Download Non Muscle Invasive Bladder Cancer

Non Muscle Invasive
Bladder
Cancer
Lawrence Karsh, MD FACS CPI
Director of Research
Attending Urologist
The Urology Center of Colorado
Lawrence I Karsh MD FACS CPI
Director of Research
Bladder Cancer


Most frequent malignant tumor of the urinary
tract
Male > female; ratio 3:1





4th most common cancer in men; 8th in Women
72,570 estimated new cases in USA 2013
15,210 estimated deaths in USA 2013
Ages: 50-70 most common; “any” age can get
Most common type is Transitional Cell
Natural History- at diagnosis
70-80% are non-muscle invasive at
presentation
60% are low grade
40% are high grade
50%-70% will recur at 5 yr
10%-30% will progress to muscle invasive
5%-10% are metastatic
Low grade ca can develop into high grade

Bladder Cancer -Risks

Smoking – 4x greater risk



Aniline dyes/aromatic amines




Phenacetin – non steroid-anti inflammatory pain reliever;
not much used any longer (illegal); is used to cut cocaine
Cyclophosphamide – chemotherapeutic agent – leukemia,
lymphoma, severe lupus
History of pelvic radiation


Hairdressers, photo processing, painters, truck drivers,
synthetic textiles
Chemicals with leather goods, rubber
Drugs


Increases with number smoked
? If decreases after quit smoking (>25yr smoke free)
Prostate, cervical
Chronic irritation/catheters – Squamous cell
Carcinoma
in-situ





“superficial”
Bad Guy
25% high grade cancers have CIS
30-70% muscle invasive tumors have CIS
50% response to BCG
Intravesical therapy





BCG - FDA approved
Thiotepa FDA approved
Mitomycin - NOT FDA approved
Doxorubicin - NOT FDA approved
Valrubicin-FDA approved for
recurrent CIS
Intravesical Therapy- BCG
(Mycobacterium bovis)
Bacillus Calmette Guerin
Albert Calmette
From Britianica.com





Cammile Guerin
From today in science
The Tuberculosis vaccine (invented 1921)
Attenuated (weakened) form of Mycobacterium
bovis bacterium
Produces local inflammatory reaction which is
suppose to rev up the T immune system to
destroy cancer
Most effective intravesical agent
Superior for CIS
From microbiologybytes.com
BCG





Approved for CIS and recurrent Ta/T1
60-80% cystitis- no pain no gain
Most effective but most risks
Decrease recurrence by 40%
Decrease progression by 27% if use
maintenance
What is this clinical trial about
and who will benefit?
How does the therapy work?
Side Effects
Intravesical administration of
rAd-IFN with Syn3 was well
tolerated in the phase I trial
Why should I enroll in this trial?
1. Cutting edge treatment
2. May possibly delay or prevent
cystectomy if effective and
approved by the FDA
3. Advance science
4. Help next generation of patients
with similar problem
Where can I find this information?
•
•
•
•
•
www.bcan.org
www.suoctc.org
www.clinicaltrials.gov
www.nccn.org
www.tucc.com
INSTILADRINTM (RAD-IFN)