Bladder cancer treatment

Most of the cancer forms are designated on the basis of their occurrence in the particular part of the body, e.g., breast cancer, brain cancer, bladder cancer, liver cancer, lung cancer, ovarian cancer, stomach cancer, vaginal cancer and so on. Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. 

It is employed in combination witli vinblastine and bleomycin for the treatment of metastatic testicular tumours. It is also used for the remission of metastaticovarian tumours when given either alone or in combination with doxorubicin. It also exhibits activity against a host of other tumours, such as cervical cancer, neck and head cancer, penile cancer, bladder cancer and small-cell cancer of the lung. 

Photofrin (polyhematoporphyrin ethers), the first and so far only photosensitizer approved by health agencies worldwide for treatment of cancer, remains the most widely used in routine clinical practice for treatment of esophageal and lung cancers (approved), as well as in a host of off-label indications (e.g., skin cancer, bladder cancer, brain tumors, head and neck cancers, etc). 

Chemotherapy is a treatment used for some types of cancer. The treatment employs anticancer drugs to destroy cancer cells. An important cancer-fighting drug is cisplatin, which is commonly used to treat testicular, bladder, lung, esophagus, stomach, and ovarian cancers. 

The first clinical trials were performed in the 1970 s using a sodium salt derivative with an open E-ting (Fig. 1). However, the clinical efficacy was limited and severe bladder toxicity led to the termination of the clinical trials. The poor efficacy of the camptothecin sodium salt in those clinical trials was probably due to the fact that the open E-ring form of camptothecin (carboxylate derivative) is inactive as a Topi inhibitor. Following the identification of Topi as a target of camptothecin, water-soluble derivatives were produced by the pharmaceutical industry. Two of these water-soluble derivatives have been approved by the FDA for cancer treatment in the early 2000s topotecan and irinotecan. 

Dead or live bacteria may be effective to stimulate inflammatory reactions of phagocytic cells against tumor cells. The best-characterized treatment is the use of Bacillus Calmette Guerin (BCG) in the case of bladder cancer where activation of the immune response is capable of controlling tumor growth. 

Vinblastine is another vesicant vinca alkaloid that causes myelo-suppression and less neurotoxicity than vincristine. The pharmacokinetics of vinblastine are best described by a three-compartment model, with an a half-life of 25 minutes, a 3 half-life of 53 minutes, and a terminal half-life of 19 to 25 hours.12 Vinblastine has shown activity in the treatment of bladder, breast, and kidney cancer, as well as some lymphomas. The doses of vinblastine tend to be higher on a milligram per meter squared basis than vincristine. Nausea and vomiting are minimal with vinblastine. Other side effects include mild alopecia, rash, photosensitivity, and stomatitis. 

Docetaxel, another taxane, binds to tubulin to promote microtubule assembly. The pharmacokinetics of docetaxel are best described by a three-compartment model, with an a half-life of 0.08 hours, a 3 half-life of 1.6 to 1.8 hours, and a terminal half-life of 65 to 73 hours.14 Docetaxel has activity in the treatment of breast, non-small cell lung, prostate, bladder, esophageal, stomach, ovary, and head and neck cancers. Dexamethasone, 8 mg twice daily for 3 days starting the day before treatment, is used to prevent the fluid retention syndrome associated with docetaxel and possible hypersensitivity reactions. The fluid... 

Mitomycin C is an alkylating agent that forms cross-links with DNA to inhibit DNA and RNA synthesis. The pharmacokinetics of mitomycin C are best described by a two-compartment model, with an a half-life of 8 minutes and a terminal half-life of 48 minutes.31 Liver metabolism is the primary route of elimination. Mitomycin C has shown clinical activity in the treatment of anal, bladder, cervix, gallbladder, esophageal, and stomach cancer. Side effects consist of myelosuppression and mucositis, and it is a vesicant. 

Figure 1.2 Examples of immunostaining intensity from comparison of pRB-IHC in 27 cases of FFPE tissues of bladder cancer (Table 1.4). (A-D) Negative (<10%) showing a few weak positive nuclei (arrows) (E-H) moderate positive (>10%) (I-P) strong positive (>50%). Arrows indicate positive nuclear staining for some lymphocytes or other stromal cells as an internal control. Note the lack of nuclear hematoxylin counterstaining due to low pH AR treatment. The order of cases are indicated in Table 1.4. Reproduced with permission from Shi et al.. Biotech. Histochem. 2007 82 301-309. See color insert.

Intravesical infusion of linear PEI/pDNA polyplexes was evaluated in patients with superficial bladder cancer where intravesical therapy with bacillus Calmette-Guerin had failed [6, 224]. Patients had low grade superficial bladder cancer, which expressed H19. The therapeutic pDNA contains H19 gene regulatory sequences that drive the expression of an intracellular toxin. Escalating doses of 2-20 mg plasmid per intravesical treatment were applied, with responders continuing to receive polyplexes once a month every month for 1 year. The treatment resulted in complete ablation of the marker tumor, without any new tumors in four of the 18 patients (22% overall complete response rate). Eight of the 18 patients (44%) had complete marker tumor ablation or a 50% reduction of the marker lesion. 

Further studies have shown additional cancer types, most notably ovarian and bladder cancer, non-Hodgkin s lymphoma and acute myeloid leukaemia, to be at least partially responsive to IL-2 treatment. However, a persistent feature of clinical investigations assessing IL-2 effects on various cancer types is variability of response. Several trials have yielded conflicting results, and no reliable predictor of clinical response is available. 

Lage, J.M. et al., Histological parameters and pitfalls in the interpretation of bladder biopsies in Bacillus Calmette-Guerin treatment of superficial bladder cancer, J. Urol., 135, 916, 1986. 

Badalament RA. 1998. Diagnosis and treatment of bladder cancer. httr) //www.cancemews.com/bladdercn.htm. 

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