New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk that cancer will recur (come back).
Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
A link to a list of current clinical trials is included for each treatment section. For some types or stagesof cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
· Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
· A clinical trial of biologic therapy.
· A clinical trial of chemoprevention therapy given after treatment so the condition will not recur(come back).
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage 0 bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
· Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
· A clinical trial of chemoprevention therapy given after treatment to stop cancer from recurring(coming back).
· A clinical trial of intravesical therapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage I bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage II bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage III bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
· External radiation therapy (may be as palliative therapy to relieve symptoms and improve quality of life).
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage IV bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Treatment Options for Recurrent Bladder Cancer
Treatment of recurrent bladder cancer depends on previous treatment and where the cancer hasrecurred. Treatment for recurrent bladder cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withrecurrent bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Chemoradiation May Help Some Patients with Bladder Cancer Avoid Radical Surgery
Researchers in the United Kingdom have found that adding chemotherapyto radiation therapy as a treatment for bladder cancer may reduce the risk of a recurrence more than radiation alone, without causing a substantial increase in side effects.
The combined treatment approach—known as chemoradiation—was tested in 360 patients with muscle-invasive bladder cancer, a potentially deadly form of the disease. Results from the randomizedphase III study appeared April 19, 2012, in the New England Journal of Medicine.
“The success of this trial could mean that fewer patients need to have their bladders removed,” study co-leader Nick James, Ph.D., of the University of Birmingham, wrote in an e-mail message. “This approach also provides a viable treatment alternative for frailer patients who are too weak for surgery.”
“These data are really quite compelling,” said one of the editorialists, William Shipley, M.D., of Massachusetts General Hospital and Harvard Medical School. Chemoradiation, he continued, can now be regarded as one of several treatment options for patients with muscle-invasive bladder cancer and their physicians to consider.
Preserving the Bladder
In the study, 182 participants were randomly assigned to receive chemotherapy with fluorouracil andmitomycin C in addition to radiation therapy; the other 178 received radiation therapy alone. All participants had muscle-invasive bladder cancer.
Thirty-three percent of the patients who received chemoradiation experienced a relapse in the bladder or in the surrounding tissues within 2 years, compared with 46 percent of those who had radiation therapy alone. The results also showed that, after a median follow-up of about 70 months, the addition of chemotherapy cut the relative risk of invasive disease recurrence by almost half.
There was not a statistically significant difference in overall survival between the chemoradiation and radiation-only groups. More patients in the radiation-only group than in the chemoradiation group had their bladders surgically removed (cystectomy) following a recurrence, and the researchers noted that this increased rate of surgery could make it difficult to determine whether the combination treatment improves survival.
Although the trial did not directly compare chemoradiation with surgical removal of the bladder, the findings add to evidence that a considerable proportion of patients with muscle-invasive bladder cancer can avoid radical surgery for the disease, noted Bhadrasain Vikram, M.D., chief of the Clinical Radiation Oncology Branch of NCI’s Radiation Research Program.
“These trials are hard to do because of the relative rarity of muscle-invasive bladder cancer and—especially in the United States—the conviction of many urologists that removal of the bladder is the preferred treatment whenever possible,” Dr. Vikram added. (Non-muscle-invasive bladder cancers are not life threatening, and minor surgery during cystoscopy is often effective.)
Similar Results Seen in Anal Cancer
The rationale behind testing chemoradiation for bladder cancer was that the chemotherapy would make the radiation therapy more effective, as has been demonstrated in some other cancers. Indeed, the new results mirror the experience of patients with anal cancer, who have been able to avoid the trauma of having the anus removed surgically, noted Dr. Shipley.
When chemotherapy is used to treat bladder cancer in the United States, doctors have traditionally used cisplatin-based combinations rather than fluorouracil and mitomycin C. It will be up to individual physicians to decide which drug to use in a chemoradiation regimen, the editorialists noted.
Regardless of which drugs are used, surgery will remain a critical option for patients treated with an organ-preservation strategy. Patients who have a recurrence after receiving chemoradiation need additional treatment such as surgery; not all patients are candidates for surgery, however.
“Although chemoradiation presents an option for patients who are ineligible for surgery, the current study does not specifically address this patient population,” said Matthew Milowsky, M.D., co-director of the urologic oncology program at UNC Lineberger Comprehensive Cancer Center in Chapel Hill, NC. “This approach is not for all patients, and it is important to appropriately select patients for bladder preservation therapy,” he added.
Matching Patients to Therapies
Future studies will assess potential tumor markers that could help identify candidates for the procedure at the time of diagnosis. One potential marker is a protein called MRE11, which is involved in the cellular response to radiation-induced DNA damage, Dr. Shipley noted.
In the meantime, the new results could increase interest in strategies that aim to preserve the bladder. “Removing the bladder is a major operation with implications for the rest of the patient’s life,” said study co-leader Robert Huddart, Ph.D., from the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, in a statement.
In the United States, bladder preservation is underutilized, noted Howard Sandler, M.D., chair of Radiation Oncology at Cedars-Sinai Medical Center. The vast majority of patients who are eligible for surgery get surgery, he said, in part because there are few good studies comparing radiation-based approaches with surgery.
“The take-home message of this study is that patients with muscle-invasive bladder cancer should have a discussion with their physicians about the role of bladder preservation using chemotherapy and radiation therapy,” said Dr. Sandler.
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