Real Hope for the World’s Most Expensive Cancer: Bladder Cancer

More than 12 million new cases of bladder cancer occur annually, making it the ninth most common cancer worldwide. In three out of every four cases, the cancer occurs as a non-muscle invasive papillary tumor that shows a very high rate of recurrence— about 80 percent within five years of the original diagnosis.

Thanks to this very high recurrence rate and need for frequent surgery, bladder cancer is considered to be the most expensive cancer to manage on a per-patient basis. The world market for treating bladder cancer is projected to reach $544.4 million by the year 2015.

One of the ways we might be able to reduce recurrence rates and improve long-term outcomes for people with bladder cancer is through photodynamic diagnosis or PDD. By causing the cancer tissue to glow or fluoresce, PDD allows the surgeon to more clearly discern where the cancer is, and to then use lasers to specifically remove the cancerous tissue or lesions using what’s called laser ablation.

Researchers at the Urology Centre, Guys and St. Thomas’ NHS Foundation Trust in London recently sought to assess the safety and effectiveness of laser ablation for non-muscle-invasive bladder cancer in an elderly population with the help of PDD.

Here’s what they found, as reported in the 3 May 2013 issue of BJU International:

  • Additional lesions were found in 21% of patients using PDD that were not found using the standard “white light” approach.
  • After three months, the recurrence rate was only about 4% for patients who underwent PDD after laser ablation, compared to nearly 11% for those who underwent the white light approach instead.
  • After one year, 47% of PDD patients had a recurrence, compared to about 65% of white light patients.
  • Even with the addition of PDD, the cost of laser ablation was found to be much lower than that of the standard approach (£912 versus £1844).
  • Over the course of a patient’s lifetime, laser ablation was more clinically effective and more cost effective as well, based on criteria set by the National Institute for Health and Care Excellence.

Another way to help turn the tide of recurrent bladder cancer is to use photodynamic therapy (PDT).  Researchers in Seoul, Korea, recently reported on the use of Radachlorin-based PDT to treat patients with high-grade non-muscle-invasive bladder cancer. These patients were not responding well to the standard treatment using bacille Calmette-Guérin (BCG) therapy, and they were refusing to undergo standard surgery (radical cystectomy).

The recurrence-free rates were 91% after one year, about 64% after two years, and 60% at two and a half years. The researchers concluded that PDT with Radachlorin is a safe and effective approach for these bladder cancer patients—especially those who are either unresponsive or intolerant of the standard BCG therapy.

As you can see, the combination of photodynamic principles can be successfully applied to both diagnosis and treatment of bladder cancer.

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Wong KA, Zisengwe G, Athanasiou T, O’Brien T, Thomas K. Outpatient laser ablation of non-muscle-invasive bladder cancer: is it safe, tolerable and cost-effective? BJU Int. 2013 May 9. [Epub ahead of print]

Lee JY, Diaz RR, Cho KS, Lim MS, Chung JS, Kim WT, Ham WS, Choi YD. Efficacy and safety of photodynamic therapy in recurrent high-grade non-muscle-invasive bladder cancer refractory or intolerant to bacille Calmette-Guérin immunotherapy. J Urol. 2013 May 3. [Epub ahead of print]

For related content, please read this earlier NHF article.

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