Treatment Schedule of Intravesical Chemotherapy with Mitomycin C in Superficial Bladder Cancer: Short-Term Courses or Maintenance Therapy

ONCOLOGY AND CHEMOTHERAPY

has a different spectrum and incidence of local and systemic toxicity. This excellent summary article condenses practically all that is known about the use, side effects and clinical results from the use of these drugs into an accessible format. It should be required reading. 1 figure, 9 tables, 36 references William W. Hoffman, M.D. Dallas, Texas

Intravesical Chemotherapy: How Effective is it? N. M. HENEY,

Massachusetts

General Hospital,

Boston,

Massachusetts Urology, suppl. 3, 31: 17-19 (Mar.) 1988 Transitional cell tumors of the bladder recur in 20 to 70 per cent of the patients after transurethral resection or fulguration. The probability of tumor recurrence is increased with multiple lesions, high grade tumors, positive urinary cytology findings and dysplasia at sites distant from the tumor. Similarly, in some patients tumors do not recur. Single, small, grade I, stage Ta tumors that are fully removed have a lesser probability of recurrence. Although tumor recurrence is worrisome to the patient, it is of much less significance than tumor progression to muscle invasion. The probability of progression is low (2 per cent) in grade 1, stage Ta tumors, intermediate in grade 2 tumors and approximately 50 per cent in grade 3, stage Tl tumors. The tendency to muscle invasion has been shown to be associated with ablation of A, B and H antigens on the tumor cells and certain chromosomal abnormalities. With these perspectives in mind the urologist considering intravesical chemotherapy might hope to reduce or prevent recurrence in the low grade, low stage group and to prevent tumor progression in the high grade group. The former has been accomplished as reported in various studies but there is debate regarding the effect of intravesical chemotherapy in reducing probability of tumor progression. Intravesical chemotherapy has been shown to reduce or prevent recurrence of low grade, low stage transitional cell tumors of the bladder. Thiotepa, mitomycin C, doxorubicin and bacillus Calmette-Guerin are the drugs used most widely for intravesical chemotherapy in the United States; only thiotepa has been approved by the Food and Drug Administration for use within the bladder. Results of studies with these agents are reviewed. Many studies attest to the ability of the commonly used intravesical agents to ablate intravesical tumor and reduce tumor recurrence rate. However, the ability of these drugs to slow or arrest tumor progression to muscle invasion remains uncertain. Without large scale, prospective, randomized studies to address this issue a definitive answer may not be available for the foreseeable future. 1 table, 24 references William W. Hoffman, M.D. Dallas, Texas

Treatment Schedule of Intravesical Chemotherapy With Mitomycin C in Superficial Bladder Cancer: ShortTerm Courses or Maintenance Therapy A. P. M. VAN DER MEIJDEN AND F. M. J. DEBRUYNE, De-

partment of Urology, University Hospital Nijmegen, Nijmegen, The Netherlands

899

Urology, suppl. 3, 31: 26-29 (Mar.) 1988 Among patients who present with transitional cell carcinoma of the bladder, 60 to 70 per cent have tumors confined to the epithelium and/or the submucosal layer (stages Ta, Tis and Tl). Of these patients 60 to 70 per cent will have recurrent tumors after the initial transurethral resection and 10 to 30 per cent subsequently will have invasive disease. lntravesical chemotherapy with mitomycin C in patients with superficial bladder cancer after transurethral resection has proved to be highly effective in preventing tumor recurrences and/or progression. No consensus has been reached on the appropriate dose and treatment schedule. This and other variables, such as different criteria for entry and followup in the reported studies to date make it impossible to compare the results. There are indications that long-term mitomycin C instillation therapy (up to 2 years) improves recurrence rate, progression rate and survival. Considering prognostic factors in patients with superficial bladder tumors it is justified and necessary to investigate this regimen in future protocols. 2 tables, 19 references William W. Hoffman, M.D. Dallas, Texas

BCG (RIVM) Versus Mitomycin Intravesical Therapy in Superficial Bladder Cancer: First Results of Randomized Prospective Trial F. M. J. DEBRUYNE, A. P. M. VAN DER MEIJDEN, A. D. H. GEBOERS, M. P. H. FRANSSEN, M. J. W. VAN LEEUWEN, P. A. STEERENBERG, W. H. DE JONG AND J. J. RUITENBERG, Department of Urology, University Hospital Nijmegen,

!KO Cancer Center, Nijmegen; Dutch National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands; and the members of the Dutch Southeast Cooperative Urological Group and of the European Organization for Research and Treatment of Cancer-Genitourinary (EORTC-GU) Group Urology, suppl. 3, 31: 20-25 (Mar.) 1988 The preliminary results are presented of a randomized prospective 2-arm study in which bacillus Calmette-Guerin (BCG) RIVM, a Dutch BCG preparation, is compared to mitomycin C in patients with primary or recurrent superficial bladder tumors, including carcinoma in situ. Therapeutic regimens were as follows: after complete transurethral resection of all visible tumors, BCG RIVM (1 x 109 bacilli in 50 ml. saline) was instilled once a week for 6 consecutive weeks, and mitomycin C (30 mg. in 50 ml. saline) was administered once a week for 1 month (weeks 1 to 4) and thereafter once a month for a total of 6 months. The incidence of side effects in 165 patients and the recurrence rate of tumors in 308 patients after a followup of 12 months are reported. Drug-induced or chemical cystitis was observed in 13 of 78 BCG-treated patients (16.7 per cent) and in 12 of 87 (13.8 per cent) mitomycin C-treated patients. In the same groups bacterial cystitis occurred in 17 (21.8 per cent) and in 16 (18.4 per cent) patients, respectively. Of 148 patients in the BCG-treated group 44 (29.8 per cent) had recurrent tumors, compared to 40 of 160 (25.0 per cent) in the mitomycin C group. The recurrence rate for BCG-treated patients was 0.33, compared to 0.29 for those given mitomycin C (p = 0.560, not significant). These preliminary data demonstrated no statistically significant difference between the 2 arms with regard to toxicity and recurrence of tumors. These results are in contrast to other studies demonstrating