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Bladder Cancer: An Overview of Epidemiology and Treatment Strategies

Bladder Cancer: An Overview of Epidemiology and Treatment Strategies. Alvaro Morales, M.D. Centre for Urological Research Queen’s University Canada. What is Known about Bladder Cancer. Over 60,000 new cases/year in North America Over 13,000 deaths/year in North America

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Bladder Cancer: An Overview of Epidemiology and Treatment Strategies

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  1. Bladder Cancer: An Overview of Epidemiology and Treatment Strategies Alvaro Morales, M.D. Centre for Urological Research Queen’s University Canada

  2. What is Known about Bladder Cancer • Over 60,000 new cases/year in North America • Over 13,000 deaths/year in North America • 4th most common cancer in men • 8th most common in women • More common in men than women • 29.0 vs. 7.4/100,000 • Peak incidence in the 7th decade

  3. What is Known - 2 • More common in white than black people • 18.2 versus 8.2/ 100,000 • More common in industrialized countries • Except Egypt • Large majority diagnosed early • Hematuria • Potentially curable

  4. Lifetime Probability of Developing Cancer, By Site, Men, US, 1999-2001 Site Risk Prostate 1 in 6 Lung and bronchus 1 in 13 Colon and rectum 1 in 17 Urinary bladder 1 in 28 Non-Hodgkin lymphoma 1 in 46 Melanoma 1 in 53 Kidney 1 in 67 Oral Cavity 1 in 73 Stomach 1 in 81 Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 5.2 Statistical Research and Applications Branch, NCI, 2004. http://srab.cancer.gov/devcan

  5. Relative Survival (%) During Three Time Periods,By Cancer Site 1983-1985 1995-2000 Site 1974-1976 • Breast (female) 75 78 88 • Colon 50 58 63 • Lung and bronchus 13 14 15 • Melanoma of the skin 80 85 91 • Ovary 37 41 44 • Pancreas 3 3 4 • Prostate 67 75 99 • Rectum 49 55 64 • Urinary bladder 73 78 82 Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.

  6. 2005 Estimated US Cancer Deaths Men295,280 Women275,000 Lung and bronchus 31% Prostate 10% Colon and rectum 10% Pancreas 5% Leukemia 4% Esophagus 4% Liver and intrahepatic 3%bile duct Non-Hodgkin 3% Lymphoma Urinary bladder 3% Kidney 3% All other sites 24% • 27% Lung and bronchus • 15% Breast • 10% Colon and rectum • 6% Ovary • 6% Pancreas • 4% Leukemia • 3% Non-Hodgkin lymphoma • 3% Uterine corpus • 2% Multiple myeloma • 2% Brain/ONS • 22% All other sites . Source: American Cancer Society, 2005.

  7. What is Known - 3 • Most tumors “curable” at diagnosis • Most recur within 2 years • Surveillance mandatory • Search for intravesical treatments

  8. Thiotepa Mitomycin-C Adriamycin BCG Interferon- Bropiramine Valrubicin Gemcitabine Efficacious Agents

  9. BCG Efficacy • In prevention of recurrence: 40% - 80% • For high risk cancers: ± 60% • For treatment of CIS: ±70%

  10. BCG and MMC in High Risk TCC 3 year Failure-free Survival Rates Author Mitomycin C BCG+maintenance Lamm et al. (2000) --- 75% Di Stasi et al. (2003) 28% 50% Martinez-Piñeiro et al. (1990) --- 85% Lamm et a.l (1995) 35% 55% Malmstrom et al. (1999) 34% 49% Au et al. (2001) 26% --- Lamm et al. (1991) --- 50% Weighted average calculation: BCG 61% . MMC: 36%

  11. Drawbacks of BCG • Room for improved efficacy • 20-40% of non responders • Significant variability in dosage • Number of CFU from batch to batch • Risks of handling • Biohazard precautions (hood, gown gloves and mask) • Protection from light • Potential contamination of household • Safety profile

  12. Drawbacks of BCG - II • Administration contraindicated following resection • Need for expert catheterization • Potential for sepsis • Self-perpetuating infection • Need for prolonged anti-TB treatment

  13. Toxicity of Full and 1/3 Dose BCG Martinez P et al. Eur Urology 31:31-41, 1997

  14. Treatment Algorithm for High Risk TCC - 2004 Initial TUR  pT1G3, muscularis propria present and negative Evans CP, Busby JE. BJUI 92:345, 2003

  15. Treatment Algorithm For High Risk TCC – 2010(?) Initial TUR  pT1G3, muscularis propria present and negative MCC MCC Evans CP, Busby JE. BJUI 92:345, 2003

  16. Conclusions • BCG remains the standard treatment for high risk superficial TCC • MCC dual mechanism of action not shared with BCG • MCC effective in phase II studies • MCC a better safety profile and easier to handle

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