Hexvix (hexaminolevulinate) guided fluorescence cystoscopy from Photocure is said to improve the detection of bladder cancer and reduce the rate of early tumor recurrence compared to white-light cystoscopy alone, according to a new study published in the Journal of Urology.
The prospective, randomized study conducted in 28 centers in Europe and North America demonstrated that by using Hexvix guided fluorescence cystoscopy, Ta/T1 tumors that had not been seen under conventional cystoscopy were detected in 47 (16%) of the patients with Ta or T1 tumors (p=0.001). Of these tumors that were only seen using Hexvix cystoscopy, 28 (59%) were medium-grade tumors (G2), and 19 were tumors of high risk of recurrence and progressions (high-grade or T1). Furthermore, 32% of the patients with carcinoma in situ (CIS) were identified only by Hexvix guided fluorescence cystoscopy.
The study group, led by H. Barton Grossman, Professor of Urology at MD Anderson Cancer Center (Houston, TX), also reports a 16% relative reduction of bladder tumor recurrence in patients with Ta /T1 tumors assessed with Hexvix guided fluorescence cystoscopy compared with white-light cystoscopy alone (p=0.026). At nine months' follow-up, there was a 9% absolute decrease in recurrence in the Hexvix group compared with white-light cystoscopy alone, which means that only 11 patients needed to undergo the procedure to avoid one recurrence.
The group also reports reduced recurrence of aggressive/clinically significant lesions. They found more CIS, T1 and muscle-invasive disease recurrence in the patients who had undergone white-light cystoscopy compared to Hexvix guided cystoscopy (24% vs. 16%, respectively; p=0.17).
Improved tumor detection is likely to result in more accurate tumor mapping and disease staging, yielding more complete cancer resection. A reduced recurrence rate is an objective marker for these benefits.
Posted by Lee Mather
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