Device-assisted intravesical chemotherapy treatment for nonmuscle invasive bladder cancer: 2022 update

Abstract

Purpose of reviewTo critically analyze the oncological outcomes and safety profile of device-assisted intravesical chemotherapy studies reported in 2021. Studies were considered eligible if they included patients with nonmuscle invasive blood cancer (NMIBC), had a prospective or retrospective design, included at least 10 patients, were published in 2021, and assessed the oncological impact of device-assisted intravesical chemotherapy and/or reported standardized adverse effects (AEs).Recent findingsEight new studies reported oncological outcomes after hyperthermic intravesical chemotherapy (HIVEC). In Bacillus Calmette-Guérin (BCG) naive patients, the reported 2-yr. recurrence-free survival (RFS) ranged from 70.7% to 82.4%, with one study reporting 2 yr. progression free survival (PFS) of 92%. In both BCG naive and BCG refractory patients, the reported 1-yr. RFS ranged from 60.5% to 70% and PFS was 94% in one study. For radiofrequency-induced HIVEC, the reported 5-yr. estimates were 38%for RFS and 91.5%for PFS. Regarding AEs, 10.2% of patients had severe AEs. Six studies reported AEs after HIVEC; the majorities were grade 1–2 AEs.SummaryData coming from the studies published in the last years provides support for a consolidating role of device-assisted intravesical chemotherapy as a safe and effective alternative first- or second-line adjuvant treatment of patients with NMIBC.

Epirubicin and Non-Muscle Invasive Bladder Cancer Treatment: A Systematic Review

“…In case of MMC, a recent Randomized Clinical Trial (RCT) showed that RFS at 24 months was 61% (95% CI 51-69%) in the chemohyperthermia arm and 60% (95% CI 50-68%) in the control arm (HR 0.92, 95% CI 0.62-1.37; log-rank p = 0.8) [36]. These results should be interpreted taking into account that it was used for chemohyperthermia instillations only the Combat bladder recirculating system (Combat Medical, St. Albans, UK) and there are many other systems available for hyperthermia intravesical instillations [37], and their use may lead to other results. Further, from the all available data it was observed no difference in case of RFS estimates between patients treated with EPI and patients treated with MMC [38].…”

Hyperthermic Intravesical Chemotherapy (HIVEC) Using Epirubicin in an Optimized Setting in Patients with NMIBC Recurrence after Failed BCG Therapy

“…Hyperthermia between 40 and 44 • C enhances the cytotoxic effects of chemotherapeutic agents [15]. Although HIVEC using MMC and a microwaveinduced system that heats the bladder wall has shown promising oncological results [16], the treatment may provoke frequent side effects and even severe adverse effects, leading to the discontinuation of treatment in up to 38% of cases [17].…”