Research in bladder cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better ways to treat bladder cancer. The following is a selection of research showing promise for treating bladder cancer.

We’ve included information from the following sources. Each item has an identity number that links to a brief overview (abstract).

• PubMed, US National Library of Medicine (PMID)
• American Society of Clinical Oncology (ASCO)
• Canadian Cancer Trials and ClinicalTrials.gov (NCT)

Researchers are looking for the best ways to treat bladder cancer using surgery and to improve surgical techniques. Minimally invasive surgeries that cause less damage to the body are a common area of study.

Laparoscopic radical cystectomy is a minimally invasive surgery to remove the whole bladder. It uses a laparoscope placed in the abdomen through small cuts (incisions). Surgeons may do a laparoscopic radical cystectomy to avoid making the large incision needed to do an open radical cystectomy. A laparoscopic radical cystectomy is more complicated and takes longer to do, but studies show people who have this surgery usually have a shorter recovery time, fewer blood transfusions and fewer problems (complications) than those who have open surgery. Research shows a laparoscopic radical cystectomy is as effective as the standard open surgery (Actas Urológicas Españolas, PMID 30327148, PMID 28624175, PMID 27908634; European Urology, PMID 26272237).

Robot-assisted radical cystectomy is a type of laparoscopic cystectomy. The surgeon sits near the operating table and controls robotic arms to remove the bladder through several small incisions in the abdomen. The robotic arms have tools that turn and bend like the human wrist. Robot-assisted surgery tends to have less bleeding and a quicker recovery. But recent studies show that robot-assisted radical cystectomy does not have a large benefit over standard open surgery. Both approaches to radical cystectomy have similar complication rates, risk that the cancer will come back (recur) and mortality rates. Researchers continue to study robot-assisted radical cystectomy (European Urology, PMID 29784190; Urologic Clinics of North America, PMID 29650134; Current Urology Reports, PMID 28634646).

The following is noteworthy research in chemotherapy and other drugs for bladder cancer.

Intravesical therapy is a treatment that places a drug directly into the bladder. It is a standard treatment for early stage bladder cancer using drugs such as bacillus Calmette-Guérin (BCG) or mitomycin (Mutamycin). Researchers are studying intravesical therapy using other drugs, combinations of drugs and different doses for bladder cancer that hasn’t grown into the muscle layer of the bladder (non-muscle invasive). They are looking for factors such as improved disease-free survival and lower risk of recurrence (JAMA, PMID 29801011; Cell Physiology and Biochemistry, PMID 28278504; European Urology, PMID 27085624, PMID 25301758; BMC Cancer, PMID 26014129). Studies also looked at using lower doses of intravesical BCG. Results show that standard-dose BCG seems to work better because it reduces the risk of recurrence. More research is needed because some people with bladder cancer, depending on certain criteria, may still benefit from low-dose intravesical BCG (Medicine, PMID 29049231, PMID 26656345; Journal of Urology, PMID 26307162).

Systemic chemotherapy is when drugs travel through the bloodstream to reach and destroy cancer cells all over the body. It is given through a needle into a vein and commonly used before or after radical cystectomy surgery. Researchers are looking for different second-line chemotherapy drugs that may be used if bladder cancer comes back or the standard chemotherapy with cisplatin didn’t work. Researchers studied vinflunine, but this drug doesn’t improve survival (Core Evidence, PMID 29416444; Annals of Oncology, PMID 26487582; Journal of Urology, PMID 26410730). Studies are now looking at combining systemic chemotherapy with targeted therapy as second-line therapy.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells. Researchers are studying different targeted therapy drugs to see how well they work to treat bladder cancer that has spread to other parts of the body (advanced or metastatic bladder cancer). Researchers often study targeted therapy drugs in combination with chemotherapy or after chemotherapy. Some of the targeted therapy drugs that researchers are studying include:

• ramucirumab (Cyramza) with docetaxel (Taxotere) (Lancet, PMID 28916371)
• lapatinib (Tykerb) (Journal of Clinical Oncology, PMID 28034079)
• erdafitinib (Canadian Cancer Trials, NCT 03390504; ASCO, Abstract 4503)

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. It is commonly used to treat bladder cancer. New immunotherapy drugs showing promise in treating bladder cancer include tremelimumab and olaparib (Lynparza) (Canadian Cancer Trials, NCT 02516241, NCT 03459846; World Journal of Urology, PMID 29855698).

Photodynamic therapy (PDT) uses photosensitizer drugs to destroy cancer cells. These drugs make cells sensitive to light. Researchers studied PDT using 5-aminolevulinic acid as a treatment for early stages of bladder cancer (International Journal of Urology, PMID 28191719). A small trial looked at using during surgery to remove the bladder tumour through the urethra (transurethral resection of bladder tumour, or TURBT). Researchers found that PDT during this surgery may be a treatment option for bladder cancer that has not grown into the muscle layer of the bladder (Photodiagnosis and Photodynamic Therapy, PMID 27671517).

Bladder cancer may come back (recur) after it has been treated. Researchers are looking for ways to improve follow-up after treatment for bladder cancer.

Bladder EpiCheck is a urine test to check if bladder cancer has come back. It looks for certain changes in your genetic material (DNA) that can mean there are cancer cells in the urine. Researchers are studying how well Bladder EpiCheck works compared to the standard cystoscopy for monitoring people who have had bladder cancer (Canadian Cancer Trials, NCT 02700464).

Researchers continue to try to find out more about bladder cancer. Clinical trials are research studies that test new ways to treat bladder cancer. They also look at ways to prevent, find and manage cancer.

Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for bladder cancer were first shown to be effective through clinical trials.

Find out more about clinical trials.