Intravesical mitomycin C salvage chemotherapy after BCG failure

Abstract

Objectives: To evaluate the effect of an intravesical mitomycin C (MMC) protocol in patients refractory to prior intravesical BCG treatment for superficial transitional cell carcinoma, in an effort to prevent or delay recurrence and radical cystectomy.

Methods: Patients who demonstrated biopsy proven superficial tumor recurrence after prior BCG treatment received six weekly intravesical instillations of MMC 40 mg, followed by monthly instillations of MMC 40 mg for 10 to 20 months. Interval cystoscopy, biopsy, and urine cytological evaluations were performed to evaluate recurrence and progression until last recorded follow-up date.

Results: 19 consecutive patients were treated based on order of presentation after BCG failure. 53% (10/19) of patients had a complete response to mitomycin, 5% (1/19) had a partial response, and 42% (8/19) had evidence of recurrence. Average disease-free interval after start of mitomycin treatment was 16 months, 22 months for complete responders. Stage progression occurred in 16% (3/10) of patients; no patients developed muscle invasive disease. 26% (5/19) of patients completed the entire protocol, reasons for withdrawal included significant side effects or tumor recurrence.

Conclusion: The results suggest that mitomycin C salvage chemotherapy is a possible alternative to cystectomy for high-risk recurrent superficial transitional cell cancer disease after BCG failure.