What’s New in Bladder Cancer Research?

Research on bladder cancer is being done in many university hospitals, medical centers, and other institutions around the world. Each year, scientists find out more about what causes bladder cancer, how to find it as soon as possible, and how to better treat it.

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 developing tests to find gene or protein changes in bladder cancer cells that can help predict a person’s prognosis (outlook). These tests might also help doctors choose the best treatment, or help find bladder cancers that come back (recur) after treatment. Some of these types of biomarker tests are already being used (see Tests for Bladder Cancer), and others are now being tested.

Researchers also hope this knowledge can be used to develop new ways to treat bladder cancer, too.

Bladder cancer early detection and diagnosis

Urine tests to look for bladder cancer

Several newer tests look for substances (biomarkers) in urine that might show if a person has bladder cancer (see Tests for Bladder Cancer). At this time, these tests are used mainly 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 studying 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 advances in bladder cancer treatment have been made in recent years, and many newer types of treatment are now being studied. Here are some examples.

Intravesical therapy

For non-muscle invasive bladder cancer, researchers are looking at many new medicines to see if putting them directly 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 intravesical BCG therapy.

Current studies are also looking at different ways to apply these treatments.

For example, studies are looking at:

• Heating intravesical chemotherapy before it's put into the bladder (known as hyperthermic intravesical therapy)
• Delivering the chemo drug mitomycin into the bladder along with a pulsed electrical current, a treatment called electromotive mitomycin therapy
• Using combinations of chemo drugs to see if there's a better response
• 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 studying 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.

PDT is already used to treat some other types of cancer. To learn more about this kind of treatment, see Photodynamic Therapy.

Robotic cystectomy

Cystectomy (removal of the bladder) is a common treatment for bladder cancer, especially if it invades the muscle layer of the bladder wall. Many surgeons now do robotic cystectomies. During these surgeries, they sit at a control panel in the operating room and move robotic arms attached to long, thin surgical instruments. This method lets the surgeon operate through several small cuts (incisions) in the abdomen instead of one large one. This tends to shorten the time a person needs to be in the hospital and helps them recover faster after surgery, although the long-term outcomes with this approach aren’t yet clear.

Bladder-preserving treatments

While cystectomy is often recommended to try to cure bladder cancer (especially if it has invaded the muscle layer in the bladder wall), removing a person’s bladder can have a profound effect on their quality of life. Doctors are now studying whether some newer approaches that don’t require removing the entire bladder might be just as effective.

For example, trimodality therapy, which includes an extensive transurethral resection of bladder tissue (TURBT), chemotherapy, and radiation therapy, is often an option for some people who can’t have or don’t want a cystectomy.

Researchers are now looking at whether adding newer medicines, such as immunotherapy drugs, might help make this treatment approach even more effective.

Treating advanced bladder cancer

Advanced bladder cancers are hard to remove completely, so medicines are often used to try to shrink these tumors. Chemotherapy has been a mainstay of treatment for advanced bladder for many years. Unfortunately, some of the most effective chemo drugs, such as cisplatin, can have major side effects, and some people might not be healthy enough to get them. Even when chemo is given, it doesn’t always get rid of all of the cancer.

In recent years, some newer types of medicines have become an important part of the treatment for bladder cancer.

Immunotherapy drugs known as checkpoint inhibitors are now an important part of the treatment for many bladder cancers, either alone or combined with chemo or other drugs. Many newer types of immunotherapy are now being studied as well.

Antibody-drug conjugates (ADCs) are a newer type of medicine. They combine a chemo drug with an antibody that helps bring the chemo to the cancer cells, sparing normal cells. ADCs are now part of the treatment for many bladder cancers, and many newer ADCs are now being developed.

Many targeted therapy drugs are now being studied for use in bladder cancer. These medicines target specific parts of cancer cells that make them different from normal cells. Targeted therapy drugs work differently from standard chemo drugs. They may work in some cases when chemo drugs don’t, and they tend to have different side effects. As researchers are learning more about the changes in bladder cancer cells, these types of medicines are likely to become more important in treating bladder cancer.

While it’s unlikely that any single type of treatment will cure all bladder cancers, researchers are always looking at combining different types of treatment to see if this might be more effective. This might include some newer types of medicines (such as immunotherapy or targeted therapy), as well as treatments that have been used for many years, including surgery, radiation therapy, and chemotherapy.