A civil trial in Las Vegas is pitting two cancer victims against Takeda Pharmaceuticals, the maker of the diabetes drug Actos. This comes only a month after a Louisiana jury ordered Takeda to pay $6 billion in punitive damages in another case involving Actos.

The trial in Las Vegas has been marked by the use of ultra-aggressive tactics by Takeda’s defense attorneys. Early in the trial Takeda’s counsel made antagonistic attempts to have District Judge Kerry Earley removed from the case, raising vague questions of impropriety.

Earley announced there was no appearance of impropriety and that she would not remove herself from the trial.

Since then the defense attorneys have been overly aggressive in court and so disrespectful that the plaintiff’s attorneys have requested that Judge Wall sanction Takeda’s counsel – which she is considering.

Perhaps all Takeda has left in their defense is intimidation, because none of the facts appear to be in their favor.

The prescription drug pioglitazone, which was sold under the name Actos, was prescribed to treat patients with Type 2 Diabetes. An FDA review in 2011 discovered that patients taking Actos for more than a year had an increased risk of bladder cancer. That same year the drug was banned in several European countries over the same concerns.

In the Lousiana trial it was alleged that Takeda knew about the potential link with bladder cancer even before Actos was approved and that during testing prior to approval bladder cancer was observed in test animals. In one of the first Actos lawsuits it was also maintained that subsequent clinical trials on human subjects also revealed an Actos and bladder cancer link that Takeda chose not to disclose.

Robert Eglet, a lawyer representing one of the plaintiffs in the Las Vegas case, announced that he is seeking another multibillion-dollar verdict against Takeda and the company’s defense lawyers responded by trying to disrupt the court proceedings.

It might be the only tactic they have left.