| Innovation |
AUGUST , 2023 | THE HEALTH
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The standard of care for bladder cancer is chemotherapy , concurrent chemotherapy and radiation or radical cystectomy - removal of the bladder . But a significant proportion of patients , particularly those who are 80 and older , receive no definitive therapy for their bladder cancer at all . Or they go straight to cystectomy .
Q : Why do some patients not get chemotherapy , which can be very effective ? Often , patients are older , so many aren ’ t good candidates for chemotherapy - which is an aggressive treatment - because they are frail or have poor kidney function or other comorbidities . Of course , cystectomy is a major abdominal surgery with risks for this group as well . About 60 per cent of patients who undergo cystectomy will have a complication within the first 90 days of their operation .
Afterwards , most patients will also have a urinary stoma , a bag that collects their urine outside of their body . It ’ s something they ’ ll need to manage for the rest of their lives .
We need therapies that are less burdensome for all patients with bladder cancer . Even for patients with localised bladder cancer who don ’ t have their bladders removed , the disease can become almost chronic :
Recurrent tumours in the bladder are common , and there is the risk of developing a more aggressive tumour . For this reason , patients need ongoing surveillance , often with in-office endoscopy of the bladder ( called cystoscopy ) and repeat treatments . That ’ s hard for the patient and the healthcare system . We need treatments with better durability .
Q : Chemotherapy for bladder cancer can also be applied locally , straight to the bladder . But there ’ s a drawback to that method , right ? What excites me most is thinking outside the box and developing treatment paradigms that have the potential to change the way we treat bladder cancer .
Treating the bladder directly with chemotherapy agents is called intravesical therapy . It has been a standard of care therapy for bladder cancer for many years . A catheter is placed into the bladder and the medication is instilled through the catheter , where it is held for a couple of hours .
Patients tend to tolerate this fairly well , but it has limited effectiveness in treating the cancer in the long-term . It ’ s possible that an hour or two is not long enough .
Q : What approaches is Janssen working on to address unmet needs in the
treatment of bladder cancer ? Janssen has a number of clinical programs underway , which span the full spectrum of urothelial carcinoma , from nonmuscle invasive and muscle-invasive bladder cancer to metastatic disease . These include therapeutic options for the treatment of patients with certain gene mutations , as well as novel drug delivery technologies built to directly treat organ-confined tumours in the bladder ( pictured above ).
Several years ago , a group of scientists from Boston started thinking about developing a device that could be used in the bladder . It ’ s a very unique organ , in that it ’ s a hollow place where things can float around . The idea was , can you create something that could be placed in the bladder and then releases a medication in a slow , sustained way , over a longer period of time ?
Q : Are you excited about the potential for new options for bladder cancer patients ? What excites me most is thinking outside the box and developing treatment paradigms that have the potential to change the way we treat bladder cancer and that may transform patient outcomes in the future . – The Health
This article appeared recently on the website of Johnson & Johnson
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