Chemoprevention of superficial bladder cancer

Patients who have bladder cancer with superficial disease are at high risk for recurrence but low risk for progression to muscle invasive disease and are regularly monitored with cystoscopy to detect recurrent tumors. This clinical setting (high recurrence rate, excellent surveillance, and low risk of progression in stage) provides an ideal setting for secondary chemoprevention. Vitamins, difluoromethylornithine, and cyclooxygenase inhibitors have demonstrated activity in preclinical models of bladder cancer. Limited clinical data suggests that vitamins and their analogs may be useful for decreasing the rate of tumor recurrence in patients with superficial bladder cancer. Ongoing clinical trials are exploring the roles of fenretinide, difluoromethylornithine, and celecoxib in the treatment of patients with a history of superficial bladder cancer.