Current perspectives in bladder cancer management

Abstract

Summary More than 350,000 new cases of bladder cancer are diagnosed worldwide each year; the vast majority (> 90%) of these are transitional cell carcinomas (TCC). The most important risk factors for the development of bladder cancer are smoking and occupational exposure to toxic chemicals. Painless visible haematuria is the most common presenting symptom of bladder cancer; significant haematuria requires referral to a specialist urology service. Cystoscopy and urine cytology are currently the recommended tools for diagnosis of bladder cancer. Excluding muscle invasion is an important diagnostic step, as outcomes for patients with muscle invasive TCC are less favourable. For non‐muscle invasive bladder cancer, transurethral resection followed by intravesical chemotherapy (typically Mitomycin C or epirubicin) or immunotherapy [bacillus Calmette‐Guérin (BCG)] is the current standard of care. For patients failing BCG therapy, cystectomy is recommended; for patients unsuitable for surgery, the choice of treatment options is currently limited. However, novel interventions, such as chemohyperthermia and electromotive drug administration, enhance the effects of conventional chemotherapeutic agents and are being evaluated in Phase III trials. Radical cystectomy (with pelvic lymphadenectomy and urinary diversion) or radical radiotherapy are the current established treatments for muscle invasive TCC. Neoadjuvant chemotherapy is recommended before definitive treatment of muscle invasive TCC; cisplatin‐containing combination chemotherapy is the recommended regimen. Palliative chemotherapy is the first‐choice treatment in metastatic TCC.

Synergistic induction of apoptosis by mapatumumab and anthracyclines in human bladder cancer cells

“…Each year more than 350,000 new cases of bladder cancer are diagnosed globally (1), making bladder cancer the ninth most frequent cancer worldwide (2). Epirubicin (EPI) and pirarubicin (THP) are a new generation of anthracycline drugs, widely used as anticancer chemotherapeutic agents in various types of cancers including bladder cancer (2,3).…”

Bladder cancer in the EMPA-REG OUTCOME trial

“…In the EMPA-REG OUTCOME trial, cases of bladder cancer were identified from adverse events coded using the following preferred terms in the Medical Dictionary for Regulatory Activities (MedDRA): 'bladder cancer'; 'bladder cancer recurrent'; 'bladder cancer transitional cell carcinoma'; and 'transitional cell carcinoma'. Transitional cell carcinoma accounts for over 90% of all bladder cancers [3]. Documentation relating to events coded as transitional cell carcinoma was medically reviewed and cases confirmed.…”

Bladder cancer prevention

“…Animal studies show that the risk of cyclophosphamide-induced bladder cancer is significantly lower when the treatment is accompanied by the administration of Mesna (sodium 2-mercaptoethanesulphonate) [66].…”