Lntravesical Instillation of Mitomycin C in the Prophylactic Treatment of Recurring Superficial Transitional Cell Carcinoma of the Bladder*

Abstract

Twenty-six patients with an elevated recurrence rate of stage O or A bladder tumours were treated prophylactically after transurethral resection (TUR) with short-term intravesical instillations of mitomycin C in a non-randomised study. The data before intravesical chemotherapy (IVC) were taken as the internal control for each patient. Mitomycin C was administered in one course of 10 daily doses of 40 mg, starting 24 to 48 hours after TUR. The average follow-up was 13.9 months before and 28.5 months after IVC. Before IVC, the average number of recurrences was 2.6, with an average recurrence rate of 1 every 5.3 months. After IVC there was no tumour recurrence in 4 patients, with a mean of 12.2 months' follow-up, but there was tumour recurrence in 22 patients. For 17 patients (77%) the free interval averaged 2.3 times longer than the mean interval of recurrence before IVC and for 18 patients (82%) the recurrence rate averaged 3.3 times less than the recurrence rate before IVC.

Quality of care in patients with bladder cancer

“…In fact, Southwest Oncology Group 8795 was closed prematurely in 1991 after accruing approximately one‐half of the projected number of subjects (349 in lieu of 720) as evidenced by the superiority of BCG over mitomycin C in recurrence‐free survival (let alone placebo). With regard to the point 5 (meta‐analysis demonstrating an advantage of a single perioperative intravesical dose of chemotherapy was first reported in 2004—multiple studies published in the 1980s and 1990s demonstrated the benefits of perioperative intravesical chemotherapy 7, 15‐21. Some contend that with time, compliance with practice guidelines will be sufficient.…”

“…With regard to the point 5 (meta-analysis demonstrating an advantage of a single perioperative intravesical dose of chemotherapy was first reported in 2004-multiple studies published in the 1980s and 1990s demonstrated the benefits of perioperative intravesical chemotherapy. 7,[15][16][17][18][19][20][21] Some contend that with time, compliance with practice guidelines will be sufficient. Notwithstanding the statistically significant increase of compliance with at 4 cystoscopies, 4 cytologies, and an induction course of BCG, we anticipate only 25% compliance by the year 2024.…”

Mitomycin C: a clinical update

“…At an average of 34 months, 11.1% had recurrent tumors among the MMC treated group compared to 54.8% among those receiving no treatment. The activity of MMC was confirmed in treatment of low stage tumors occurring in patients in France (12), England (13), Italy (14), Hungary (15) and Germany (16). Among 117 patients failing thiotepa, 43 (37%) had negative cytology following MMC therapy (17).…”

Intravesical Instillation of Beta‐Interferon in the Treatment of Bladder Cancer

“…With respect to drug tolerance, it is important to note that other drugs currently employed can cause substantial toxicity, such as myelosuppression (thiotepa) (Veenema et al, 1962), chemical cystitis and contact dermatitis (mitomycin C , doxorubicin and ethoglucid) (Devonec et al, 1983;Garnick et al, 1985) and bladder irritability (BCG) (Martinez-Pineiro et al, 1990).…”