Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/0613—Apparatus adapted for a specific treatment
  • A61N5/062—Photodynamic therapy, i.e. excitation of an agent
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K41/00—Medicinal preparations obtained by treating materials with wave energy or particle radiation ; Therapies using these preparations
  • A61K41/0057—Photodynamic therapy with a photosensitizer, i.e. agent able to produce reactive oxygen species upon exposure to light or radiation, e.g. UV or visible light; photocleavage of nucleic acids with an agent
  • A61K41/0061—5-aminolevulinic acid-based PDT: 5-ALA-PDT involving porphyrins or precursors of protoporphyrins generated in vivo from 5-ALA
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K41/00—Medicinal preparations obtained by treating materials with wave energy or particle radiation ; Therapies using these preparations
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/0601—Apparatus for use inside the body
  • A61N5/0603—Apparatus for use inside the body for treatment of body cavities
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/10—Drugs for disorders of the urinary system of the bladder
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
  • A61B1/307—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the urinary organs, e.g. urethroscopes, cystoscopes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/0601—Apparatus for use inside the body
  • A61N5/0603—Apparatus for use inside the body for treatment of body cavities
  • A61N2005/061—Bladder and/or urethra
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N2005/0658—Radiation therapy using light characterised by the wavelength of light used
  • A61N2005/0662—Visible light
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N2005/0658—Radiation therapy using light characterised by the wavelength of light used
  • A61N2005/0662—Visible light
  • A61N2005/0663—Coloured light

Definitions

• This invention relates to a method of photodynamic therapy (PDT) for bladder cancer and its use as an adjuvant or neoadjuvant therapy in the treatment of bladder cancer.
• PDT photodynamic therapy
• Bladder cancer is the ninth most common cancer diagnosis worldwide, with more than 330 000 new cases each year and more than 130 000 deaths per year. At any point in time, 2.7 million people have a history of urinary bladder cancer.
• cystoscopy is initially performed in the office, using flexible instruments.
• 70% of cases are diagnosed as non-muscle-invasive bladder cancer (NMIBC) and approximately 30% as muscle- invasive bladder cancer (MIBC).
• NMIBC non-muscle-invasive bladder cancer
• TUR transurethral resection
• PDD photodynamic diagnosis
• a photosensitizer or a precursor thereof i.e. a "photosensitizing agent”
• the photosensitizer or precursor thereof is taken up into the cells, where a precursor of a photosensitizer is converted into an active photosensitizer.
• the photosensitizer is excited and, upon relaxation to its ground state, fluorescence occurs, which is detected.
• Hexyl 5 -ALA ester hexaminolevulinate, HAL
• HAL preferably penetrates rapidly proliferating cells, e.g. tumor cells, where it is converted into porphyrins, such as protoporphyrin IX (PpIX), which are photosensitizers and fluorescent compounds. Under subsequent blue-light illumination, the porphyrins emit red light and thus enable specific and accurate visualization of the tumor.
• Hexvix® in the US and Canada Cysview®, (Photocure ASA/Photocure Inc/Ipsen SA) is a commercially available approved diagnostic agent that comprises HAL.
• Hexvix® is used together with blue light in the photodynamic detection of bladder cancer during cystoscopy and TUR procedures, see e.g. Cysview®, Highlights of Prescribing Information, 2011).
• photodynamic detection has become an important part of the overall management of bladder cancer, i.e. diagnosis and treatment of this condition (see e.g. Thomas et al., Urology 68, Supplement, 2006, 206).
• HAL-guided cystoscopy and TUR has increased detection of both papillary tumors and flat carcinoma-in-situ (CIS) lesions, the latter of which are difficult to detect with white light alone.
• HAL-guided TUR of bladder cancer in patients with NMIBC has further reduced the rate of residual tumor after such procedures and has led to superior recurrence free survival (RFS) rates and prolonged RFS intervals compared to white light TUR alone (see Rink et al., Eur Urol 4(64), 2013, 624). It is believed that superior RFS rates in patients who underwent
• HAL-guided TUR of bladder cancer is due to improved detection rates and resection of otherwise undetected tumors (Burger et al, Eur Urol 5(64), 2013, 846-854).
• PDT - as PDD - involves the administration of a photosensitizer or a precursor thereof (i.e. a "photosensitizing agent") to an area of interest.
• the therapeutic effect of PDT is based on a phototoxic reaction: the photosensitizer or precursor thereof is taken up into the cells, where a precursor of a photosensitizer is converted into an active photosensitizer.
• the photosensitizer Upon exposure of the area of interest to light of a suitable wavelength, the photosensitizer is excited from a ground singlet state to an excited singlet state. It then undergoes intersystem crossing to a longer-lived excited triplet state.
• One of the few chemical species present in tissue with a ground triplet state is molecular oxygen.
• Waidelich et al, Urol 2003, 61(2), 332-337 also used 5-ALA but chose irradiation with white light from a xenon bulb.
• the light was transmitted into the bladder via a glass fiber which was inserted into the working channel of a cystoscope. Centration of the tip of the fiber was done with the help of a balloon catheter which was specifically designed for the procedure on the basis of a transurethral irrigation catheter. The position to the tip of the fiber was monitored by ultrasound. PDT was performed under general anesthesia and a light dose of 100 J/cm was provided over a period of 60 to 150 minutes (i.e. at a fluence rate of 11.1-27.7 mW/cm ). From the 12 patients that were treated, all patients complained about urinary frequency and urgency that was medically treated. In 7 patients, the symptoms subsided within a week while in 5 patients, they persisted for 3 weeks
• HAL has been used in PDT of bladder cancer.
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient in need of such treatment of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient in need of such treatment of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof, and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of photodynamic therapy for bladder cancer, wherein said composition is instilled into the bladder of a patient in need of such treatment, and the inside of said bladder is exposed to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5 -ALA ester
• the invention provides a composition comprising hexyl 5-ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of photodynamic therapy for bladder cancer, wherein said composition is instilled into the bladder of a patient in need of such treatment, and the inside of said bladder is exposed to blue light having a fluence rate of 1.5 to 12.5 mW/cm2, wherein said blue light is provided at light dose of 0.2 to 15 J/cm .
• HAL hexyl 5-ALA ester
• the photodynamic therapy according to the invention seems to impact bladder cancer on different levels: if the method of the invention is carried out together with a TUR, due to a phototoxic reaction as described above, residual tumor cells, i.e. tumor cells which have not been removed during TUR and/or re-attached tumor cells, i.e. tumor cells which have been detached during the TUR but which remain in the bladder due to insufficient flushing, are killed.
• the photodynamic therapy according to the invention seems to stimulate the patient's immune system to fight the bladder cancer, see Example 3 in this application.
• the photodynamic therapy according to the invention can be carried out with commercially available equipment, see below, and is very well tolerated, with only few and transient adverse events (see Fradet et al, J. Urol. 2007, 178, 68-73).
• the bladder cancer in the context of the invention is either muscular invasive bladder cancer (MIBC) or non-muscular invasive bladder cancer (NMIBC).
• MIBC muscular invasive bladder cancer
• NMIBC non-muscular invasive bladder cancer
• the bladder cancer is preferably NMIBC, which appears as papillary tumors and flat lesions (carcinoma in situ, CIS).
• hexyl 5-ALA ester denotes n-hexyl aminolevulinate, i.e. n- hexyl 5-amino-4-oxo-pentanoate.
• pharmaceutically acceptable salt denotes a salt that is suitable for and fulfils the requirements related to for instance safety, bioavailability and tolerability (see for instance P. H. Stahl et al. (eds.) Handbook of Pharmaceutical Salts, Publisher Helvetica Chimica Acta, Zurich, 2002).
• hexyl 5-ALA ester The synthesis of hexyl 5-ALA ester is known in the art. It may e.g. be prepared as described in WO 96/28412, the entire contents of which are incorporated herein by reference. Briefly, hexyl 5-ALA ester may be prepared by reaction of 5-ALA with hexanol in the presence of a catalyst, e.g. an acid. Further, hexyl 5-ALA ester hydrochloride is commercially available, e.g. in the form of Hexvix® (e.g. Photocure ASA) or Cysview® (e.g. Photocure Inc.).
• Hexvix® e.g. Photocure ASA
• Cysview® e.g. Photocure Inc.
• the hexyl 5 -ALA ester for use in the invention is preferably in the form of a pharmaceutically acceptable salt.
• Such salts are preferably acid addition salts with pharmaceutically acceptable organic or inorganic acids.
• Suitable acids include, for example, hydrochloric, nitric, hydrobromic, phosphoric, sulfuric, sulfonic acid and sulfonic acid derivatives, the salts of ALA-esters and the latter acids are described in WO 2005/092838, the entire contents of which are incorporated herein by reference.
• a preferred acid is hydrochloride acid, HCl. Synthetic procedures for salt formation are conventional in the art and are for instance described in WO 2005/092838.
• the concentration of HAL in the composition for use in the invention is conveniently in the range of 0.1 to 5 % by weight of the total weight of the composition for use in the invention.
• composition or the equivalent concentration of a pharmaceutically acceptable salt of HAL preferably 0.15 to 3.5%, and most preferably 0.17%, which corresponds to e.g. 0.2% HAL hydrochloride (8mM).
• composition for use in the invention may comprise pharmaceutically acceptable carriers, excipients, or stabilizers.
• the composition for use in the invention is preferably a liquid composition, more preferably a suspension or even more preferably a solution of HAL in a liquid carrier.
• Preferred liquid carriers are water or aqueous solutions, most preferred liquid carriers are aqueous buffers.
• the composition for use in the invention is an aqueous solution of HAL and most preferably a solution of HAL in an aqueous buffer, preferably a phosphate buffer.
• the composition for use in the invention comprises as a liquid carrier an aqueous phosphate buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water.
• HAL or the pharmaceutically acceptable salt thereof is provided in a lyophilized form, and is reconstituted in a liquid carrier, preferably in water or an aqueous solution, most preferably in an aqueous buffer, prior to use.
• a liquid carrier preferably in water or an aqueous solution, most preferably in an aqueous buffer, prior to use.
• the composition for use in the invention is a liquid composition comprising water
• the pH of said composition is preferably in the range of 4.5 to 7.5, more preferably a pH in the range of 5.7 to 7.2.
• the composition for use of the invention is Hexvix®, i.e. a solution of HAL hydrochloride (2mg/ml; 8mM) in an aqueous buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water.
• Hexvix® i.e. a solution of HAL hydrochloride (2mg/ml; 8mM) in an aqueous buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water.
• the amount of the composition, which is instilled into the bladder may vary according to the bladder volume and size. In general, and as observed in the use of Hexvix®, a volume of about 50 ml of the composition comprising 0.2% HAL hydrochloride (8mM) is suitable and sufficient.
• the composition for use in the invention is instilled preferably into the empty bladder through a catheter and is left in the bladder from about 20 minutes to about 3 hours, more preferably from about 30 minutes to about 2 hours, most preferably no less than about 1 hour. Prior to exposing the inside of the bladder to light, the bladder is evacuated. If the patient cannot retain the composition for about 1 hour, at least about 1 hour should be allowed to pass from the instillation of the composition into the bladder to the start of exposing the inside of the bladder to light.
• Hexvix® is instilled into the bladder through a catheter and is left in the bladder for about 1 hour.
• the bladder is then evacuated, before the inside of the bladder is exposed to light. If the patient cannot retain the composition for about 1 hour, at least about 1 hour is allowed to pass from the instillation of Hexvix® to the start of exposing the inside of the bladder to light.
• the inside of the bladder is exposed to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• the inside of the bladder is exposed to blue light having a fluence rate of 2.5 to 7.0 mW/cm , e.g. 5.5, 6.0 or 6.5 mW/cm 2 or 5.5 to 8.5 mW/cm 2 , e.g. 6.0, 6.5. 7.0, 7.5 or 8.0 mW/cm 2 .
• the inside of the bladder is exposed to blue light having a fluence rate of 1.5 to 12.5 mW/cm and said blue light is provided at a light dose of 0.2 to 15 J/cm .
• the inside of the bladder is exposed to blue light having a fluence rate of 1.5 to 12.5 mW/cm and said blue light is provided at a light dose of 0.2 to 15 J/cm .
• the inside of the bladder is exposed to blue light having a
• a fluence rate of 5.5 to 8.5 mW/cm e.g. 6.0, 6.5. 7.0, 7.5 or 8.0 mW/cm and said blue light is provided at a light dose of 0.7 to 10.2 J/cm .
• the inside of the bladder is exposed to blue light having a fluence rate of
• a light dose of 0.3 to 8.0 J/cm e.g. 6.5, 7.0 or 7.5 J/cm .
• the inside of the bladder is exposed to
• said blue light is provided at a light dose of 0.3 to 8.0 J/cm , e.g. 6.5, 7.0 or 7.5 J/cm .
• the inside of the bladder is exposed to blue light
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient in need of such treatment of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof, exposing the inside of said bladder to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5 -ALA ester
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient in need of such treatment of a composition comprising hexyl 5- ALA ester (HAL) or a pharmaceutically acceptable salt thereof, exposing the inside of said bladder to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm , wherein said white light is provided
• HAL hexyl 5- ALA ester
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of photodynamic therapy for bladder cancer, wherein said composition is instilled into the bladder of a patient in need of such treatment and the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of
• photodynamic therapy for bladder cancer wherein said composition is instilled into the bladder of a patient in need of such treatment and the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm and wherein said white light is provided at a light dose of 0.4 to 26.5 J/cm2 and said blue light is provided at light dose of 0.2 to 15 J/cm 2 .
• the inside of the bladder is exposed to white light
• the inside of the bladder is exposed to white
• irradiation i.e. exposure of the inside of the bladder to blue or white and blue light, is carried out for a period of 2 to 20 minutes.
• blue light i.e. wavelengths of from about 360 nm to about 450 nm
• white light i.e. visible light with wavelengths of from about 350 to about 700 nm
• blue light i.e. wavelengths of from about 360 nm to about 450 nm
• the inside of the bladder may first be exposed to white light and then to blue light or vice versa.
• the inside of the bladder is first exposed to white light, then to blue light.
• the light source may be a lamp or laser.
• a commercially available, rigid or flexible blue-light cystoscope e.g. from Karl Storz, Olympus, Richard Wolf
• Such blue-light cystoscopes allow for both white and blue light irradiation, and no modifications such as light fibers or diffusing tips are needed to use such cystoscopes in the method of the invention.
• Commercially available cystoscopes are equipped with a lamp, e.g. a xenon arc lamp which emits white light and means to provide blue light, e.g. a filter system blocks all other wavelengths than those of blue light.
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient of a solution of HAL hydrochloride in an aqueous buffer, and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm , wherein said white light is provided at a light dose of 0.4 to 26.5 J/cm and said blue light at light dose of 0.2 to 15.0 J/cm 2 .
• the solution comprises 2mg/ml HAL hydrochloride.
• Preferred fluence rates and/or light doses for blue light have been disclosed before and are preferably used in this second embodiment.
• preferred fluence rates and/or light doses for white light have been disclosed before and are preferably used in this second embodiment.
• preferred combinations of fluence rates and/or light doses for blue light and of fluence rates and/or light doses for white have been disclosed before and are preferably used in this second embodiment.
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient of a solution of HAL hydrochloride in an aqueous buffer, and exposing the inside of said bladder to blue light having a fluence rate of 2.5 to 7.0 mW/cm , e.g. 5.5, 6.0 or 6.5
• said blue light is provided at a light dose of 0.7 to 10.2 J/cm or 0.3
• the inside of said bladder is exposed to white light having a fluence rate of 5.0 to 12.5
• the inside of said bladder is exposed to white light having a fluence rate of 5.0 to 12.5
• mW/cm e.g. 7.0, 9.0 or 11.0 mW/cm and to blue light having a fluence rate of 2.5 to
• the solution comprises 2mg/ml HAL hydrochloride.
• Preferred fluence rates and/or light doses for blue light have been disclosed before and are preferably used in this third embodiment.
• preferred fluence rates and/or light doses for white light have been disclosed before and are preferably used in this third embodiment.
• preferred combinations of fluence rates and/or light doses for blue light and of fluence rates and/or light doses for white have been disclosed before and are preferably used in this third embodiment.
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient of a solution of HAL hydrochloride in an aqueous buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water, and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a
• the solution comprises 2mg/ml HAL hydrochloride.
• Preferred fluence rates and/or light doses for blue light have been disclosed before and are preferably used in this fourth embodiment.
• preferred fluence rates and/or light doses for white light have been disclosed before and are preferably used in this fourth embodiment.
• preferred combinations of fluence rates and/or light doses for blue light and of fluence rates and/or light doses for white have been disclosed before and are preferably used in this fourth embodiment.
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient of a solution of HAL hydrochloride in an aqueous buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water, and exposing the inside of said bladder to blue light
• blue light is provided at a light dose of 0.7 to 10.2 J/cm or 0.3 to 8.0 J/cm , e.g. 6.5, 7.0 or 7.5 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 5.0 to 12.5 mW/cm , e.g. 7.0, 9.0 or
• the inside of said bladder is exposed to white light having a fluence rate of 5.0 to 12.5 mW/cm , e.g. 7.0,
• the solution comprises 2mg/ml HAL hydrochloride.
• Preferred fluence rates and/or light doses for blue light have been disclosed before and are preferably used in this fifth embodiment.
• preferred fluence rates and/or light doses for white light have been disclosed before and are preferably used in this fifth embodiment.
• preferred combinations of fluence rates and/or light doses for blue light and of fluence rates and/or light doses for white have been disclosed before and are preferably used in this fifth embodiment.
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient of a solution of HAL hydrochloride in an aqueous buffer, and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm , wherein said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0
• the solution comprises 2mg/ml HAL hydrochloride.
• Preferred fluence rates and/or light doses for blue light have been disclosed before and are preferably used in this sixth embodiment.
• preferred fluence rates and/or light doses for white light have been disclosed before and are preferably used in this sixth embodiment.
• preferred combinations of fluence rates and/or light doses for blue light and of fluence rates and/or light doses for white have been disclosed before and are preferably used in this sixth embodiment.
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient of a solution of HAL hydrochloride in an aqueous buffer, and exposing the inside of said bladder to blue light having a fluence rate of 2.5 to 7.0 mW/cm e.g. 5.5, 6.0 or 6.5
• blue light is provided at a light dose of 0.7 to 10.2 J/cm or 0.3 to 8.0 J/cm , e.g. 6.5, 7.0 or 7.5 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 5.0 to 12.5 mW/cm , e.g. 7.0, 9.0 or
• J/cm e.g. 10.0, 11.5 or 13.5 J/cm and said blue light at light dose of 0.3 to 8.0 J/cm , e.g. 6.5, 7.0 or 7.5 J/cm 2 .
• the solution comprises 2mg/ml HAL hydrochloride.
• Preferred fluence rates and/or light doses for blue light have been disclosed before and are preferably used in this seventh embodiment.
• preferred fluence rates and/or light doses for white light have been disclosed before and are preferably used in this seventh embodiment.
• preferred combinations of fluence rates and/or light doses for blue light and of fluence rates and/or light doses for white have been disclosed before and are preferably used in this seventh embodiment.
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient of a solution of HAL hydrochloride in an aqueous buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water, and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm , wherein said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm , wherein said white light is provided at a light dose of 0.4 to 26.5 J/cm and said blue light at light dose of 0.2 to 15.0 J/cm 2 .
• the solution comprises 2mg/ml HAL hydrochloride.
• Preferred fluence rates and/or light doses for blue light have been disclosed before and are preferably used in this eighth
• preferred fluence rates and/or light doses for white light have been disclosed before and are preferably used in this eighth embodiment.
• preferred combinations of fluence rates and/or light doses for blue light and of fluence rates and/or light doses for white have been disclosed before and are preferably used in this eighth embodiment.
• the invention provides a method of photodynamic therapy for bladder cancer, comprising the instillation into the bladder of a patient of a solution of HAL hydrochloride in an aqueous buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water, and exposing the inside of said bladder to blue light
• the inside of said bladder is exposed to white light having 2 2 a fluence rate of 5.0 to 12.5 mW/cm , e.g. 7.0, 9.0 or 11.0 mW/cm and to blue light
• the solution comprises 2mg/ml HAL hydrochloride.
• Preferred fluence rates and/or light doses for blue light have been disclosed before and are preferably used in this ninth
• preferred fluence rates and/or light doses for white light have been disclosed before and are preferably used in this ninth embodiment.
• preferred combinations of fluence rates and/or light doses for blue light and of fluence rates and/or light doses for white have been disclosed before and are preferably used in this ninth embodiment.
• the light source is preferably a
• said solution of HAL hydrochloride is instilled into the bladder through a catheter and is preferably left in the bladder for about 1 hour.
• the bladder is evacuated prior to exposing the inside of the bladder to light. If the patient cannot retain the said solution for about 1 hour, at least about 1 hour is allowed to pass from the instillation of the solution to the start of exposing the inside of the bladder to light.
• the method of photodynamic therapy for bladder cancer according to the invention can be used as stand-alone bladder cancer treatment. Alternatively, it can be used as adjuvant therapy in the treatment of bladder cancer, i.e. in addition to a primary/main therapy for bladder cancer.
• the invention provides a method of treating bladder cancer wherein a method of photodynamic therapy is used as adjuvant therapy, said method of photodynamic therapy comprises the instillation into the bladder of a patient of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof, and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm 2 and to blue light having a fluence rate of 1.5 to 12.5 mW/cm 2.
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to
• the invention provides a method of treating bladder cancer wherein a method of photodynamic therapy is used as adjuvant therapy, said method of photodynamic therapy comprises the instillation into the bladder of a patient of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof, and exposing the inside of said bladder to blue light having a
• the inside of said bladder is provided at a light dose of 0.7 to 10.2 J/cm or 0.3 to 8.0 J/cm , e.g. 6.5, 7.0 or 7.5 J/cm .
• the inside of said bladder is
• the inside of said bladder is exposed to white light having a fluence rate of 5.0 to 12.5 mW/cm , e.g. 7.0,
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of treating bladder cancer wherein a method of photodynamic therapy is used as adjuvant therapy, said method of photodynamic therapy comprises the instillation of the composition into the bladder of a patient in need of such treatment and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 2 2
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm , wherein said white light is provided at a light dose of 0.4
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of treating bladder cancer wherein a method of photodynamic therapy is used as adjuvant therapy, said method of photodynamic therapy comprises the instillation of the composition into the bladder of a patient in need of such treatment and exposing the inside of said bladder to blue light having a fluence rate of 2.5 to 7.0 mW/cm 2 , e.g. 5.5, 6.0 or 6.5 mW/cm 2 or 5.5 to 8.5 mW/cm 2 , e.g. 6.0, 6.5. 7.0, 7.5 or 8.0 mW/cm .
• HAL hexyl 5 -ALA ester
• said blue light is provided at a light dose of 0.7 to 10.2 J/cm 2 or 0.3 to 8.0 J/cm 2 , e.g. 6.5, 7.0 or 7.5 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 5.0 to 12.5 mW/cm , e.g. 7.0, 9.0 or
• the inside of said bladder is exposed to white light having a fluence rate of 5.0 to 12.5
• mW/cm e.g. 7.0, 9.0 or 11.0 mW/cm and to blue light having a fluence rate of 2.5 to
• 7.0 mW/cm e.g. 5.5, 6.0 or 6.5 mW/cm
• said white light is provided at a light dose of 0.6 to 15.0 J/cm 2 , e.g. 10.0, 11.5 or 13.5 J/cm 2 and said blue light at light dose of 0.3 to 8.0 J/cm 2 e.g. 6.5, 7.0 or 7.5 J/cm 2 .
• the composition for use in the method is an aqueous solution of HAL and most preferably a solution of HAL in an aqueous buffer, preferably a phosphate buffer.
• the composition for use in the method comprises as a liquid carrier an aqueous phosphate buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water.
• the bladder cancer in said tenth or eleventh embodiment, or in said preferred alternative tenth or eleventh embodiment may be NMIBC or MIBC.
• the main treatment is TUR, i.e. a procedure where the bladder is visualized through the urethra and tumors and lesions are resected. TUR is often followed by immune- and/or chemotherapy.
• the method of photodynamic therapy of the invention is preferably carried out as adjuvant therapy to TUR in patients who are in need of such treatment, i.e. patients who have been diagnosed with NMIBC or in patients who are suspected to have NMIBC.
• the adjuvant therapy of the invention may be carried out simultaneously with the TUR or after a TUR.
• a method of treating NMIBC thus may commence with the instillation into the bladder of a patient in need of such treatment of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof, and exposing the inside of said bladder to white light for a visual inspection and then switching to blue light for fluorescence detection and treatment of lesions. Said lesions are then resected, e.g. under white light. The completeness of the resection may be monitored by use of blue light. In the said method, the inside of the bladder is exposed to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5 -ALA ester
• said aforementioned white light has a fluence rate of 3.0 to 22.0 mW/cm .
• said aforementioned blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• said aforementioned white light is provided at a light dose of 0.4 to 26.5 J/cm . The irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• the invention provides a method of treating NMIBC by simultaneously carrying out an adjuvant therapy and a transurethral resection of NMIBC, said method comprises a) instillation of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof into the bladder of a patient in need of such NMIBC treatment, b) exposing the inside of said bladder to white light for a visual inspection followed by exposing said inside to blue light for fluorescence detection and treatment of lesions; c) resection of said lesions; and d) optionally monitoring the completeness of the resection by exposing said inside to blue light for fluorescence detection of residual NMIBC, wherein the blue light has a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5 -ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• the invention provides a method of treating NMIBC by simultaneously carrying out an adjuvant therapy and a
• transurethral resection of NMIBC said method comprises a) instillation of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof into the bladder of a patient in need of such NMIBC treatment, b) exposing the inside of said bladder to white light for a visual inspection followed by exposing said inside to blue light for fluorescence detection and treatment of lesions; c) resection of said lesions; and d) optionally monitoring the completeness of the resection by exposing said inside to blue light for fluorescence detection of residual
• HAL hexyl 5 -ALA ester
• NMIBC NMIBC, wherein the white light has a fluence rate of 3.0 to 22.0 mW/cm and the blue light has a fluence rate of 1.5 to 12.5 mW/cm .
• said white light is provided at a light dose of 0.4 to 26.5 J/cm and said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of treating NMIBC by simultaneously carrying out an adjuvant therapy and a transurethral resection of NMIBC, wherein a) said composition is instilled into the bladder of a patient in need of such NMIBC treatment, b) the inside of said bladder is exposed to white light for a visual inspection followed by exposing said inside to blue light for fluorescence detection and treatment of lesions; c) said lesions are resected; and d) optionally the completeness of the resection is monitored by exposing said inside to blue light for fluorescence detection of residual NMIBC, wherein the blue light has a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5 -ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• the invention provides a composition comprising hexyl 5-ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of treating NMIBC a method of treating NMIBC by simultaneously carrying out an adjuvant therapy and a transurethral resection of
• HAL hexyl 5-ALA ester
• NMIBC NMIBC
• said composition is instilled into the bladder of a patient in need of such NMIBC treatment, b) the inside of said bladder is exposed to white light for a visual inspection followed by exposing said inside to blue light for fluorescence detection and treatment of lesions; c) said lesions are resected; and d) optionally the completeness of the resection is monitored by exposing said inside to blue light for fluorescence detection of residual NMIBC, wherein the white light has a fluence rate
• said white light is provided at a light dose of 0.4 to 26.5 J/cm and said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• compositions comprising hexyl 5-ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of treating NMIBC, i.e. embodiments 1 - 11, are described above and can be used in this alternative twelfth embodiment.
• HAL hexyl 5-ALA ester
• the adjuvant therapy for treating NMIBC may commence with the instillation into the bladder of a patient having undergone TUR of a composition comprising hexyl 5-ALA ester (HAL) or a pharmaceutically acceptable salt thereof and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm 2 .
• HAL hexyl 5-ALA ester
• the invention provides an adjuvant therapy for treating NMIBC, comprising instillation of a composition comprising hexyl 5-ALA ester (HAL) or a pharmaceutically acceptable salt thereof into the bladder of a patient having undergone TUR and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5-ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• the invention provides an adjuvant therapy for treating NMIBC, comprising instillation of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof into the bladder of a patient having undergone TUR and exposing the inside of said bladder to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5 -ALA ester
• said white light is provided at a light dose of 0.4 to 26.5 J/cm and said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in an adjuvant therapy for treating NMIBC, wherein said composition is instilled into the bladder of a patient who has undergone TUR and the inside of said bladder is exposed to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5 -ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in an adjuvant therapy for treating NMIBC, wherein said composition is instilled into the bladder of a patient having undergone TUR and the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0
• HAL hexyl 5 -ALA ester
• said white light is provided at a light dose of 0.4 to 26.5 J/cm and said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• compositions comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in this adjuvant therapy for NMIBC, i.e. embodiments 1 - 11, are described above and can be used in this alternative thirteenth embodiment.
• HAL hexyl 5 -ALA ester
• the method of treating NMIBC according to the invention may be carried out once or repeatedly, e.g. two or more times, e.g. 3, 4, 5 or 6 times, with a period between the treatments of e.g. 4 days to 4 weeks, e.g. 1, 2 or 3 weeks.
• the adjuvant therapy for NMIBC according to the invention may be carried out once or repeatedly, e.g. two or more times, e.g. 3, 4, 5 or 6 times, with a period between the treatments of e.g. 4 days to 4 weeks, e.g. 1, 2 or 3 weeks, either together with a TUR, e.g. after a TUR, or alone.
• the adjuvant therapy for treating NMIBC of the invention can be used in combination with chemotherapy, e.g. systemic or intravesical administration of suitable chemotherapeutic agents for NMIBC, such as cisplatin, methotrexate, vinblastine, valrubicin, adriamycin or mitomycin C and/or in combination with suitable immunotherapeutic agents for NMIBC, such as systemic administration of anticancer vaccines or intravesical administration of Bacillus Calmette-Guerin (BCG).
• suitable chemotherapeutic agents for NMIBC such as cisplatin, methotrexate, vinblastine, valrubicin, adriamycin or mitomycin C
• suitable immunotherapeutic agents for NMIBC such as systemic administration of anticancer vaccines or intravesical administration of Bacillus Calmette-Guerin (BCG).
• the adjuvant therapy for treating NMIBC according to the invention may replace or partially replace other adjuvant therapies like chemotherapy and/or immunotherapy.
• the adjuvant therapy according to the invention replaces or partially replaces other adjuvant therapies which are intravesically administered, e.g. mitomycin and/or BCG.
• the adjuvant therapy for treating NMIBC according to the invention partially or fully replaces BCG.
• BCG treatment is usually started a few weeks after a transurethral resection of NMIBC and is given once a week for 6 weeks.
• the adjuvant therapy according to the invention may replace 1, 2, 3, 4, 5 or all 6 of such BCG treatments.
• Full replacement of BCG by the adjuvant therapy according to the invention is preferably used in BCG refractory NMIBC patients, i.e. patients where BCG therapy does not lead to the desired treatment success.
• the invention provides a adjuvant therapy for treating NMIBC in BCG refractory patients, comprising instillation of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof into the bladder of a BCG refractory patient and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5 -ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• the invention provides an adjuvant therapy for treating NMIBC in BCG refractory patients, comprising instillation of a composition comprising hexyl 5 -ALA ester (HAL) or a
• said white light is provided at a light dose of 0.4 to 26.5 J/cm and said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in an adjuvant therapy for treating NMIBC in BCG refractory patients, wherein said composition is instilled into the bladder of a BCG refractory patient and the inside of said bladder is exposed to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• HAL hexyl 5 -ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• said white light is provided at a light dose of 0.4 to 26.5 J/cm and said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the irradiation/the light exposure is carried out for a period of 2 (for small and/or few lesions) to 20 minutes (for large and/or multiple lesions).
• compositions comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in this adjuvant therapy for treating NMIBC in BCG refractory patients, i.e. embodiments 1 - 11, are described above and can be used in this preferred alternative fourteenth embodiment.
• HAL hexyl 5 -ALA ester
• cystectomy i.e. removal of the bladder and adjacent organs, i.e. prostate and seminal vesicles in men, and uterus and adnexa in women, including the dissection of regional lymph nodes.
• Cystectomy is also advocated in patients with NMIBC who are at high risk of progression, i.e. patients having multiple recurrent high-grade tumors or high-grade Tl tumors or high-grade tumors with concurrent carcinoma-in-situ (CIS). Further, cystectomy is advocated in patients with NMIBC who have received BCG
• the method of photodynamic therapy of the invention is preferably carried out as a neoadjuvant therapy to cystectomy, i.e. prior to such a cystectomy, in patients who are in need of such treatment, i.e. patients who have been diagnosed with MIBC.
• the invention provides a method of neoadjuvant therapy for treating MIBC prior to a cystectomy, said method comprising a) instillation into the bladder of a patient in need of said treatment of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof; and b) exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm 2 .
• HAL hexyl 5 -ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to
• embodiments and preferred embodiments of this method of neoadjuvant therapy for treating MIBC i.e. embodiments 1 - 11, are described above and can be used in this fifteenth embodiment.
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of neoadjuvant therapy for treating MIBC, said method comprises a) instillation of the composition into the bladder of a patient in need of said treatment; and b) exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm 2 ;
• HAL hexyl 5 -ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm 2 and to blue light having a fluence rate of 1.5 to 12.5 mW/cm 2.
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm , wherein said white light is provided at a light dose
• compositions comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of neoadjuvant therapy for treating MIBC, i.e. embodiments 1 - 11, are described above and can be used in this alternative fifteenth embodiment.
• HAL hexyl 5 -ALA ester
• the invention provides a method of treating MIBC, said method comprising a) neoadjuvant therapy and b) a subsequent cystectomy, the method of treating MIBC comprising a) instillation into the bladder of a patient in need of said treatment of a composition comprising hexyl 5-ALA ester (HAL) or a pharmaceutically acceptable salt thereof and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm ; and b) carrying out a cystectomy.
• HAL hexyl 5-ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to
• the invention provides a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in a method of treating MIBC, said method comprising a) neoadjuvant therapy and b) a subsequent cystectomy, the method of treating MIBC comprising a) instillation of the composition into the bladder of a patient in need of said treatment and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm ; and b) carrying out a cystectomy.
• HAL hexyl 5 -ALA ester
• said blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to 12.5 mW/cm .
• the inside of said bladder is exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm and to blue light having a fluence rate of 1.5 to
• compositions comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof for use in this method of treating MIBC, i.e. embodiments 1 - 11, are described above and can be used in this alternative sixteenth embodiment.
• HAL hexyl 5 -ALA ester
• the time period between the neoadjuvant therapy of the invention described above and the cystectomy may vary but is preferably zero to 6 weeks, e.g. zero to 4, 3, 2 or 1 week. "Zero" means that the cystectomy is carried out directly after the neoadjuvant therapy, i.e. after the light irradiation/light exposure of the inside of the bladder is finalized.
• the neoadjuvant therapy can be carried out repeatedly prior to the cystectomy, e.g. two or more times, e.g. 3, 4, 5 or 6 times, with a period between the treatments of e.g. 4 days to 4 weeks, e.g. 1, 2 or 3 weeks.
• the neoadjuvant therapy can be carried out in combination with neoadjuvant radiotherapy and/or neoadjuvant chemotherapy.
• neoadjuvant radiotherapy Although being the gold standard for MIBC treatment and advocated in patients with certain types of NMIBC, radical cystectomy only provides 5 -year survival in about 50% of patients. In order to improve these unsatisfactory results, the use of neoadjuvant therapies has been explored since the 1980s.
• Neoadjuvant radiotherapy has been used, down staging of the cancer after radiotherapy takes about 4-6 weeks. However, a delay of surgery in patients with locally advanced bladder cancer beyond 90 days has shown to cause a significant increase in extravesical disease (81 vs 52%). Neoadjuvant radiotherapy is not recommended according to the current European guidelines on MIBC since no data exist to support that neoadjuvant radiotherapy for operable MIBC increases survival.
• Neoadjuvant chemotherapy has many advantages including that chemotherapy is delivered at the earliest time-point, when the burden of micrometastatic disease is expected to be low; that tolerability of chemotherapy is expected to be better before cystectomy rather than after; and that hypothetically patients with micrometastatic disease might respond to neoadjuvant therapy and reveal favorable pathological status determined mainly by negative lymph node status and negative surgical margins.
• Neoadjuvant cisplatin-containing chemotherapy has shown to significantly improve survival (5% absolute improvement in survival at 5 years).
• delayed cystectomy may compromise the outcome in patients who are not sensitive to chemotherapy and generally, pre-operative anemia and neuropathy is more common in patients receiving neoadjuvant chemotherapy prior to cystectomy.
• the adjuvant or neoadjuvant therapies according to the method of the invention have several advantages compared to neoadjuvant radiotherapy, (neo)adjuvant chemotherapy and (neo)adjuvant immunotherapy, where nausea, vomiting, fatigue, anemia, damage to epithelial surfaces, intestinal discomfort/gastrointestinal stress, nephrotoxicity, neurotoxicity, swelling, depression of the immune system and infertility are well-known and common adverse effects.
• nausea, vomiting, fatigue, anemia, damage to epithelial surfaces, intestinal discomfort/gastrointestinal stress, nephrotoxicity, neurotoxicity, swelling, depression of the immune system and infertility are well-known and common adverse effects.
• HAL in the form of Hexvix®/Cysview®
• HAL has a highly favorable metabolic profile compared to chemotherapeutics, e.g. cisplatin.
• HAL interferes with the body's own heme biosynthetic pathway and leads of accumulation of photoactive porphyrins, particularly protoporphyrin IX (PpIX), which is the last intermediate in heme synthesis. Since such photoactive porphyrins are compounds which naturally occur in the body, there is a "natural process" in the body for degrading (metabolizing) and excreting degraded heme.
• a rat bladder carcinoma cell line was used in these experiments to establish superficial bladder tumors in Female Fischer rats weighing 150 - 175 g as described in Francois, et al, J. Urol. 190(2), 2013, 731-736. The animals were used in the experiments 5 days after tumor cell inoculation.
• Lyophilized HAL in the form of Hexvix® powder was dissolved in PBS to a final concentration of 2 mg/ml (8 mM). 0.5 ml of the solution was instilled into the rat bladder and was left in the bladder for about 1 hour.
• the rats were sacrificed 48 hours after illumination by an overdose of pentobarbital. Bladders were filled in with formaldehyde (4%), removed from the animals and transferred into a vials with formaldehyde (4%) for a minimum of 4 h.
• the bladder was macroscopically cut into 4 parts and fixed for 48 h. Following different cycles of dehydration with gradients of ethanol and xylene, the bladder tissue was included into paraffin. Paraffin embedded sections of 5 ⁇ were cut and used for histology with haematoxylin / eosin staining. Results
• Bladders of animals in the control group showed no inflammation (sign of a PDT effect) but persistent and chorion infiltrating tumors for both fluence rates/light doses.
• the bladders of 1 animal (50%) in the 3.5 mW/cm / 4 J/cm group (n 2) showed no inflammation, persistent and chorion infiltrating tumors while the tumor in the bladder of another animal (50%) looked less compact and the superficial layer of said tumor was destroyed.
• HAL Hexvix®
• a solution of HAL was instilled into the bladder of patients through a catheter and was left in the bladder for about 1 hour. If the patient could not retain the composition for about 1 hour, at least about 1 hour was allowed to pass from the instillation of Hexvix® to the start of exposing the inside of the bladder to light.
• a commercially available blue-light cystoscope was inserted into the bladder and a TUR was carried out by exposing the inside of the bladder to white light for the visual inspection, subsequent blue light exposure for fluorescence detection of bladder cancer lesions, resection of the detected lesions under white light and monitoring of the completeness of the resection by use of blue light.
• Blue light was provided at a fluence rate of 1.5 to 12.5 mW/cm and a light dose
• the resected bladder tumors were processed according to methods known in the art and primary cell cultures were established from said patient-derived bladder tumor under appropriate conditions in culture medium. No in vitro primary cell cultures could be established from said resected bladder tumors. No HAL/white light group:
• a commercially available white light cystoscope was inserted into the bladder of patients and a TUR was carried out by exposing the inside of the bladder to white light for the visual inspection, detection of bladder cancer lesions, resection of said lesions and monitoring of the completeness of the resection.
• Resected bladder tumors were processed identically to those in the HAL/blue light group. In vitro primary cell cultures of such resected bladder tumors could be established. The fact that no in vitro primary cell cultures could be established from resected bladder tumors in the HAL/blue light patient group points towards a phototoxic effect, i.e. that tumor cells were killed in the applied TUR procedure.
• NMIBC neurodegenerative disease .
• the study population comprised 551 patients which were randomized into two groups (see below). The groups were similar in age, gender, race, bladder cancer history and prior intravesical therapy.
• HAL group 271 patients.
• the method of the invention was carried out as follows: A solution of HAL (Hexvix®) was instilled into the bladder of patients through a catheter and was left in the bladder for about 1 hour. If the patient could not retain the composition for about 1 hour, at least about 1 hour was allowed to pass from the instillation of Hexvix® to the start of exposing the inside of the bladder to light.
• cystoscopy was carried out with a commercially available cystoscope (blue and white light).
• the inside of the bladder was first exposed to white light and visually assessed, followed by exposure to blue light to detect cancerous lesions in the bladder.
• Transurethral resection (TUR) of the detected lesions was carried out under white light and completion of the resection was assessed under blue light.
• White light group 280 patients. Cystoscopy and TUR of bladder cancer under white light only, no HAL.
• Tumor recurrence was observed during the 9 months follow-up period in 157 of the 280 patients in the white light group (56.1%) and in 128 of 271 patients in the
• Calmette-Guerin is an immunotherapy agent for the treatment of bladder cancer. It is usually repeatedly instilled into the bladder. Tumor recurrence rate in both patient groups were determined and the results are displayed in Table 1
• Table 1 Tumor recurrence rate by group and BCG treatment
• Mitomycin is a chemotherapeutic agent for the treatment of bladder cancer. It may be instilled after TUR (single instillation) to e.g. prevent tumor cell seeding, i.e. re-attachment to the bladder wall of tumor cells which were dislocated during resection. Mitomycin was administered after TUR to 16 patients in the HAL group (5.9%)) and to 20 patients in the white light group (7.1%).
• Tumor recurrence rate in both patient groups were determined and the results are displayed in Table 2 Table 2: Tumor recurrence rate by group and BCG and/or mitomycin treatment
• Embodiment 1 Composition comprising hexyl 5 -ALA ester (HAL) or a
• Embodiment 2 Composition for use according to Embodiment 1, wherein the blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• Embodiment 3 Composition for use according to Embodiment 1 or 2, wherein the inside of the bladder is exposed to blue light having a fluence rate of 2.5 to 7.0 mW/cm .
• Embodiment 4 Composition for use according to Embodiment 3, wherein the blue light is provided at a light dose of 0.3 to 8.0 J/cm .
• Embodiment 5 Composition for use according to any of Embodiments 1 to 4, wherein the inside of said bladder is further exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm 2 .
• Embodiment 6 Composition for use according to Embodiment 5, wherein said white light is provided at a light dose of 0.4 to 26.5 J/cm .
• Embodiment 7 Composition for use according to Embodiment 5, wherein said inside of the bladder is exposed to white light having a fluence rate of 5.0 to 12.5 mW/cm .
• Embodiment 8 Composition for use according to Embodiment 7, wherein said white
• light is provided at a light dose of 0.6 to 15.0 J/cm .
• Embodiment 9 Composition for use according to any of Embodiments 1 to 8, wherein said composition is an aqueous solution of HAL, preferably a solution of HAL in an aqueous buffer, more preferably a solution of HAL in a phosphate buffer.
• Embodiment 10 Composition for use according to Embodiment 9, wherein the pH of said composition is in the range of 4.5 to 7.5, preferably in the range of 5.7 to 7.2.
• Embodiment 11 Composition for use according to any of Embodiments 1 to 10, wherein said composition is a solution of 2 mg/ml HAL hydrochloride in an aqueous buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water.
• Embodiment 12 Composition for use according to any of Embodiments 5 to 11, wherein said inside of the bladder is first exposed to white light and then to blue light.
• Embodiment 13 Composition for use according to any of Embodiments 1 to 12, wherein a blue-light cystoscope is used as a light source to provide and blue light or said blue and white light.
• Embodiment 14 Composition for use according to Embodiment 13, wherein said blue- light cystoscope is a commercially available blue-light cystoscope.
• Embodiment 15 Composition for use according to any of Embodiments 1 to 14, wherein the inside of the bladder is exposed to blue light or to blue and white light for a period of 2 to 20 minutes.
• Embodiment 16 Composition for use according to any of Embodiments 1 to 15 for use in a method of treating bladder cancer wherein said method of photodynamic therapy is used as adjuvant therapy.
• Embodiment 17 Composition for use according to Embodiment 16, wherein said bladder cancer is NMIBC and said method of photodynamic therapy is simultaneously carried out with a transurethral resection of NMIBC.
• Embodiment 18 Composition for use according to Embodiment 16, wherein said bladder cancer is NMIBC and said method of photodynamic therapy is carried in a patient having undergone transurethral resection of NMIBC.
• Embodiment 19 Composition for use according to Embodiments 16-18, wherein said method of photodynamic therapy replaces or partially replaces other adjuvant therapies.
• Embodiment 20 Composition for use according to Embodiment 19, wherein said other adjuvant therapies are chemotherapy and/or immunotherapy, preferably BCG treatment.
• Embodiment 21 Composition for use according to Embodiment 19, wherein said method of photodynamic therapy is carried out in BCG refractory patients.
• Embodiment 22 Composition for use according to any of Embodiments 1 to 15 for use in a method of treating bladder cancer wherein said method of photodynamic therapy is used as neoadjuvant therapy.
• Embodiment 23 Composition for use according to Embodiment 22, wherein said bladder cancer is MIBC.
• Embodiment 24 Composition for use according to Embodiment 23, wherein said method of photodynamic therapy is carried out prior to a cystectomy.
• Embodiment 25 Composition for use according to Embodiment 24, wherein the cystectomy is carried out directly after the method of photodynamic therapy.
• Embodiment 26 Method of photodynamic therapy for bladder cancer comprising the instillation into the bladder of a patient in need of such treatment of a composition comprising hexyl 5 -ALA ester (HAL) or a pharmaceutically acceptable salt thereof and exposing the inside of said bladder to blue light having a fluence rate of 1.5 to 12.5 mW/cm 2 .
• HAL hexyl 5 -ALA ester
• Embodiment 27 Method according to Embodiment 26, wherein the blue light is provided at a light dose of 0.2 to 15.0 J/cm .
• Embodiment 28 Method according to Embodiment 26 or 27, wherein the inside of the bladder is exposed to blue light having a fluence rate of 2.5 to 7.0 mW/cm .
• Embodiment 29 Method according to Embodiment 28, wherein the blue light is provided at a light dose of 0.3 to 8.0 J/cm .
• Embodiment 30 Method according to any of Embodiments 26 to 29, wherein the inside of said bladder is further exposed to white light having a fluence rate of 3.0 to 22.0 mW/cm 2 .
• Embodiment 31 Method according to Embodiment 30, wherein said white light is provided at a light dose of 0.4 to 26.5 J/cm .
• Embodiment 32 Method according to Embodiment 30, wherein said inside of the bladder is exposed to white light having a fluence rate of 5.0 to 12.5 mW/cm .
• Embodiment 33 Composition for use according to Embodiment 32, wherein said white light is provided at a light dose of 0.6 to 15.0 J/cm .
• Embodiment 34 Method according to any of Embodiments 26 to 33, wherein said composition is an aqueous solution of HAL, preferably a solution of HAL in an aqueous buffer, more preferably a solution of HAL in a phosphate buffer.
• said composition is an aqueous solution of HAL, preferably a solution of HAL in an aqueous buffer, more preferably a solution of HAL in a phosphate buffer.
• Embodiment 35 Method according to Embodiment 34, wherein the pH of said composition is in the range of 4.5 to 7.5, preferably in the range of 5.7 to 7.2.
• Embodiment 36 Method according to any of Embodiments 26 to 35, wherein said composition is a solution of 2 mg/ml HAL hydrochloride in an aqueous buffer comprising disodium phosphate dehydrate, potassium dihydrogen phosphate, sodium chloride, hydrochloric acid, sodium hydroxide and water.
• Embodiment 37 Method according to any of Embodiments 30 to 36, wherein said inside of the bladder is first exposed to white light and then to blue light.
• Embodiment 38 Method according to any of Embodiments 26 to 37, wherein a blue- light cystoscope is used as a light source to provide and blue light or said blue and white light.
• Embodiment 39 Method according to Embodiment 38, wherein said blue-light cystoscope is a commercially available blue-light cystoscope.
• Embodiment 40 Method according to any of Embodiments 26 to 39, wherein the inside of the bladder is exposed to blue light or to blue and white light for a period of 2 to 20 minutes.
• Embodiment 41 Method according to any of Embodiments 26 to 40 for use in a method of treating bladder cancer wherein said method of photodynamic therapy is used as adjuvant therapy.
• Embodiment 42 Method according to Embodiment 41, wherein said bladder cancer is NMIBC and said method of photodynamic therapy is simultaneously carried out with a transurethral resection of NMIBC .
• Embodiment 43 Method according to Embodiment 41, wherein said bladder cancer is NMIBC and said method of photodynamic therapy is carried in a patient having undergone transurethral resection of NMIBC.
• Embodiment 44 Method according to Embodiments 41 to 43, wherein said method of photodynamic therapy replaces or partially replaces other adjuvant therapies.
• Embodiment 45 Method according to Embodiment 44, wherein said other adjuvant therapies are chemotherapy and/or immunotherapy, preferably BCG treatment.
• said other adjuvant therapies are chemotherapy and/or immunotherapy, preferably BCG treatment.
• Embodiment 46 Method according to Embodiment 44, wherein said method of photodynamic therapy is carried out in BCG refractory patients.
• Embodiment 47 Method according to any of Embodiments 26 to 40 for use in a method of treating bladder cancer wherein said method of photodynamic therapy is used as neoadjuvant therapy.
• Embodiment 48 Method according to Embodiment 47, wherein said bladder cancer is MIBC.
• Embodiment 49 Method according to Embodiment 48, wherein said method of photodynamic therapy is carried out prior to a cystectomy.
• Embodiment 50 Method according to Embodiment 49, wherein the cystectomy is carried out directly after the method of photodynamic therapy.

Landscapes

• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Chemical & Material Sciences (AREA)
• Pharmacology & Pharmacy (AREA)
• Engineering & Computer Science (AREA)
• Medicinal Chemistry (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Biomedical Technology (AREA)
• Organic Chemistry (AREA)
• General Chemical & Material Sciences (AREA)
• Chemical Kinetics & Catalysis (AREA)
• Molecular Biology (AREA)
• Epidemiology (AREA)
• Radiology & Medical Imaging (AREA)
• Pathology (AREA)
• Biophysics (AREA)
• Biochemistry (AREA)
• Urology & Nephrology (AREA)
• Surgery (AREA)
• Bioinformatics & Cheminformatics (AREA)
• Physics & Mathematics (AREA)
• Optics & Photonics (AREA)
• Heart & Thoracic Surgery (AREA)
• Medical Informatics (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
• Radiation-Therapy Devices (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
• Medicinal Preparation (AREA)

Priority Applications (19)

Applications Claiming Priority (2)

Related Child Applications (2)

Publications (1)

Family

ID=55066354

Family Applications (1)

Country Status (18)

Cited By (1)

Families Citing this family (3)

Citations (1)

Family Cites Families (13)

• 2016
  • 2016-12-19 AU AU2016372575A patent/AU2016372575B2/en active Active
  • 2016-12-19 BR BR112018011965A patent/BR112018011965A2/pt not_active Application Discontinuation
  • 2016-12-19 CA CA3008552A patent/CA3008552C/en active Active
  • 2016-12-19 EP EP16810437.0A patent/EP3389716B1/en active Active
  • 2016-12-19 ES ES16810437T patent/ES2910034T3/es active Active
  • 2016-12-19 SG SG11201805000RA patent/SG11201805000RA/en unknown
  • 2016-12-19 WO PCT/EP2016/081809 patent/WO2017103285A1/en not_active Ceased
  • 2016-12-19 DK DK16810437.0T patent/DK3389716T3/da active
  • 2016-12-19 PL PL16810437T patent/PL3389716T3/pl unknown
  • 2016-12-19 JP JP2018532037A patent/JP6995755B2/ja active Active
  • 2016-12-19 KR KR1020187020005A patent/KR102787192B1/ko active Active
  • 2016-12-19 RU RU2018123834A patent/RU2745194C2/ru active
  • 2016-12-19 CN CN202411499253.8A patent/CN119345612A/zh active Pending
  • 2016-12-19 MX MX2018007166A patent/MX385912B/es unknown
  • 2016-12-19 CN CN201680079638.6A patent/CN108697800A/zh active Pending
  • 2016-12-19 US US16/063,142 patent/US11235168B2/en active Active
• 2018
  • 2018-06-10 IL IL259925A patent/IL259925B/en unknown
  • 2018-06-14 CL CL2018001612A patent/CL2018001612A1/es unknown
  • 2018-07-06 ZA ZA2018/04530A patent/ZA201804530B/en unknown
• 2022
  • 2022-01-31 US US17/588,978 patent/US11980772B2/en active Active

Patent Citations (1)

Non-Patent Citations (5)

Also Published As

Similar Documents

Legal Events