As we seek to increase awareness of bladder cancer and the patients we serve, it is important to celebrate the enormous strides we have made in further understanding this disease. Recent scientific breakthroughs have resulted in novel treatments that have directly and positively impacted the lives of patients with bladder cancer. Bladder cancer is the sixth most common cancer worldwide, with more than half a million people diagnosed in 2018. Unfortunately, in that same year, more than 200,000 have died from this terrible disease.
For decades, there was little progress or innovation in the treatment of bladder cancer. Clinicians had few therapeutic options to offer their patients, and the available therapies often were quite toxic, difficult to tolerate, and eventually stopped working. Five-year survival rates were stagnant. Thankfully, that is changing.
Early Diagnosis can Complicate the Treatment Approach
Although screening tests are currently not recommended for individuals at average risk, bladder cancer can often be diagnosed at an early, organ-confined stage, which is advantageous in terms of prognosis. Nonetheless, early diagnosis can also pose therapeutic dilemmas. The more we learn about the biology of cancer, the more we understand the importance of intervening early in the course of the disease. Eliminating cancer is a much more daunting task once the disease has begun to spread. Thus, irradicating early bladder cancer reliably and durably is an important and meaningful goal.
Treating earlier and less invasive forms of bladder cancer, however, requires us to move away from systemic treatments and embrace local therapies. A majority (approximately 73 percent) of patients with bladder cancer are older than 65 years of age and they often have significant medical comorbidities. For this reason, providing effective localized therapies, while limiting systemic toxicities, is crucial.
We are currently combining sophisticated drugs and devices to help subsets of patients with bladder cancer in unprecedented ways. Doing so, however, has required innovation and outside-the-box thinking.
Effective Cancer Treatments can’t be Forced into New Contexts
As the appreciation for earlier therapeutic interventions has grown among the oncology community, it is tempting to aggressively apply systemic therapies active in metastatic tumors to less aggressive forms of disease. Unfortunately, therapies for metastatic disease may not offer the same risk-benefit or value to patients with more confined forms of disease.
With more than 90 percent of bladder cancers arising from epithelial cells that line the inside of the bladder, it would also be convenient if therapies that are effective for other epithelial cancers could be successfully applied in bladder cancer. However, there is a major barrier to this approach; unlike other organs, the bladder efficiently eliminates substances through the emptying process when the patient voids. Local injections or instillations of medications into the bladder have been of limited effectiveness, as these therapies are often sub optimally dosed and suffer from limited retention times within the bladder.
Intervening in Cancer Earlier Requires New Therapies, New Ways to Evaluate Them
Successfully treating and working toward cures for early-stage bladder cancer will likely require local and continuous delivery of therapies that can overcome the obstacles presented by the normally functioning bladder. With this unmet need in mind, we are investigating drug-device combinations that may provide reliable and potent intravesical drug delivery to the bladder.
Additional potential benefits of this investigational combination approach may include better tolerability, limited systemic toxicity, and improved compliance with treatment regimens due to their ease and convenience. Devices may also be combined with different drugs to customize treatments for individual patients, an approach that we continue to explore.
As we develop new strategies for earlier interventions in bladder cancer, definitions for clinically meaningful success will continue to evolve. Close collaboration between scientists, clinicians, and regulators is necessary as we consider novel and emerging endpoints, such as event-free and disease-free survival. Eventually, we seek to intercept cancers before they even arise. Doing so will require new ways of quantifying cancer risk and characterizing different types of pre-cancerous lesions.
The Future of Bladder Cancer: More Treatment Options, a More Patient-Centered Approach
Up until recently, the therapeutic landscape for bladder cancer had trailed behind that of other solid tumors, but the gap is closing. In many ways, progress in bladder cancer treatment is now mirroring what has already occurred in prostate and kidney cancer. In both diseases, breakthrough interventions have enabled urologists to maintain patients within their purview longer before referring them to other providers for later stage systemic or palliative treatments. This continuity of care, combined with innovative new therapies and patient services, will greatly enhance our ability to provide potential options to patients and their families facing a new diagnosis of bladder cancer. At Janssen, we seek to provide a therapeutic solution across the spectrum of disease as we work to transform the treatment of bladder cancer.
