June 5, 2024

Peg grateful for a “new age” in bladder cancer treatment

Wedding photo of husband and wife with a woman, the bride.
Peg Cokins with her husband, George Cokins, and granddaughter, Kallie Knight Gountanis.

In January, Peg Cokins watched her granddaughter get married. It was a milestone that, in 2016, she didn’t think she’d live to see when she was diagnosed with metastatic bladder cancer.

“Every minute, we’re just so grateful,” she said.

Cokins, 75, of Lake Geneva, Wis., has had no evidence of disease since her treatments in a clinical trial at UW Health | Carbone Cancer Center. The trial tested a new targeted chemotherapy approach that has since been approved by the Food and Drug Administration for standard use in bladder cancer. Cokins had such a good response that she has been off treatments since 2020.

“It’s why clinical trials are so important for patients, because it creates opportunities to bring them the most cutting-edge therapies,” said Dr. Joshua Lang, a medical oncologist specializing in genitourinary cancers who oversaw UW’s trial site. “And when we do it right, we can get these amazing, amazing benefits like what happened for Peg.”

Cokins was diagnosed with early-stage bladder cancer in 2004 after she noticed blood in her urine. Over the next decade, her urologist kept her in a monitoring mode, using small surgeries to remove recurrent bladder lesions as well as a type of immunotherapy that has been in use since the 1970s.

“It was very superficial. I remember the urologist saying to me, ‘This is more annoying than life-threatening. Surveillance is the key,’” she said.

In 2014, her bladder cancer spread to her right kidney, and that kidney was removed. Then, in January 2016, it spread to her lymph nodes, which led to her stage IV diagnosis. Cokins started the gold standard available chemotherapy, and although somewhat effective, it needed to be discontinued due to the side effect of significant hearing loss. In 2017, her cancer spread to her liver.

Cokins was among the first patients in a 2017 trial at Carbone Cancer Center testing the use of an antibody-drug conjugate—a targeted treatment that used antibodies to bind to a specific protein expressed by the bladder cancer cells and deliver a precision payload of chemotherapy. Cokins showed an immediate response and continued receiving the treatments throughout its FDA approval process.

“It felt so exciting, so wonderful really,” Cokins recalled. “I was so encouraged as the tumors kept shrinking and was hopeful that others were seeing similar results.”

Lang said the antibody-drug conjugate approach benefited about 40% of patients, which was much better than the standard approaches of that time. Additional research has shown that combining that antibody-drug conjugate with immunotherapy has yielded a 70-80% response rate for patients.

“Now we’re finding that using it as a backbone to combine with other therapies has been more successful than anything we’ve ever tried in bladder cancer,” he said.

Lang and Cokins decided to stop her treatments in March 2020, given how well Cokins responded, and she continues to see Lang twice a year to monitor for any recurrence.

Cokins is not only grateful for her own health but being able to help advance a new treatment option for other bladder cancer patients.

“Other people besides me are living longer, attending their grandchildren’s weddings, and their own big life events,” she said. “They have a much better chance of that now, and it all goes back to my clinical trial and the work of the UW doctors and nurses.”

Cokins has also supported research at Carbone with a fundraiser she started in 2018, when she celebrated her 70th birthday.

“I didn’t know if I would make it to 70,” she said. “I was feeling so grateful and thinking, ‘What can we do to give back?’”

More than five years later, her fundraiser has generated more than $37,000 toward bladder cancer research. She is thankful to the friends, family and community members who have pledged their support each year.

“Luckily it’s a new age for bladder cancer,” she said. “Research continues to supply us with hope.”