Photocure’s blue light cystoscopy demonstrates 38% recurrence reduction in BRAVO study

Photocure ASA, a bladder cancer company, has unveiled new clinical evidence demonstrating the advantages of blue light cystoscopy (BLC) over traditional white light cystoscopy (WLC) in reducing bladder cancer recurrence. The findings, published in JU Open Plus, come from the BRAVO study (Bladder Cancer Recurrence Analysis in Veterans and Outcomes), a real-world, propensity-score-matched analysis conducted within the Veterans Affairs (VA) Healthcare System.

The study, which evaluated 626 patients over a three-year period, revealed that BLC-assisted transurethral resection of bladder tumors (TURBT) led to a 38% lower risk of recurrence compared to WLC alone. The results reinforce previous randomized clinical trial findings and bolster the case for BLC’s broader adoption in bladder cancer management.

How Does Blue Light Cystoscopy Improve Bladder Cancer Detection?

Bladder cancer is among the most recurrent cancers, with high relapse rates due to the limitations of traditional detection methods. Standard white light cystoscopy (WLC) has long been used for diagnosing and monitoring non-muscle invasive bladder cancer (NMIBC), but studies indicate that it often fails to detect smaller or less visible tumors.

In contrast, blue light cystoscopy (BLC) utilizes a photosensitizing agent called hexaminolevulinate (HAL), which selectively accumulates in cancerous cells. Under blue light illumination, cancerous tissue fluoresces, allowing for improved detection of lesions that might otherwise be overlooked. This enhanced visualization enables more complete tumor removal, reducing the likelihood of recurrence.

The BRAVO study’s findings reinforce what previous randomized controlled trials have suggested—BLC significantly improves detection accuracy, ultimately leading to better treatment outcomes.

What Did the BRAVO Study Reveal About Bladder Cancer Recurrence?

The BRAVO study represents one of the most extensive real-world analyses of BLC versus WLC. Conducted within the Veterans Affairs Healthcare System, which provides equal access to care regardless of financial background, the study offers high-quality long-term data.

A total of 626 patients were included, with 313 receiving WLC and 313 undergoing BLC-assisted TURBT. The median age at diagnosis was 71 years, and the median follow-up period was 3.7 years, focusing primarily on a high-risk NMIBC population.

The study found that patients who underwent blue light cystoscopy experienced a 38% lower risk of recurrence compared to those who received WLC alone. The hazard ratio for recurrence was calculated at 0.62 (95% CI: 0.45-0.86, p<0.01), confirming a statistically significant reduction in relapse rates. While a positive trend toward reduced disease progression was observed in the BLC group, with a hazard ratio of 0.71 (95% CI: 0.37-1.38; p=0.32), statistical significance was not reached due to the limited number of patients who progressed during the study period.

The study also highlighted the role of BLC in influencing treatment decisions. Patients in the BLC group were significantly more likely to receive intravesical BCG therapy (61% vs. 43%; p<0.01) or intravesical chemotherapy (48% vs. 27%; p<0.01). This supports the idea that BLC not only enhances tumor detection but also facilitates better-informed treatment choices, ensuring that high-risk patients receive the most appropriate therapies to reduce recurrence risks.

These results further align with a Cochrane review of nearly 3,000 patients across 15 randomized trials, which similarly found that BLC reduces bladder cancer recurrence by 34%.

Why Is Bladder Cancer Recurrence a Critical Challenge?

Bladder cancer is one of the most frequently recurring malignancies, with up to 70% of NMIBC patients experiencing relapse within five years of their initial diagnosis. The economic and clinical burden of recurrence is substantial, often requiring repeated TURBT procedures, prolonged surveillance, and ongoing treatment with BCG or chemotherapy.

The difficulty in achieving complete tumor removal during initial TURBT plays a major role in these high recurrence rates. Residual cancerous tissue left behind due to missed lesions significantly increases the risk of regrowth. This challenge highlights why improving detection methods, such as incorporating BLC into standard practice, is essential.

Given its ability to enhance lesion identification, BLC is becoming a key tool for precision risk stratification, ensuring that patients receive the most appropriate and effective treatment strategies.

How Does the BRAVO Study Impact Clinical Practice?

The growing body of evidence supporting blue light cystoscopy has led to its inclusion in several major urological guidelines. Both the American Urological Association (AUA) and the Society of Urologic Oncology (SUO) currently recommend BLC for NMIBC patients, citing its ability to enhance tumor detection and reduce recurrence rates.

According to Dr. Steven Williams, Chief of the Division of Urology at the University of Texas Medical Branch, the BRAVO study provides further validation for BLC’s effectiveness, particularly in a real-world setting outside of controlled clinical trials. He noted that the study’s findings align with prior research, reinforcing the importance of incorporating BLC into routine bladder cancer management.

Similarly, Anders Neijber, Chief Medical Officer at Photocure, emphasized that long-term data from the BRAVO study confirm the generalizability of BLC’s benefits, demonstrating its impact beyond clinical trial environments.

What’s Next for Blue Light Cystoscopy Adoption?

With mounting clinical evidence, blue light cystoscopy is gaining traction as a standard-of-care tool for bladder cancer detection and treatment planning. However, challenges remain in ensuring widespread adoption, particularly regarding reimbursement policies, which need to be expanded to improve access. As BLC adoption grows, increasing physician training will be crucial to ensure that urologists are proficient in its use, maximizing its effectiveness in real-world practice. Hospitals and cancer centers will also need to integrate BLC systems into standard protocols, further facilitating its accessibility for patients.

As bladder cancer incidence continues to rise globally, advancements in diagnostic technology such as blue light cystoscopy will play an increasingly vital role in reducing recurrence rates and improving patient outcomes. The BRAVO study provides yet another strong endorsement of BLC’s effectiveness, reinforcing the push for its wider clinical adoption.