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Urdu“Ravi was one of my best students. It’s comforting that he can see me through this,” Peter says.
In 2019, Peter noticed blood in his urine. He went to his urologist near his home in Holmes, New York, and was diagnosed with high-grade non-muscle invasive bladder cancer. He was treated intravesically—where the medication is inserted directly into the bladder through a catheter—with Bacillus Calmette-Guerin (BCG), an immunotherapy, and mitomycin, a chemotherapy.
Unfortunately, the cancer recurred. His doctors then recommended a cystectomy, which removes the whole bladder and prostate.
Hoping to avoid such extensive surgery, Peter decided to look for other options. That’s when he got in touch with Dr. Munver, who he’d reconnected with at a memorial service for a colleague a few years ago.
Dr. Munver remembers his teacher and his alma mater fondly. “As a senior in Peter’s honors physics class, I was so impressed at how passionate and meticulous he was in teaching us. It must have been destiny that brought us back together after so many years,” he says. “It was humbling when Peter reached out to me, and I informed him that there were potential options other than immediately removing the bladder.”
Dr. Munver surgically removed Peter’s tumor, and then treated him with intravesical BCG combined with the immunotherapy medication interferon to get the best possible results.
Right Time and Place
A few months later, the tumor returned again. “Peter and I discussed various treatment options. Bladder removal was one, but understandably he wanted to try another option before that,” Dr. Munver says. “I knew that Peter had done his research, and I was confident that we could offer him an alternative.”
Around this same time, Nitin Yerram, M.D., director of urologic research at Hackensack, was working on introducing a new intravesical therapy using two chemotherapy drugs to the hospital. “It’s a massive undertaking to bring a new therapy to our patients, and we’d been working on it for months,” Dr. Yerram says. “Right when we were about to go live, Peter was looking for options.”
The new therapy, called intravesical chemotherapy, is specifically for patients with recurrent non-muscle bladder cancers that aren’t responding to BCG. Dr. Yerram notes that studies show up to 50 percent of patients respond to this therapy, helping them avoid major surgery. “If you think of the patients for whom BCG didn’t work, and if this works for 50 percent, that’s a lot less cystectomies,” says Peter. “I felt like it was worth a try.”
Peter’s treatment is weekly for six weeks. Both drugs are put directly into the bladder through a catheter, one at a time. He holds the first drug in for 90 minutes at the clinic. He is then sent home with the second drug, which he holds in for two hours.
“He gets it done right in the clinic and then he goes home—no anesthesia needed. He’s able to work around his schedule to make sure he gets these innovative treatments,” says Dr. Yerram. “Patients don’t have systemic side effects like nausea and hair loss that we see with other chemotherapy.”
A couple of months after the end of his treatment, Peter will undergo tests with Dr. Munver to see if the tumor has disappeared. If it has, he’ll either be monitored or started on a maintenance therapy every 3–6 months for up to three years.
“We’ve created a comprehensive bladder cancer program at Hackensack. Part of that is providing standard-of-care treatments, such as BCG and cystectomy, that we have so much experience in. But it’s also providing these new innovative therapies and new clinical trials,” says Dr. Yerram. “We have all these options that can really benefit patients.”
