Carmela’s Story: New Treatment for Bladder Cancer Calls for Celebration

Carmela Brunelli and her husband, John, celebrated their 50th wedding anniversary last summer with a long overdue tropical vacation and a dinner party for immediate family. This was a momentous occasion for the couple, who met in high school, that not only marked the longevity of their marriage but also Carmela’s 11-year cancer journey.

Carmela, 73, was diagnosed with bladder cancer in 2010. She began her treatment with a urologist based in New Jersey who prescribed Bacillus Calmette-Guerin (BCG) – a first-line therapy considered the standard of care for bladder cancer. After three years of BCG treatments and intermittent recurrences, her doctor felt he did all he could.

In 2013, he said to Carmela, “I think it’s time to see someone in New York.” That someone was Dr. James McKiernan, a nationally recognized leader in state-of-the-art surgical therapies for bladder and prostate cancers and chair of the Department of Urology at Columbia University Vagelos College of Physicians and Surgeons.

When Carmela and John met Dr. McKiernan for the first time, the three immediately hit it off. 

“I just knew right away that he was somebody I would get along with and could trust,” says Carmela. “I think it’s really important to have a doctor and team who are great communicators. Dr. McKiernan, the nurses, and staff always follow up and include my husband in all the communications. I feel like I really hit the jackpot.” 

Clinical trial provides innovative new treatment, offers hope

Bladder cancer is the sixth most common cancer in the U.S., with nearly 84,000 new cases estimated this year. While new therapies for bladder cancer are emerging, the primary treatment for high-risk stage 1 disease has remained relatively unchanged for decades. 

At the Herbert Irving Comprehensive Cancer Center, Dr. McKiernan’s close collaborator, Dr. G. Joel DeCastro, is leading a phase 2 clinical trial to test a new combination chemotherapy treatment for direct bladder instillation in patients who have limited options after their initial treatments were unsuccessful. With bladder instillation, or intravesical therapy, patients receive the chemotherapy drugs via injection directly into the bladder through a catheter. The drug remains in the bladder for up two hours and only affects the cells lining the inside of the bladder, avoiding any damage to surrounding tissue. This drug combination is promising for an entirely new, bladder-saving treatment option for patients. 

“I knew it would just be a matter of time until I would have to have surgery to remove my bladder altogether. I never wanted that,” says Carmela. “It has always been my goal to keep my bladder for as long as I can.”

“People who come to us are often told by other hospitals that they’ve done everything they can and cannot save their bladder, yet the cancer hasn’t spread or gone out of control,” says Dr. McKiernan. “Patients like Carmela are looking for hope, an opportunity to save their bladder. Historically, we haven’t had anything new to offer them beyond the standard of care, which is removing their bladder.”

In late 2020, after Carmela’s cancer had recurred once again, Dr. McKiernan enrolled her in the trial with the new combination therapy. She completed treatment in January of 2021 and has since continued with monthly maintenance therapy. To date, Carmela’s cancer has remained in remission. She carries hope that preserving her bladder is possible, and she is grateful for her care team at the cancer center. 

“I would love to tell newly diagnosed people to seek out a doctor who is the top at their field, a really good communicator, and someone who makes you their priority,” says Carmela. “I consider Dr. McKeirnan my guardian angel. Dr. McKiernan and his staff are compassionate and truly care. I feel like they’re part of my family.”