New drug combination doubles survival for people with bladder cancer

The findings show that giving people with metastatic bladder cancer enfortumab vedotin (an antibody drug conjugate) and pembrolizumab (an immunotherapy drug) can stop their disease getting worse and helps them live twice as long compared to those given just chemotherapy.

Life expectancy for people with metastatic bladder cancer is just one year, and the treatment they are given, chemotherapy, hasn’t changed in 40 years. This new trial, called EV302, involved nearly 900 people aimed to change this and to develop the first new treatment for bladder cancer that has spread in nearly four decades.

The team found that the 442 people given this new combination of drugs (enfortumab vedotin and pembrolizumab) lived nearly twice as long compared to the 444 people given chemotherapy (31.5 vs 16 months). In addition, the researchers showed that the risk of death was 53% lower in those given the combination, which was also associated with better disease control rates. And encouraging, side effects from the drug combination were very similar to those experienced by people given chemotherapy. 

Professor Tom Powles, Professor of urology cancer at Queen Mary University of London and the director of Barts Cancer Centre, led the trial at Barts Health. Speaking on the results, he said: “We’ve long known that we need to improve people’s chances of surviving bladder. This study has achieved that in a dramatic manner. We’ve shown that combining these two drugs helped people live twice as long compared to those given standard chemotherapy, with unprecedented responses. There is new hope in bladder cancer, and I can’t thank those who took part in the trial enough for doing so.”

Paul Goodfellow was diagnosed with invasive bladder cancer in December 2019, just three months after retiring. His initial treatment was 3 cycles of chemotherapy followed by major surgery to remove the cancer, which included removing his bladder. “It was a big operation”, explains Paul. “For about a year after, all my scans came back clear."

“But in late 2021, I was told my cancer had spread. I was devastated, my whole family was. I was offered a limited amount of chemotherapy cycles which would hopefully halt the spread but would have a short-term effect. It appeared to be the only option for me, so I was prepared to start the treatment.

“Then a few days later, I got a call from the Macmillan Specialist Nurse who had supported me before, throughout and after my surgery. She told me about a bladder cancer clinical trial at St Bartholomew’s Hospital run by Professor Powles and his team. She asked if I was interested in knowing more about it, and with nothing to lose, I jumped at the chance!

“That’s when I joined the EV302 trial. I’ve been having the new combination of drugs for 22 months. I am over the moon to say I had an 80% response rate after just three cycles. My cancer hasn’t gone away, but it’s not getting worse.

“Thanks to this trial, I feel really well. I’m getting to spend time with my wife, family and dog that I didn’t think I’d have. I’m still walking around three miles a day and going on campervan trips with my wife and sometimes our children and grandchildren join us.

“I could not have envisaged the things we are doing and have done since the awful news we received in 2021. These drugs are absolutely incredible, and I hope more people can benefit from these treatments in the future.”

These findings will be presented at a plenary session at the European Society of Medical Oncology (ESMO) conference Sunday 22 October. The study was carried out by Barts Health NHS Trust and Queen Mary University of London, with funding support from the Experimental Cancer Medicine Centre.