Unmet Needs in NMIBC Bladder Cancer Treatment

Standard methods are improved by new complementary and transformative approaches.

While there are many existing methods of detecting and treating NMIBC, there remain high unmet needs in the area, particularly when it comes to improving early detection and management of the disease.

Approaches to testing for bladder cancer

The way that early signs of possible bladder cancer are noticed are:

Patients' symptoms

Patients themselves may be aware of abnormalities that could be signs of bladder cancer. These signs are usually the trigger for employing more technical levels of detection. Learn more about the signs that patients should look out for.

  • Urinalysis : Tests for blood in the urine (hematuria)
  • Urine cytology : A visual check of urine sample by a doctor, using a microscope, to see how the cells look and behave
  • Urine tumor marker tests : There are many new tests available and under development that can identify markers in urine which may be signs of bladder cancer.

None of these tests are yet good enough to replace cystoscopy, but can be valuable to support in decision making. There is a lot of research ongoing to develop reliable tests, so that at least some of the cystoscopies can be replaced. This would mean less burden for the patients and less burden on the health care resources.

Cystoscopy

A tube with light and a still or video camera lens on the end of it, is inserted into the bladder to allow the doctor to inspect for signs of cancer cells (lesions).

Biopsy

Samples of tissue taken from the bladder are inspected in a lab by a pathologist to determine if the cells are cancerous.

Imaging

Imaging tests may be done if there is a suspicion that the cancer has spread out from the bladder. These tests are combined with the other tests to determine the degree, or stage of development, of the bladder cancer. The imaging tests that may be used when diagnosing bladder cancer can include:

  • CT scan
  • CT guided needle biopsy
  • Intravenous pyelogram (IVP)
  • Retrograde pyelogram
  • MRI scan
  • Ultrasound
  • X-ray
  • Bone scan

The wide range of tests applied to detect bladder cancer is because of the variety and complexity of needs. Usually, a diagnosis of bladder cancer is made after combining multiple tests, which together provide a confirmation of the presence of cancer as well as the degree/stage of its development.

The outcome of these tests helps the medical team to define which treatment options are relevant for the patient.

The unmet need in testing is for:

  • Tests which can replace multiple methods of testing.
  • Improving upon the accuracy of testing methods.
  • Speeding up the time taken to correctly diagnose.
  • combine testing with the ability to take immediate action to treat or manage the cancer.

Approaches to treating non-muscle invasive bladder cancer

TURBT

Non-muscle invasive bladder cancer is treated with a TURBT (trans-urethral resection of bladder tumor). The surgeon inserts a cystoscope into the bladder, through which instruments can be passed.

There is a light at the end of the cystoscope to allow the surgeon to see inside the bladder and inspect it, or guide the instruments that are used to:

  • Cut away and remove all the cancerous cells.
  • Take samples of abnormal areas for further testing.

Intravesical therapy

Directly applying drugs into the bladder through the urethra after a TURBT is done on a non-invasive or minimally invasive bladder cancer, in order to prevent the cancer from recurring and progressing.

  • Chemotherapy inserting medicines directly into the bladder to destroy cancer cells (before or after surgery). The drugs commonly used include: mitomycin, docetaxel, thiotepa and gemcitabine. Several new approaches to enhance the effect of the chemotherapy are emerging and in development.
  • Immunotherapy, stimulating the body's natural defenses, the immune system, to attack bladder cancer cells. This is done for example with the Bacillus Calmette-Guerin (BCG) approach, inserting a germ into the bladder, which attracts the body's immune cells, where they may also battle the cancerous cells.

The unmet needs in bladder cancer treatments lie in:

  • Increasing the precision of the methods applied i.e. more accurate detection and more complete removal of tumors.
  • Reducing the recurrence of the bladder cancer.
  • Reducing the need for high-cost and low-availability medical resources, such as surgery.

Photocure has developed and commercialized Hexvix®/Cysview®, based on the Photocure Technology® platform, for better detection and management of non-muscle invasive bladder cancer. Learn more about Photocure's innovative bladder cancer products.