Photocure has developed  Hexvix to improve the detection of tumours in the bladder by "staining" the tumour with red fluorescence during blue light illumination. In addition to improving visualisation during cystoscopy (bladder inspection), Hexvix may help the urologist perform a more complete local surgery

In the EU/EEA, Hexvix is indicated for the detection of bladder cancer, such as carcinoma in situ, in patients with known bladder cancer or high suspicion of bladder cancer, based on e.g. screening cystoscopy or positive urine cytology. Blue light fluorescence cystoscopy should be used as an adjunct to standard white light cystoscopy, as a guide for taking biopsies. Hexvix is currently not approved outside the EU/EEA.

Carcinoma in situ, white light. (Courtesy of Prof. Zaak, Münich)

Carcinoma in situ, blue light. (Courtesy of Prof. Zaak, Münich)

Hexvix contains hexaminolevulinate (HAL), which is administered as a 50 mL solution into the bladder for one hour. HAL enters normal and malignant bladder tissue. It is then metabolised to photoactive porphyrins (PAP) that accumulate selectively in the tumour cells and give red fluorescence during blue light illumination. After evacuation of the Hexvix solution, bladder inspection is performed using both white and blue light (fluorescence) to detect the tumour (See Fig. 1 above).

Hexvix fluorescence cystoscopy may also be used for fluorescence guided local surgery, called transurethral resection (TUR). Tumour fluorescence is believed to make local surgery more complete, resulting in fewer recurrences. However, this is is the subject of on-going studies.