses found in the left and right abdomen near the surgical site.  The oncologist and the urologist noticed, however, that they had a strange shape and ordered an additional CT to figure out what it is, although I cannot imagine what else it could be.  If it is, in fact, a recurrence, the next steps will be radiation therapy and a round of immunotherapy afterwards.  Prior to the surgery he received adjuvant chemotherapy which did very little, so I don't think chemotherapy will ever be an option again.  I've read that the Squamous cell variant  is often resistant to chemotherapy.  Does anyone happen to know of any studies where this variant is responsive to Radiation and/or immunotherapy?  My deepest thanks to you all.  
 peace and blessings.

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2 months 1 week ago #60692 by joea73
Replied by joea73 on topic possible recurrence
A study on the effectiveness of immunotherapy to squamous bladder cancer was published in 2020.   The study was conducted by various hospitals in Germany, involving urologists and pathologists.   The study showed a high expression of PD-L1 protein on squamous bladder cancers.  This is good news for patients with squamous bladder cancer.   At this point, Immunotherapy drugs such as Pembrolizumab( Keytruda by Merck) had been approved for advanced urothelial bladder cancer.  But immunotherapy has shown only effective if PD-L1 expression on the patients' cancer cells is high.  So, those urothelial bladder cancer patients with low expression of PD-L1 are usually not eligible for immunotherapy.   What this study found was that squamous bladder cancer cells showed high expression ( high numbers) of PD-L1, so they think immunotherapy will be effective for squamous bladder cancer.  The clinical case the study group conducted was 65 years old patient, who developed squamous type bladder cancer after having been initially treated with BCG for T1HG.
The patient was treated with OPDIVO® (nivolumab) immunotherapy drug by BRISTOL MYERS SQUIBB and cancer had disappeared. 

Below is the link to the study.

Therapeutic implications of PD-L1 expression in bladder cancer with squamous differentiation

FYI, Immunotherapy is also called immune checkpoint inhibitor therapy.   PD-L1 is an immune checkpoint, often found on the urothelial bladder cancer cells, is used to hide from T-killer cells.   According to MERCK's, many tumor cells produce antigens, which may be released in the bloodstream or remain on the cell surface.   Our innate immune cells such as dendritic cells are called antigen-presenting cells.  Their role is to pick up antigens and deliver them to lymph nodes and help activate anti-bodies and T-killer cells which are antigen-specific.   The activated T-killer cells come and identify the cancer cells and supposed to attack the cancer cells.  But,  when the cancer cells have many PD-L1s on the cell surface,  The PD-1 immune checkpoint of  T-killer cells shakes hand with the PD-L1 immune checkpoint of the cancer cells, and T-killer cells just go away.  What immune checkpoint inhibitor therapy (immunotherapy) is to put a glove on either PD-L1 or PD-1 immune checkpoint, so T-killer cells and the cancer cells cannot shake their hands and let T-killer cells attack the cancer cells.  Keytruda by MERCK and OPDIVO by BRISTOL MYERS SQUIBB are the drugs that put gloves on the PD-1 immune checkpoint of T-killer cells.  

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2 months 1 week ago #60693 by Cariboy72
Replied by Cariboy72 on topic possible recurrence
Thank you so much for the response!  I've been having difficulty finding information on this topic.  Your post has been encouraging to us.    Wishing everyone the best!

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