Adjuvant Chemotherapy for Superficial Transitional Cell Bladder Carcinoma

Kurth, K. H.; Tunn, U.; Ay, Reginald; Schröder, Fritz H.; Pavone‐Macaluso, M.; Debruyne, F.M.J.; Kate, Fiebo Ten; Pauw, M. De; Sylvester, Richard

doi:10.1097/00005392-199708000-00016

Cited by 6 publications

(6 citation statements)

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“…Although the superiority of any of the commonly used intravesical drugs has never been demonstrated [20, 24, 25], the time to initate therapy is important for treatment outcome. Bouffioux et al [26]designed two parallel prospective randomized studies, one with mitomycin C 30 mg, the other with doxorubicin 50 mg, as adjuvant intravesical treatment after TUR given either early on the day of TUR or as delayed therapy between 7 and 15 days after TUR.…”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

“…With 2,535 patients enrolled in controlled studies, evidence fails to support the conclusion that intravesical chemotherapy reduces the rate of tumor progression. On the other hand, overall only about 14% of all patients in an EORTC GU Group study followed up to 10 years progressed either during intravesical treatment or at any time [25, 28]. …”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

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Treatment of Superficial Bladder Tumors: Achievements and Needs

Bouffioux²,

et al. 2000

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Section: Adjuvant Chemotherapymentioning

confidence: 99%

Section: Adjuvant Chemotherapymentioning

confidence: 99%

Treatment of Superficial Bladder Tumors: Achievements and Needs

Bouffioux²,

et al. 2000

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“…For CIS, the success rate is 63% but the number of the reported patients is relatively small [22]. As far as chemoprophylaxis is concerned , a EORTC-GU Group study, that was conducted to compare the efficacy of TUR alone with that of TUR followed by intravesical doxorubicin or ethoglucid instillations, showed that the time to first tumor recurrence was significantly longer with the use of both drugs [25]: recurrence rate per patient year chemoprophylaxis has reduced short-and intermediate-term tumor recurrence rates, it has not altered disease progression. Like most of the different chemotherapeutic agents used, epirubicin is associated with local irritative symptoms, although less than those with adriamycin [27,28,[30][31][32][33][34][35].…”

Section: Doxorubicin (Adriamycin)mentioning

confidence: 99%

“…The CR rate achieved with a single 6-week induction course is about 72% which is far superior to that observed with MMC, doxorubicin and thiotepa (40%, 25% and 15%, respectively, for short follow-up periods) [13,25]. BCG effectiveness increases with short-term, quarterly maintenance therapy [13], while long-term tumor-free response rates with chemotherapeutic agents decline below 20% [50,96,98].…”

Section: Intravesical Chemoprophylaxis or Bcg Immunoprophylaxismentioning

confidence: 99%

Intravesical Therapy of Superficial Bladder Cancer

Moutzouris

2000

CPD

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Transurethral resection (TUR) of the superficial transitional cell carcinoma (TCC) of the bladder is known to be insufficient in controlling the disease because of the unacceptable rates of recurrence, progression and ultimate cystectomy. Adjuvant intravesical chemo-and/or immunotherapy is administered in an effort to enhance the efficacy of surgery alone. The initial tumor stage and grade, the multifocality of this cancer and the history of previous recurrences remain the determinant factors in survival. It is important to decide exactly which patients are at risk, and, therefore, do need treatment. Knowledge of the natural history of the disease will facilitate this decision making, although the natural history of TCC is largely unpredictable owing to tumor heterogeneity. Several cytotoxic and immune modifying agents have been used intravesically in different treatment schedules. However, despite their effectiveness, no consensus exists about the optimal antineoplastic regimen. The selection of the latter is a subject of continuous investigation. Intravesical treatment with cytotoxic drugs has been demonstrated to achieve an acceptable reduction in short- and intermediate-term recurrence rates, but has no proven ability in preventing disease progression to muscle-invasive cancer or prolonging survival. On the other hand, bacillus Calmette-Guerin (BCG) currently appears to be the most effective agent for intravesical use, especially in patients with high grade and stage neoplasms but the optimum strain, dosage and duration schedule have not been determined. Clinical trials have shown that BCG provides long-term protection from tumor recurrence, while there is evidence that it may favorably alter the progression rate of the disease with prolongation of survival. Toxicity of intravesical chemo- and immunotherapy still remains a major problem and attempts at reducing the dosage, and, thus, toxicity without affecting efficacy are underway. This review endeavors to present updated information on intravesical chemotherapy in treating superficial bladder cancer, the expanding role of intravesical immunotherapy, the recent work comparing various immunotherapeutic regimens with chemotherapeutic intravesical therapies, and the progress made towards achieving optimal treatment regimens.

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“…As a consequence, major clinical and basic research efforts are dedicated to prevent recurrences and, even more importantly, to prevent progression (to muscle-invasive disease, stage ≥T 2 ; observed overall in 13% and, depending on grade and stage, in 6–30% of the patients) of superficial papillary T a /T 1 tumors by the adjuvant application of chemo- and immunotherapeutic agents. A large nuber of studies have been devoted to the determination of the efficacy of different chemotherapeutic agents, such as thiotepa, doxorubicin and mitomycin C. These studies have provided conclusive evidence that adjuvant chemotherapy is superior to transurethral resection alone in regard to time of first recurrence and recurrence rate per year, but not to progression and survival [2, 3]. Intravesical immunotherapy with live, attenuated Mycobacterium bacillus Calmette-Guérin (BCG) has been shown to be effective in the prophylaxis and treat…”

Section: Introductionmentioning

confidence: 99%