1 / 19

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

melita
Download Presentation

Bladder Cancer: An Overview of Epidemiology and Treatment Strategies

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related