Bladder cancer research has seen few advancements over the past 30 years
Although bladder cancer is the 9th most common cancer worldwide, mortality rates have remained relatively unchanged. In the EU, only 1 agent (vinflunine) has been approved in the last few decades. 1-3
Prognosis varies, with survival rates substantially dropping as the tumour progresses beyond the bladder.1 Managing bladder cancer can be challenging, as the majority of patients are older and many have comorbidities. This challenge is compounded once tumours recur or metastasize, and treatment options become limited.1,4,5
Bladder cancer classification
Bladder cancer is generally categorised according to the depth of tumour invasion6-7
Bladder Cancer: The Facts
- Non–muscle-invasive bladder cancer (≈70%)
- Muscle-invasive bladder cancer (≈30%)
- Metastatic bladder cancer (≈4%)
Mutation rate by cancer type1,2
Researching the role of the immune system in the management of bladder cancer
Bladder cancer is one of several cancers associated with a high rate of mutations, which may be linked to a heightened immunogenicity.7,8 The immune response to tumour cells may be influenced by interactions within the tumour microenvironment, as various types of tumour-infiltrating immune cells have been reported in bladder cancer.9,10 Understanding the role of tumour-infiltrating immune cells and the pathways governing the immune response can help guide immune-directed strategies specific to patients with bladder cancer.
TUMOUR-INFILTRATING IMMUNE CELLS REPORTED IN BLADDER CANCER10
- SEER stat fact sheets: bladder cancer. National Cancer Institute website. http://seer.cancer.gov/statfacts/html/urinb.html. Accessed February 4, 2015.
- Witjes JA, Compérat E, Cowan NC, et al. Muscle-invasive and metastatic bladder cancer. European Association of Urology 2015. http://uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic. Accessed July 21, 2015.
- Galsky MD, Domingo-Domenech J. Advances in the management of muscle-invasive bladder cancer through risk prediction, risk communication, and novel treatment approaches. Clin Adv Hematol Oncol. 2013;11:86-92. PMID: 23598909
- Clark PE, Agarwal N, Biagioli MC, et al; National Comprehensive Care Network (NCCN). Bladder cancer. J Natl Compr Canc Netw.2013;11:446-475. PMID: 23584347
- Prout GR, Wesley MN, Yancik R, Ries LA, Havlik RJ, Edwards BK. Age and comorbidity impact surgical therapy in older bladder carcinoma patients: a population-based study. Cancer. 2005;104:1638-1647. PMID: 16130136
- Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet. 2009;374:239-249. PMID: 19520422
- American Cancer Society. Bladder cancer. http://www.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf. Last revised February 25, 2015. Accessed March 5, 2015.
- Lawrence MS, Stojanov P, Polak P, et al. Mutational heterogeneity in cancer and the search for new cancer-associated genes. Nature.2013;499:214-218. PMID: 23770567
- Rajasagi M, Shukla SA, Fritsch EF, et al. Systematic identification of personal tumour-specific neoantigens in chronic lymphocytic leukemia.Blood. 2014;124:453-462. PMID: 24891321
- Chen DS, Irving BA, Hodi FS. Molecular pathways: next-generation immunotherapy—inhibiting programmed death-ligand 1 and programmed death-1. Clin Cancer Res. 2012;18:6580-6587. PMID: 23087408
- Sjödahl G, Lövgren K, Lauss M, et al. Infiltration of CD3+ and CD68+ cells in bladder cancer is subtype specific and affects the outcome of patients with muscle-invasive tumours. Urol Oncol. 2014;32:791-797. PMID: 24794251