The Health August 2023 | Page 26

Every year , roughly 80,000 Americans endure difficult and burdensome treatments to fight bladder cancer . But innovations might change that

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THE HEALTH | AUGUST , 2023

| Innovation |

Advancing new options for bladder cancer treatment

Every year , roughly 80,000 Americans endure difficult and burdensome treatments to fight bladder cancer . But innovations might change that

BY KRISTEN MASCIA

AS A clinician who ’ s worked with thousands of patients , urologic oncologist Sumeet Bhanvadia , M . D ., Senior Director , the Janssen Pharmaceutical Companies of Johnson & Johnson , has seen first-hand how difficult and burdensome a bladder cancer diagnosis can be .

Bladder cancer patients tend to be older - in the US , the median age of diagnosis is 72 - and already balancing an array of other age-related health problems .
Bladder cancer tumours are broadly categorised into three groups : nonmuscle invasive bladder cancer , muscle-invasive bladder cancer and metastatic bladder cancer . These categories determine the treatment needed .
About three-quarters of patients have tumours that are contained in the superficial layers lining the bladder ( nonmuscle invasive ), and these can be managed by a combination of IV medications , surgeries to shave off the tumour and drugs used inside the bladder to treat the cancer .
For those with muscle-invasive disease , treatment involves chemotherapy followed by surgical removal of the bladder . Chemotherapy is intensive and often not an option for patients because of other medical problems . The surgery can also be complex and , therefore , risky for elderly patients .
Removing the bladder also means that surgeons must create another way for urine to exit the body , which for the vast majority of patients , is in the form of a permanent urinary stoma outside the body .
“ While there are options to create a urinary diversion that is internal and is
Sumeet Bhanvadia an excellent choice for some patients , the vast majority of patients will end up with a stoma ,” says Dr Bhanvadia . “ In either case , this is a major disruption to one ’ s life and can seriously impact physical and psychological health . Many times , the patient ’ s loved ones will also go through a lot to provide care and support around this .”
A global team of physician-scientists at Janssen - including Dr Bhanvadia and Chris Cutie , M . D ., Vice President , Disease Area Leader , Bladder Cancer at the Janssen Pharmaceutical Companies of Johnson & Johnson - is working on a number of studies to evaluate new therapies and drug delivery approaches to help address the ongoing unmet need patients with bladder cancer continue to face .
“ Our ambition at Janssen is to change the treatment paradigm in bladder cancer and to bring innovation to these patients who continue to experience a high unmet need ,” says Dr Bhanvadia .
For Bladder Cancer Awareness Month , we spoke with Dr Bhanvadia to learn more about the urgent need for new options to treat this challenging disease .
Q : In the US , about 800,000 people are living with bladder cancer . Who is most likely to be affected by this disease , and what causes it ? This cancer affects mainly elderly people , and there ’ s a male predominance by about three to one . In addition to age , smoking is another big risk factor : For patients who are or have been smokers , there is evidence that smoking cessation can decrease the risk of developing the disease after a certain number of years . Even after a bladder cancer diagnosis , quitting can improve cancer outcomes .
A significant proportion of patients , particularly those who are 80 and older , receive no definitive therapy for their bladder cancer at all .
Currently , there are no population-wide screenings for bladder cancer - although in high-risk groups , a lot of research is underway to explore whether targeted screening should be done for people at high risk , similar to what is being done for lung cancer .
In terms of detection , blood in the urine , called hematuria , tends to be the first warning sign of bladder cancer and warrants a prompt visit to the doctor . In women , hematuria is often attributed to a urinary tract infection and can lead to delays in the diagnosis of bladder cancer .
Q : Once bladder cancer is diagnosed , how is it treated ? We manage bladder cancers differently , depending on a patient ’ s diagnosis . We divide them into two broad buckets : muscle-invasive disease ( MIBC ) and nonmuscle invasive bladder cancer ( NMIBC ).
Seventy-five per cent of new cases are nonmuscle invasive , and about 25 per cent are muscle-invasive or metastatic , in which the cancer has spread beyond the bladder . Unfortunately , the muscle-invasive kind is lethal : Up to 50 per cent of patients who have their bladders removed still have some kind of recurrence elsewhere in the body down the road .