Bladder cancer is one of the 10 most common cancers in the world and the fifth most frequent in Spain, with nearly 20,000 diagnoses per year. It is much more common in men than in women and is closely linked to smoking.
Detecting it in its early stages is crucial to improving the patient’s prognosis. However, this is a particularly difficult task due to the non-specific nature of the initial symptoms and the lack of effective, non-invasive screening methods.
Although there have been major advances in the diagnosis and treatment of many types of cancer in recent decades, the clinical management of patients with bladder cancer has experienced few changes in the last 40 years.
Despite good survival rates, the high recurrence rate, invasive and costly diagnostic procedures and painful and prolonged treatment characteristics make this disease a serious clinical and social problem. In fact, bladder cancer is considered the most expensive tumour per patient to national health systems.
One of the main problems with bladder cancer is its high rate of recurrence. Even after treatment, it reappears in 70 % of patients. In addition, the new tumour is often more aggressive than the previous one. Patients therefore need to undergo follow-up examinations two to four times a year for at least five years. Moreover, the standard follow-up method is not infallible and can miss small or macroscopically invisible tumours.
For more than 30 years, a type of therapy complementary to surgery which activates the immune system to destroy tumour cells has been used to prevent recurrences and the progression of the disease. Although it works in a high percentage of patients, it is not without adverse effects. Additionally, patients who do not respond to treatment may need surgery to remove the bladder completely. Having an indicator to help predict which patients will not respond to standard therapy would allow alternatives to be explored at an early stage.
This debate will feature three researchers who are leading projects supported by the ”la Caixa” Foundation to advance in the development of new diagnostic and monitoring systems, as well as more precise and effective treatments. What are these projects? What progress has been made?
Diagnostic methods based on liquid biopsy techniques have gained significant relevance in recent years. Liquid biopsy involves the analysis of molecules or cells from any bodily fluid for diagnostic or predictive purposes. In the case of bladder cancer, urine is a key fluid since it is in contact with the tumour.
The team led by Marta Dueñas has developed a diagnostic tool that can detect possible cancer cells through a simple urine test. The new system, called BlaDimiR, has been shown to be more than 90 % accurate in tests performed to date. The test is simple, fast, inexpensive and non-invasive. It involves detecting small RNA molecules in patients’ urine samples. And so far in its development it has proven more effective than cystoscopy and other approved systems, because it can even locate low-grade tumours that often go undetected. It can also predict whether a patient will respond to the standard treatment for bladder cancer, which causes severe inflammation and pain, or, as in half of all patients, will not benefit from current therapies.
The project is now working on the validation of the diagnostic tool and prediction system. Its implementation would significantly improve the quality of life of patients, as it would allow us to know who will respond correctly to this therapy or who should resort to alternatives (currently, a patient is subjected to a total of 10 to 40 interventions during the years of follow-up), and would significantly reduce the costs of these interventions for health systems.
A promising alternative to current treatments is the use of nanoparticles capable of administering therapeutic agents directly to the tumour. The Bladdebots project, led by Samuel Sánchez with the participation of Antoni Vilaseca, has succeeded in developing nanorobots that target bladder cancer. These nanorobots are made up of a porous sphere, the surface of which has different components that perform different functions: in addition to an enzyme that reacts with the urea present in urine and allows the machine to propel itself, the nanoparticles also carry radioactive iodine, a treatment used for localised tumour treatment. The combination of these two elements makes it possible to target the treatment more directly and efficiently at the tumour.
According to data from trials conducted on mice, a single dose results in a 90 % reduction in tumour volume. This type of treatment would increase efficiency and reduce the number of hospital visits, the length of hospitalisation and the associated costs. The next step in the research, which the team is already working on, is to study whether these tumours recur after treatment.
Speakers:
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Marta Dueñas, researcher in charge of the Genitourinary, Cellular and Molecular Oncology group at the Hospital 12 de Octubre Research Institute (i+12) de Madrid.
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Samuel Sánchez, leader of the Smart Nano-Bio-Devices group and ICREA research professor at the Institute for Bioengineering of Catalonia (IBEC) de Barcelona.
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Antoni Vilaseca, adjunct physician of the Urology Service at Hospital Clínic de Barcelona, researcher in the Genetics and Urology Tumours group of the IDIBAPS and associate professor at the Universitat de Barcelona (UB).
Moderator:
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Esther Armora, society editor specialising in science and health at ABC.
Projects supported by CaixaResearch:
