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Superficial Bladder Cancer - Current Mangement and Future Trends

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Published Date Nov 1, 2005
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Quick Overview

Superficial bladder cancers (SBC) comprise tumours with low aggressiveness but a high recurrence rate as well as lesions with a high risk of progression.

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Executive Summary

Superficial bladder cancers (SBC) comprise tumours with low aggressiveness but a high recurrence rate as well as lesions with a high risk of progression. All SBC are amenable to intravesical therapy and treatment failure is associated to a considerable discomfort for patients that may eventually require aggressive surgery. The current intravesical chemotherapies and immunotherapies have so far shown limitations in reversing the natural history of the disease. For these reasons a load of research has been devoted in the development of new treatment options. Close to 40 different companies has been identified with R&D related activities in this field. New intravesical chemotherapeutic drugs such us gemcitabine (that has already completed the phase II of studies) and EOquinTM (at the early phase I-II experience) have shown an excellent activity profile. From the point of view of immunotherapeutic agents, Mycobacterium cell wall DNA complex (MCC) has shown a high response rate in phase I-II studies whereas Imiquimod, a promising new compound based on preclinical studies, will soon engage in phase I human trials. Analysing the emerging therapeutic strategies shows that drugs inhibiting DNA replication and related mechanisms are the leading strategy, closely followed by immunostimulators and antiangioenetic drugs. Some minor strategies are apoptotic inducers, oncolytic viruses, tubule/microtubule binders as well as antisense technology. A number of features make intravesical molecular therapy a feasible new treatment option for SBC. As far as the field of new diagnostic and prognostic tools is concerned, methods to improve the endoscopic detection of poorly visible bladder cancers and urine biomarkers for the early detection of a recurrent tumour will enable better clinical outcomes and reduce the need for invasive procedures such us cystoscopy. The 5-aminolevulinic acid (ALA) induced fluorescence may soon become routinely adopted during endoscopic procedures. Among the urine biomarkers, the Fluorescent in-situ Hybridization (FISH) has been found to be helpful particularly in those cases (not so infrequent) where a urine cytology test has shown "atypical cells" and all the diagnostic work-up has failed to demonstrate a bladder cancer. New diagnostic opportunities will drive the need for improved therapeutic options and the markets for these drugs are estimated to increase at least 10% until 2012.

Executive summary

Introduction

Superficial bladder cancer (SBC) epidemiology
Table 1. Relevant epidemiological factors for BC

Risk categories of SBC and their natural history
Table 2. Risk categories of superficial bladder cancer according to European Giudelines
Risk category

How do we approach SBC?
Step 1: make the correct diagnosis
Urine biomarkers
Table 3. Currently FDA approved biomarkers urine tests with sensitivity and specificity
values.
Step 2: remove the tumour
5-aminolevulinic acid (ALA) induced fluorescence diagnosis of TCC
Step 3: administer the most appropriate treatment

Treatment End Points

Limitations of traditional molecules for SBC
Limitations in efficacy of intravesical treatment in intermediate risk SBC
Limitations in efficacy of intravesical treatment in high risk SBC
Side effects burden of currently-used intravesical agents

Alternative treatment options
Interferon (IFN) alpha
Table 4. IFN and bladder cancer related R&D.
Gemcitabine
Table 5. Gemcitabine and bladder cancer related R&D.

Investigational drugs
With a cytotoxic mechanism
Table 6. EOquin and bladder cancer related R&D.
With an immunological mechanism
Table 7. Imiquimod and bladder cancer related R&D.

Molecular therapy
Table 8. Antisense and bladder cancer related R&D
Magnetically targeted carriers (MTC)
Polymer microspheres
Antiangiogenetic therapy
Gene therapy
Table 9. Gene therapy and bladder cancer related R&D

Appendix I: Industry related R&D projects for the treatment of bladder cancer
Company Profiles
Abbott Laboratories Inc
Agensys Inc
AnorMED Inc.
Anthra Pharmaceuticals
Ariad Pharmaceuticals Inc
AstraZeneca AB
Avidex Ltd
Axcan Pharma Inc
Bioaccelerate Inc
Bioenvision
Bioniche Life Sciences Inc
Bristol-Myers Squibb
Cell Genesys, Inc
Cephalon Inc
Eisai Co Ltd
Eli Lilly
GlaxoSmithKline Plc
Got-A-Gene AB
Halozyme Therapeutics, Inc.
ID Biomedical Corporation
IDM S.A
Intracel Holding Corporation
Introgen Therapeutics
Madaus AG
Medarex Inc
Millennium Pharmaceuticals Inc
NeoPharma AB
Novartis International AG
OncoGenex Technologies Inc
PharmaMar SA
PhotoCure AS
Pierre Fabre Group
Regulon Inc
Sanofi-Aventis
Spectrum Pharmaceuticals Inc
Sumitomo Pharmaceuticals Co Ltd
Titan Pharmaceuticals, Inc
Viscum AG
Viventia Biotech Inc

References

Abbott Laboratories Inc
Agensys Inc
AnorMED Inc.
Anthra Pharmaceuticals
Ariad Pharmaceuticals Inc
AstraZeneca AB
Avidex Ltd
Axcan Pharma Inc
Bioaccelerate Inc
Bioenvision
Bioniche Life Sciences Inc
Bristol-Myers Squibb
Cell Genesys, Inc
Cephalon Inc
Eisai Co Ltd
Eli Lilly
GlaxoSmithKline Plc
Got-A-Gene AB
Halozyme Therapeutics, Inc.
ID Biomedical Corporation
IDM S.A
Intracel Holding Corporation
Introgen Therapeutics
Madaus AG
Medarex Inc
Millennium Pharmaceuticals Inc
NeoPharma AB
Novartis International AG
OncoGenex Technologies Inc
PharmaMar SA
PhotoCure AS
Pierre Fabre Group
Regulon Inc
Sanofi-Aventis
Spectrum Pharmaceuticals Inc
Sumitomo Pharmaceuticals Co Ltd
Titan Pharmaceuticals, Inc
Viscum AG
Viventia Biotech Inc

Request Sample Pages or Access via 1stOncology™

  • You can request Free Sample Pages to Superficial Bladder Cancer - Current Mangement and Future Trends.
    To find out more about Superficial Bladder Cancer - Current Mangement and Future Trends, please read the product description below.
    We also are happy to email you out free sample pages which contain screen shots and more information on the methodology behind the product.

    Did you know that Superficial Bladder Cancer - Current Mangement and Future Trends is part of the 1stOncology™ platform and can be accessed at no extra cost?

    1stOncology™ allows you to always stay on top of what is really going on in the world of cancer drug development and have an edge when it comes to Search & Evaluation, Indication Selection & Expansion, Target Scouting, First-in-Class analysis and much, much more.


    Or

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