MEDIA RELEASE
Singapore, 16 January 2025 – Bladder cancer treatment is a pain. Literally and figuratively.
Mr Tony Wong (not his real name), in his late 80s, was diagnosed with high-risk non-muscle invasive bladder cancer. He had standard treatment which not only failed to kill the cancer, but also left him with very poor quality of life due to the side effects.
He had two options: a surgery to remove the entire bladder, which carries a three per cent risk of death and up to 50 per cent morbidity rate at his age, which was considerably unsafe for him. Or new gene therapies and systemic immunotherapies, which are costly and have variable success, and mostly not available currently in Singapore.
Singapore General Hospital (SGH) then offered a new option intended for patients like him – unresponsive to treatment and higher risk for surgery. It can also be prescribed to those whose cancer recur. In November 2023, Mr Wong became the first in Singapore to be put on a treatment using a combination of two existing chemotherapy medications – gemcitabine and docetaxel – delivered directly to his bladder via the urinary tract. He experienced no side effects and is now disease free.
“Bladder cancer treatment has long presented significant challenges, particularly for high-risk patients who don't respond to standard therapies or are unsuitable for surgery to remove the bladder completely. As the first in Singapore to offer this new combination of gemcitabine and docetaxel, we're addressing a critical gap in care. Given the limited downstream options, this approach focuses on effective disease management whilst reducing treatment-related side effects, ultimately aiming to preserve patients' quality of life,” said Dr Tan Yu Guang, Associate Consultant, Department of Urology, SGH.
Bacillus Calmette-Guérin (BCG) immunotherapy is the standard treatment for bladder cancer which has been in use since the 1970s. While generally effective, the cancer tends to recur in 50 per cent of patients. Six out of 10 patients also experience side effects like burning sensation during urination, urinary frequency and incontinence, fever and chills, fatigue, and persistent bladder discomfort during treatment.
The combination treatment, on the other hand, has a reported success rate of about 70 per cent, according to retrospective studies done overseas. SGH’s experience has similarly been encouraging. Four of five patients who received the treatment, including Mr Wong, responded well and are now disease free or are in remission. Currently, it is prescribed as an off-label treatment at SGH’s dedicated clinic for high-risk bladder cancer as gemcitabine and docetaxel are approved for intravenous route for late-stage bladder cancer and prostate cancer treatment respectively.
Pharmacy staff preparing new treatment for bladder cancer at Singapore General Hospital's Haematology Pharmacy Compounding Lab. Photo credit: SGH
The High-Risk Bladder Cancer Clinic was established in October 2023 to standardise care for the 40 to 50 new high-risk bladder cancer patients that the Department sees each year. It also facilitates ease of clinical research. Patients can be recruited into suitable clinical studies, and translational research, where tissues are studied and profiled molecularly. This clinical setup aims to advance the understanding of the disease and find novel treatments to improve patient outcomes while keeping costs low.
According to World Health Organization's GLOBOCAN 2022 report, Singapore has Southeast Asia's highest 5-year bladder cancer prevalence, despite it not being among the country's 10 most common cancers. For every 100,000 people in the Singapore population, approximately 28.8 individuals were living with bladder cancer at time of the report. In the 2nd and 3rd spot are Thailand and Brunei with a 5-year prevalence of 19.7 and 15.9 per 100,000 respectively. Worldwide, bladder cancer is the 9th most common, with a 5-year prevalence of 24.7 per 100,000, and both incidence and mortality rates are increasing.
Factors that may increase bladder cancer risk include smoking, increasing age, being male, chronic bladder inflammation, and personal or family history of cancer.
For interview opportunities, please contact:
Carol Ang (Ms)
Communications Department
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