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This Week in Managed Care: June 15, 2018
June 15, 2018

What We Need to Know About Bladder Cancer and Its Treatment

AJMC Staff
There is, currently, an unmet need in bladder cancer, a disease expected to be responsible for 16,000 deaths in 2015.
A disease with few treatment options, bladder cancer has troubled oncologists for a while. Several new approaches are now being tested in the clinic to combat this disease which, according to the American Cancer Society (ACS), will be newly diagnosed in 74,000 individuals in 2015 and will be responsible for 16,000 deaths this year as well.

Evolution and Statistics1, 2

Depending on the cell of origin in the lining of the bladder, the disease can be classified as transitional cell carcinoma (innermost tissue layer), squamous cell carcinoma (squamous cells), or the rare adenocarcinoma (secretory cells). Transitional cell carcinoma, the most common type of bladder cancer, can be low- (recurrent, but local) or high-grade (recurrent and metastatic); squamous cell bladder cancer may result from a long-term infection or irritation.

Considered a disease associated with ageing, the average age at diagnosis is 73 years, and 90% of those diagnosed with bladder cancer are at least 55 years of age. The disease does have a gender bias, with men being more susceptible to the disease than women (it is the fourth most common cancer in men). Race is another risk factor for bladder cancer—white men are twice as likely to be diagnosed with bladder cancer as black men—and smoking adds to this risk. Other risk factors include family history, genetic changes, exposure to certain chemicals, radiation therapy to the pelvic region, and long-term use of urinary catheters.

Like most other cancers, survival rates of bladder cancer are determined by the stage of the disease, with dismal 5-year survival (15%) for stage IV patients who are at an advanced stage, while for stage I, 5-year survival is 88%, according to the ACS. CT scan, MRI, chest x-ray, and bone scan are some of the techniques used for disease staging. Patient’s age and overall health, type of cancer, number and size of the tumor(s), are some other factors that can influence prognosis.

Treatment2, 3, 4

While standard treatment options for bladder cancer include surgery, radiation, chemotherapy, and immune therapy, many new drugs are being evaluated in clinical trials, which opens up options for those patients who fail standard of care treatments. City of Hope, a Comprehensive Cancer Center in California, for example, has 10 ongoing clinical trials for bladder cancer, including trials with new immuno-oncology agents that block PD-L1 and CTLA-4. Other approaches include gene therapy (still in early development); photodynamic therapy; and targeted therapies targeting bladder cancer cells (such as sunitinib, lapatinib, erlotinib, trastuzumab, and panitumumab) or blood vessels (such as bevacizumab, sorafenib, and pazopanib).

References

1.       What are the key statistics about bladder cancer? American Cancer Society website. http://www.cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-key-statistics. Accessed December 3, 2015.

2.       Bladder cancer treatment. National Cancer Institute website. http://www.cancer.gov/types/bladder/patient/bladder-treatment-pdq. Accessed December 3, 2015.

3.       Clinical trials on-line. City of Hope website. http://clinicaltrials.coh.org/specific_result.aspx?cat=1005&dx=. Accessed December 3, 2015. 

 
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