What’s New in Bladder Cancer Research?

Research on bladder cancer is taking place in many university hospitals, medical centers, and other institutions around the world. Each year, scientists find out more about what causes the disease, how to find it as soon as possible, and how to better treat it. Most experts agree that treatment in a clinical trial should be considered for any type or stage of bladder cancer. This way people can get the best treatment available now and may also get the new treatments that are thought to be even better. The new and promising treatments discussed here are only available in clinical trials.

Understanding genetic changes in bladder cancer

Scientists have learned a lot about the differences between normal cells and bladder cancer cells. They're also learning how these differences help cancer cells grow and spread to other parts of the body.

Researchers are now looking for tests that find genetic changes in bladder cancer cells to help predict a person’s prognosis (outlook). These gene changes might also help doctor's choose the best treatment, or be useful in finding bladder cancers that come back (recur) after treatment.

Researchers also hope this knowledge can be used to develop new ways to treat bladder cancer, and maybe ways to test for it, too.

Urine tests to look for bladder cancer

Several newer tests look for substances in urine that might help show if a person has bladder cancer. These tests are mostly used to help diagnose bladder cancer or to look for cancer that has come back (cancer recurrence) in people who have already been treated. Researchers are now looking to see if these tests might be helpful even earlier, to screen for bladder cancer in people who don't have symptoms. (See Can Bladder Cancer Be Found Early?)

Bladder cancer treatment

Many new types of treatment are now being studied for bladder cancer.

Surgery

Some surgeons are using a newer way to do a cystectomy (taking out the bladder) in which they sit at a control panel in the operating room and use robotic arms to do the surgery. This approach, known as a robotic cystectomy, lets the surgeon operate through several small cuts (incisions) instead of one large one. This may shorten the time a person needs to be in the hospital and help patients recover faster after surgery.

This type of surgery is already used to treat other cancers, such as prostate cancer, but it’s not yet clear if it’s as good as, or maybe even better than, standard surgery for removing the bladder. This approach is being studied to see if this is the case.

Another key area of research is looking at how to best use other treatments along with surgery to save as much of the bladder as possible. Researchers are using different combinations of chemo, radiation, and immunotherapy to preserve the bladder.

Intravesical therapy

Researchers are looking at a number of new medicines to see if putting them into the bladder after surgery can help lower the risk of the cancer coming back. The hope is to find some that are better and/or safer than currently used drugs. New drugs are also needed to treat bladder cancer that doesn't respond to BCG therapy. There's a lot of research being done in this area.

Current studies are also looking at using different chemo drugs for intravesical therapy, as well as different ways to do the treatments. For instance, studies are looking at combinations of drugs to see if there's a better cancer cell response, as well as adding a gel to the drugs to keep the drugs in contact with the cancer cells for a longer time.

See Intravesical Therapy for Bladder Cancer for more on how drugs are put right into the bladder to treat this cancer.

Photodynamic therapy

Some researchers are trying to find out if photodynamic therapy (PDT) might be useful in treating early-stage bladder cancers. In PDT, a light-sensitive drug is injected into the blood. It collects in the cancer cells over a few days. Then a special type of laser light is focused on the inner lining of the bladder through a cystoscope. The light changes the drug in the cancer cells into a new chemical that can kill them.

An advantage of PDT is that it can kill cancer cells with very little harm to nearby normal cells. One drawback is that the chemical must be activated by light, so only cancers near the surface of the bladder lining can be treated in this way. The light can’t reach cancers that have grown deeper into the bladder wall or have spread to other organs.

You can read more about this kind of treatment in Photodynamic Therapy.

Targeted therapy

As researchers have learned more about the changes in bladder cells that cause them to become cancer , they've begun to look at drugs that target these changes. Targeted therapy drugs are already used to treat many other kinds of cancer. These drugs work differently from standard chemo drugs. They may work in some cases when chemo drugs don’t, and they tend to have different (and often less severe) side effects.

Some of these drugs that are being studied for bladder cancer include rogaratinib, lapatinib (Tykerb^®), and erlotinib (Tarceva^®).

Other drugs target the blood vessels that allow tumors to grow. These are called anti-angiogenesis drugs. Examples include bevacizumab (Avastin^®), sorafenib (Nexavar^®), cabozantinib (Cometriq^®), and pazopanib (Votrient^®), which are already used for some other types of cancer. They are now being studied for use against bladder cancer, usually combined with chemotherapy.

Gene therapy

Gene therapy – adding or changing the actual genes inside cancer cells or other cells in the body – is a new treatment method being tested for bladder cancer. One approach to gene therapy uses special viruses that have been altered in the lab. The virus is put into the bladder and infects the bladder cancer cells. When this infection occurs, the virus injects a gene into the cells that can help immune system cells to attack the cancer. This and many other approaches to gene therapy are still in the early stages of development.