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Oncology

Stakeholder Opinions: Bladder Cancer

New drugs needed to challenge ineffective 20 year old drugs

Publication Date November 2008
Publisher Datamonitor
Product Type Report
Pages 95
ISBN Number not applicable
Product Code DAT01637

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£1,320.00
approximately: $1,999 | €1,473

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Summary

Introduction

The overall incidence of bladder cancer in the seven major markets is forecast to exceed 160,000 by the end of 2008. Treatment of bladder cancer employs mainly immunotherapy and chemotherapy. However, both these methods are ineffective in improving longterm survival. Thus, there is a lucrative commercial opportunity for drug developers to enter this market, especially in the metastatic setting.

Scope

  • Current diagnosis and treatment of bladder cancer, including treatment regimens by stage and geographical location
  • Issues in diagnosis, treatment strategies and unmet needs
  • Examination of pipeline activity and potential future opportunities for drug developers
  • Stakeholder opinions based on qualitative interviews with five opinion leaders from the US and Europe

Highlights

Discovery of more effective systemic therapies is crucial for the treatment of patients with advanced or metastatic disease as current therapies have little impact on survival. BCG therapy, the current standard treatment for noninvasive bladder cancer has limited use in patients who experience multiple recurrences. Patients who become refractory or intolerant to further BCG treatment have few options. There is therefore a large patient potential for drugs that can replace BCG or treat BCGrefractory patients. Bladder cancer therapy consists of cytotoxics and immunotherapy agents that have been genericized for many years. Latestage pipeline drugs consist of targeted therapies and cytotoxics including Urocidin and EOquin. Some late stage drugs have demonstrated favourable efficacy in trials and look to fill some of the unmet needs in bladder cancer.

Reasons to Purchase

  • Understand the pathology and epidemiology of bladder cancer
  • Understand the limitations of current bladder cancer treatment
  • Obtain insight into the commercial opportunities available in the bladder cancer market

Contents

  • About Datamonitor Healthcare
    • About The Oncology Pharmaceutical Analysis Team
  • Chapter 1 Executive Summary
    • Scope Of Analysis
    • Datamonitor Insight Into The Bladder Cancer Market
    • Related Reports
    • Upcoming Reports
  • Chapter 2 Disease Overview
  • Introduction
    • Disease Overview
    • Insufficient Treatment Options For Advanced Stages Of Disease
    • The Recurring Nature Of NonInvasive Tumors Leads To A Great Economic Burden
    • Anatomy Of The Bladder
    • Bladder Cancer
    • Definition
    • Pathology/Histology
    • Transitional Cell Carcinoma Is The Most Common Cancer Type In Developed Countries
    • Squamous Cell Carcinoma Accounts For 75% Of Bladder Tumors In Developing Countries
    • Adenocarcinoma Is Common In Patients With Exstrophy
    • Uncommon Bladder Cancer Types
    • Clinical Classifications
    • Epidemiology
    • Aging Population Contributes To Rising Incidence Rates
    • Rising Mortality Rates Highlight The Need For Better Treatment Options
    • Risk Factors
    • Older Age
    • Active And Passive Smokers Are More Likely To Develop Bladder Cancer
    • Chemical Industry Employees Are At Greater Risk
    • Medical Risk Factors And Prior CyclophosphamideBased Chemotherapy Increases Chances Of Developing Bladder Cancer
    • Urinary Tract Infections Are Directly Related To Invasive Scc
    • Greater Incidence In Men Than Women
    • Ethnicity And Geographical Location Affect Prognosis And Risk Of Developing Disease
    • Genetic Factors Also Affect The Chances Of Developing Bladder Cancer
    • Symptoms
    • All Cases Of Hematuria Should Be Investigated For Bladder Cancer
    • Screening
    • Urinary Markers Have Not Been Embraced For Bladder Cancer Screening
    • Diagnosis
    • Cystoscopy Is The Most Widely Used Test For Bladder Cancer
    • Staging
    • The Tnm System Is The More Descriptive Method Of Staging
    • The World Health Organization (Who) Offers A Modified Grading System
    • 75% Of Tumors Are NonInvasive At The Time Of Diagnosis
    • Prognosis And Survival
    • HighGrade Tumors Have The Worst Prognosis As Progression Is More Likely To Occur
    • Growth Factor Receptors May Serve As Prognostic Markers And Therapy Targets
    • Prevention
    • Lifestyle Changes Are Advised To Prevent Bladder Cancer
  • Chapter 3 Current Treatment Options And Controversies
  • Introduction
    • Treatment Guidelines
    • National Comprehensive Cancer Network Treatment Guidelines
    • Transurethral Resection Followed By Intravesical Bcg Is The Standard Treatment For NonInvasive Tumors And Cis In The Us
    • Radical Cystectomy Is The Preferred Treatment For Continually Recurring Tumors
    • European Treatment Guidelines
    • Eu Clinicians Use Bcg Therapy Less Than Clinicians In The Us
    • Japanese Treatment Guidelines
    • Cystectomy Is The Main Treatment Used For Bladder Cancer In Japan
    • Treatment By Stage
    • NonInvasive Bladder Cancer
    • Recurrence And Progression Must Be Prevented By Surgery And Adjuvant Intravesical Therapy If LongTerm Survival Is To Be Achieved
    • Turbt Is An Appropriate Primary Treatment Because It Eliminates Visible Tumors
    • Immunotherapy Is Preferred To Chemotherapy As An Adjuvant To Turbt
    • Few Options Are Available For BcgRefractory Patients
    • Combination Chemotherapy Is More Effective Than SingleAgent Chemotherapy
    • Invasive Bladder Cancer
    • Cystectomy Is The Standard Therapy For Invasive Tumors
    • ...However, Only 50% Of Patients Will Survive Past 5 Years Unless Adjuvant Chemotherapy Is Administered
    • Metastatic Bladder Cancer
    • BladderRemoving Surgery Remains The Best LifeSaving Strategy As Adequate Treatment Has Yet To Be Identified
    • Neoadjuvant Chemotherapy Is Recommended For Metastatic Tumors
    • CisplatinBased Combination Chemotherapy Forms The Cornerstone Of FirstLine Therapy For Metastatic Bladder Cancer
    • Patients With A Poor Performance History Receive Radiotherapy
    • Recurrent Tumors
  • Chapter 4 Unmet Needs
  • Introduction
    • Unmet Needs
    • No Treatment Available To Prevent Recurrent Tumors In NonInvasive Bladder Cancer
    • Limited Treatment Options For Patients Who Are Unfit For Current Treatment Options
    • BcgRefractory Patients Usually Fail To Respond To Chemotherapy
    • Patients Who Are Unfit For Cystectomy Receive Substandard Treatment Due To A Lack Of Options
    • Metastatic Disease Treatment Is Not Effective
    • No Standard Treatment Schedule Is Available For Adjuvant Therapy With Immunotherapy Or Chemotherapy
    • Better Routes Of Administration Than Intravesically May Lead To Longer Exposure Time And Better Drug Absorption
    • More Sensitive Detection Methods As Well As Prognostic Markers Are Needed To Combat The High Cost Of FollowUp
    • New Drugs Required For NonUrothelial Cell Tumor Treatment
  • Summary Of Unmet Needs
  • Chapter 5 Pipeline Analysis
    • Pipeline Overview
    • The Bladder Cancer Pipeline
    • Phase Iii Pipeline
    • Phase Ii Pipeline
    • Targeted Therapy Strives For A Place In The Bladder Cancer Market
    • Phase Iii Drug Profiles
    • Eoquin (Apaziquone; Spectrum Pharmaceuticals)
    • Drug Overview
    • Key Historical Events
    • Clinical Development In Bladder Cancer
    • Datamonitor Comments
    • Iressa (Gefitinib; Astrazeneca)
    • Drug Overview
    • Key Historical Events
    • Clinical Development In Bladder Cancer
    • Datamonitor Comments
    • Urocidin (Mcc; Bioniche Life Science)
    • Drug Overview
    • Key Historical Events
    • Clinical Development In Bladder Cancer
    • Datamonitor Comments
    • Valstar (Valrubicin; Indevus)
    • Drug Overview
    • Key Historical Events
    • Clinical Development In Bladder Cancer
    • Datamonitor Comments
    • Larotaxel (Xrp9881; SanofiAventis)
    • Drug Overview
    • Key Historical Events
    • Clinical Development In Bladder Cancer
    • Datamonitor Comments
  • Chapter 6 Key Opinion Leader Interview Transcripts
    • Contributing Experts
    • Key Opinion Leader Interview Transcripts
  • Appendix
    • Bibliography
  • List Of Tables
  • List Of Figures
    • About Datamonitor Healthcare
    • About The Oncology Analysis Team
    • Disclaimer
  • List Of Tables
    • Table 1: Clinical Subtypes Of Bladder Cancer
    • Table 2: Crude Incidence Rates For Bladder Cancer (Per 100,000 Persons) In The Seven Major Markets, 2002
    • Table 3: Forecast Incidence Of Bladder Cancer In The Seven Major Markets, 20022017
    • Table 4: Crude Mortality Rates For Bladder Cancer In The Seven Major Markets, 2002
    • Table 5: Risk Factors Associated With Bladder Cancer
    • Table 6: Diagnostic Tests For Bladder Cancer
    • Table 7: Tnm And Jewett Staging Systems For Primary Bladder Tumors
    • Table 8: Lymph Node Classifications In The Tnm Staging System
    • Table 9: Distant Metastasis Classification In The Tnm Staging System
    • Table 10: World Health Organization Grading System For NonInvasive Bladder Tumors
    • Table 11: Rate Of Progression And Survival Of NonInvasive Tumors In Bladder Cancer
    • Table 12: National Comprehensive Cancer Network (Nccn) Guidelines For Primary Bladder Cancer Treatment In The Us, 2008
    • Table 13: National Comprehensive Cancer Network (Nccn) Guidelines For Recurrent Bladder Cancer Treatment In The Us, 2008
    • Table 14: European Treatment Guidelines For Bladder Cancer, 2008
    • Table 15: Japanese Treatment Guidelines For Bladder Cancer
    • Table 16: LatePhase Bladder Cancer Pipeline, 2008
    • Table 17: Phase Ii Bladder Cancer Pipeline, 2008
    • Table 18: Eoquin: Key Historical Events, 200708
    • Table 19: Ongoing Clinical Trials Involving Eoquin, 2008
    • Table 20: Iressa: Key Historical Events, 200208
    • Table 21: Ongoing Clinical Trials Involving Iressa, 2008
    • Table 22: Cost Of Tice Bcg And Iressa Per Week Based On Price Of Drugs Alone
    • Table 23: Ongoing Trials In The Metastatic Transitional Cell Carcinoma (Tcc) Setting
    • Table 24: Urocidin: Key Historical Events, 200608
    • Table 25: Ongoing Clinical Trials Involving Urocidin, 2008
    • Table 26: Valstar: Key Historical Events, 19982007
    • Table 27: Larotaxel: Key Historical Events, 200408
    • Table 28: Ongoing Clinical Trials Involving Larotaxel, 2008
  • List Of Figures
    • Figure 1: Anatomy Of The Bladder
    • Figure 2: Bladder Tumor Histology And Their Abundance In The Us, 2008
    • Figure 3: Forecast Incidence Of Bladder Cancer In The Seven Major Markets, 20022017
    • Figure 4: Incidence And Mortality Of Bladder Cancer In The Seven Major Markets, 2008 And 2017
    • Figure 5: Stage Of Bladder Cancer At Diagnosis
    • Figure 6: Phase Iii Trial Demonstrating That Gc Is Less Toxic Than Mvac In Metastatic Bladder Cancer Patients
    • Figure 7: Phase Iii Trial Of Neoadjuvant Mvac Combination Therapy In Invasive Transitional Cell Carcinoma (Tcc)
    • Figure 8: Phase Iii Trial Comparing Cg And Mvac Combination Chemotherapy In Metastatic Bladder Cancer
    • Figure 9: Summary Of Unmet Needs In Bladder Cancer, 2008
    • Figure 10: Phase Iii Study Design Of Eoquin In LowGrade Papillary Tumors
    • Figure 11: Phase Ii 'Marker' Tumor Trial Of Eoquin In NonInvasive Bladder Cancer
    • Figure 12: Phase I Trial To Demonstrate Safety Of Eoquin Following Surgery
    • Figure 13: Phase Iii Trial Of Iressa In Patients With HighRisk NonInvasive Transitional Cell Carcinoma (Tcc)
    • Figure 14: Phase Iii Trial Of Urocidin Monotherapy In BcgRefractory NonInvasive Transitional Cell Carcinoma (Tcc)
    • Figure 15: Phase Ii Study Investigating Urocidin In HighRisk NonInvasive Bladder Cancer
    • Figure 16: Phase I/Ii Study Of Urocidin Monotherapy In Patients With Carcinoma In Situ (Cis) Tumors
    • Figure 17: Phase Iii Study Design For Larotaxel In Combination With Cisplatin In Metastatic Transitional Cell Carcinoma (Tcc)