Ask the Expert: Matthew Zibelman, M.D.

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What can I do to set myself up for the best possible out- come with this cancer?

This is a question I get a lot because patients want to be able to play a role and do something, which I appreciate. But there’s no clear evidence that any particular diet, lifestyle, or vitamin would be helpful. Generally, the healthier you are and the stronger you feel going into treatment, the more likely you are to feel OK and do well during the process. So wherever you are in your treatment course, it’s important to maintain a healthy diet and stay as active as possible.

What long-term side effects can treatment have?

Side effects vary from person to person. With chemotherapy, long-term side effects can include neuropathy (numbness or tingling sensations), changes in hearing or ringing in the ears, or issues with the kidneys or heart. The new immunotherapy medications can affect the thyroid gland or lead to diabetes, arthritis, or other long-term effects, many of which may require treatment.

How can I find out about clinical trials that I might participate in?

Clinical trials offer access to drugs or combinations of drugs that are not yet available. First, ask your doctor if there is a trial that may be appropriate for you and your situation. Most cancer centers have websites with information about their clinical trials. Also, the website cancer.net, which is run by the American Society of Clinical Oncology, provides resources for finding clinical trials under the “Research and Advocacy” tab.

How will we know if the cancer has come back, and what happens if it does return?

To watch for any recurrence or new disease, we use imaging tests such as CT (computerized tomography) scans, MRI (magnetic resonance imaging) scans, and bone scans, in addition to monitoring your symptoms over time. Make sure to let your doctor know about any changes that you experience, such as unexplained weight loss, new pain, or changes in energy or appetite. If the cancer does come back, treatment going forward will depend on what kind of care you have already received (e.g., chemotherapy or immunotherapy), how you are feeling, and what other medical conditions you may have. Yet another option might be enrolling in a clinical trial (see my response to the previous question).

What does the future hold for people with advanced bladder cancer?

For many years, we had no new drugs. In the last three years, five new immunotherapy drugs have been approved. These may have lasting effects on the disease. In the future, I expect we will be able to combine different drugs to treat advanced disease, improving the percentage of patients that benefit. We are also going to be able to look for markers and mutations to know who is more or less likely to respond to different therapies, enabling us to better tailor treatments to individuals. As a result, we hope we’ll be able to both control the disease and keep patients alive and feeling well for a longer period of time.