Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press118210.17650/1726-9776-2006-2-2-35-40DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. URINARY BLADDER CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак мочевого пузыряIntravesical mitomycin C salvage chemotherapy after BCG failureСпасительная внутрипузырная химиотерапия митомицином С после безуспешной БЦЖ-терапииLebedB. D.ЛебедБретт
United States

Department of Urology

Philadelphia, Pennsylvania

Отделение урологии

Филадельфия, Пенсильвания

GreenbergR. E.ГринбергРичард
United States

Department of Urologic Oncology

Philadelphia, Pennsylvania

Отделение уроонкологии

Филадельфия, Пенсильвания

Temple University HospitalFox Cancer CenterFox Chase Cancer Center300620062235401802202018022020https://oncourology.abvpress.ru/oncur/article/view/1182

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.

.

1. Alhausen A.F., Prout G.R., Daly J.J. Non-invasive papillary carcinoma of the bladder associated with carcinoma in situ. J Urol 1976; 116: 575.Alhausen A.F., Prout G.R., Daly J.J. Non-invasive papillary carcinoma of the bladder associated with carcinoma in situ. J Urol 1976; 116: 575.2. Soloway M.S., Sofer M., Vaidya A. Contemporary management of stage T1 transitional cell carcinoma of the bladder. J Urol 2002; 167(4): 1573–83.Soloway M.S., Sofer M., Vaidya A. Contemporary management of stage T1 transitional cell carcinoma of the bladder. J Urol 2002; 167(4): 1573–83.3. Smith J.A., Jr, Labasky R.F., Cockett A.T. et al. Bladder cancer clinical guidelines panel summary report on the management of non-muscle invasive bladder cancer (stages Ta, T1, and Tis). American Urological Association. J Urol 1999; 162: 1697.Smith J.A., Jr, Labasky R.F., Cockett A.T. et al. Bladder cancer clinical guidelines panel summary report on the management of non-muscle invasive bladder cancer (stages Ta, T1, and Tis). American Urological Association. J Urol 1999; 162: 1697.4. Oosterlinck W., Lobel B., Jaske G. et al. Guidelines on bladder cancer. Eur Urol 2002; 41: 105.Oosterlinck W., Lobel B., Jaske G. et al. Guidelines on bladder cancer. Eur Urol 2002; 41: 105.5. Shelley M.D., Wilt T.J., Court J. et al. Intravesical bacillus Calmette-Guerin is superior to mitomycin C in reducing tumour recurrence in high-risk superficial bladder cancer: a meta-analysis of randomized trials. BJU Int 2004; 93(4): 485–90.Shelley M.D., Wilt T.J., Court J. et al. Intravesical bacillus Calmette-Guerin is superior to mitomycin C in reducing tumour recurrence in high-risk superficial bladder cancer: a meta-analysis of randomized trials. BJU Int 2004; 93(4): 485–90.6. Bohle A., Bock P.R. Intavesical bacilli Calmette-Guerin versus mitomycin C in superficial bladder cancer: formal meta-analysis of comparative studies on tumor progression. Urology 2004; 63(4): 682–6.Bohle A., Bock P.R. Intavesical bacilli Calmette-Guerin versus mitomycin C in superficial bladder cancer: formal meta-analysis of comparative studies on tumor progression. Urology 2004; 63(4): 682–6.7. Mostofi F.K., Sobin L.H., Torloni H. Histological Typing of Urinary Bladder Tumors: International Classification of Tumors, 10. Geneva: World Health Organization, 1973.Mostofi F.K., Sobin L.H., Torloni H. Histological Typing of Urinary Bladder Tumors: International Classification of Tumors, 10. Geneva: World Health Organization, 1973.8. Catalona W.J., Hudson M.A., Gillen D.P. et al. Risks and benefits of repeated courses of intravesical bacillus Calmette-Guerin therapy for superficial bladder cancer. J Urol 1987; 137: 220–4.Catalona W.J., Hudson M.A., Gillen D.P. et al. Risks and benefits of repeated courses of intravesical bacillus Calmette-Guerin therapy for superficial bladder cancer. J Urol 1987; 137: 220–4.9. Baniel J., Grauss D., Engelstein D., Sella A. Intravesical bacillus Calmette-Guerin treatment for stage T1 grade 3 transitional cell carcinoma of the bladder. Urology 1998; 52: 785.Baniel J., Grauss D., Engelstein D., Sella A. Intravesical bacillus Calmette-Guerin treatment for stage T1 grade 3 transitional cell carcinoma of the bladder. Urology 1998; 52: 785.10. Bretton P.R., Herr H.W., Kimmel M. et al. The response of patients with superficial bladder cancer to a second course of intravesical bacillus Calmette-Guerin. J Urol 1990; 143: 710–3.Bretton P.R., Herr H.W., Kimmel M. et al. The response of patients with superficial bladder cancer to a second course of intravesical bacillus Calmette-Guerin. J Urol 1990; 143: 710–3.11. Coplen D.E., Marcus M.D., Myers J.A. et al. Long term follow up of patients treated with 1 or 2, 6-week courses of intravesical bacillus Calmette-Guerin: Analysis of possible predictors of response free of tumor. J Urol 1990; 144: 652–7.Coplen D.E., Marcus M.D., Myers J.A. et al. Long term follow up of patients treated with 1 or 2, 6-week courses of intravesical bacillus Calmette-Guerin: Analysis of possible predictors of response free of tumor. J Urol 1990; 144: 652–7.12. Soloway M.S. Intravesical therapy for bladder cancer. Urol Clin North Am 1988; 15: 661–9.Soloway M.S. Intravesical therapy for bladder cancer. Urol Clin North Am 1988; 15: 661–9.13. Kaasinen E., Rintala E., Pere A.K. et al. Weekly mitomycin C followed by monthly bacillus Calmette-Guerin or alternating monthly interferon-alpha2B and bacillus Calmette-Guerin for prophylaxis of recurrent papillary superficial bladder carcinoma. J Urol 2000; 164(1): 47–52.Kaasinen E., Rintala E., Pere A.K. et al. Weekly mitomycin C followed by monthly bacillus Calmette-Guerin or alternating monthly interferon-alpha2B and bacillus Calmette-Guerin for prophylaxis of recurrent papillary superficial bladder carcinoma. J Urol 2000; 164(1): 47–52.14. Kaasinen E., Wijkstrom H., Malmstrom P.U. et al. Nordic Urothelial Cancer Group. Alternating mitomycin C and BCG instillations in treatment of carcinoma in situ of the urinary bladder: a Nordic study. Eur Urol 2003; 43(6): 637–45.Kaasinen E., Wijkstrom H., Malmstrom P.U. et al. Nordic Urothelial Cancer Group. Alternating mitomycin C and BCG instillations in treatment of carcinoma in situ of the urinary bladder: a Nordic study. Eur Urol 2003; 43(6): 637–45.15. Guinan P., Richardson C., Hanna M. et al. BCG in the management of superficial bladder cancer. In: Therapeutic Progress in Urologic Cancers, New York: Alan R Liss; 1989. p. 447–53.Guinan P., Richardson C., Hanna M. et al. BCG in the management of superficial bladder cancer. In: Therapeutic Progress in Urologic Cancers, New York: Alan R Liss; 1989. p. 447–53.16. Koontz W.W. Jr, Heney N.M., Soloway M.S. et al. Mitomycin for patients who have failed on thiotepa. Urology 1985; 26 (Suppl) : 30–1.Koontz W.W. Jr, Heney N.M., Soloway M.S. et al. Mitomycin for patients who have failed on thiotepa. Urology 1985; 26 (Suppl) : 30–1.17. Nadler R.B., Catalona W.J., Hudson M.A., Ratliff T.L. Durability of the tumor free response for intravesical BCG therapy. J Urol 1994; 152: 367–73.Nadler R.B., Catalona W.J., Hudson M.A., Ratliff T.L. Durability of the tumor free response for intravesical BCG therapy. J Urol 1994; 152: 367–73.18. Heney N.M., Ahmed S., Flanagan M.J. et al. Superficial bladder cancer: Progression and recurrence. J Urol 1983; 130: 1083.Heney N.M., Ahmed S., Flanagan M.J. et al. Superficial bladder cancer: Progression and recurrence. J Urol 1983; 130: 1083.19. Herr H.W. Tumor progression and survival in patients with T1G3 bladder tumors: 15 year outcome. Br J Urol 1997; 80: 762.Herr H.W. Tumor progression and survival in patients with T1G3 bladder tumors: 15 year outcome. Br J Urol 1997; 80: 762.20. Lundholm C., Norlen B.J., Ekman P. et al. A randomized prospective study comparing long-term intravesical instillations of mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma. J Urol 1996; 156(2 Pt 1): 372–6.Lundholm C., Norlen B.J., Ekman P. et al. A randomized prospective study comparing long-term intravesical instillations of mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma. J Urol 1996; 156(2 Pt 1): 372–6.21. Bohle A., Jocham D., Bock P.R. Intravesical bacillus Calmette-Guerin versus mitomycin C for superficial bladder cancer: a formal meta-analysis of comparative studies on recurrence and toxicity. J Urol 2003; 169(1): 90–5.Bohle A., Jocham D., Bock P.R. Intravesical bacillus Calmette-Guerin versus mitomycin C for superficial bladder cancer: a formal meta-analysis of comparative studies on recurrence and toxicity. J Urol 2003; 169(1): 90–5.22. Rintala E., Jauhiainen K., Rajala P. et al. Alternating mitomycin C and bacillus Calmette-Guerin instillation therapy for carcinoma in situ of the bladder. The Finnbladder Group. J Urol 1995; 154(6): 2050–3.Rintala E., Jauhiainen K., Rajala P. et al. Alternating mitomycin C and bacillus Calmette-Guerin instillation therapy for carcinoma in situ of the bladder. The Finnbladder Group. J Urol 1995; 154(6): 2050–3.23. Rintala E., Jauhianen K., Kaasinen E. et al. Alternating mitomycin C and bacillus Calmette-Guerin instillation prophylaxis for recurrent papillary (stages Ta to T1) superficial bladder cancer. Finnbladder group. J Urol 1996; 156: 56.Rintala E., Jauhianen K., Kaasinen E. et al. Alternating mitomycin C and bacillus Calmette-Guerin instillation prophylaxis for recurrent papillary (stages Ta to T1) superficial bladder cancer. Finnbladder group. J Urol 1996; 156: 56.24. Malmstrom P.U., Wijkstrom H., Lundholm C. et al. 5-year followup of a randomized prospective study comparing mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma. Swedish-Norwegian Bladder Cancer Study Group. J Urol 1999; 161(4): 1124–7.Malmstrom P.U., Wijkstrom H., Lundholm C. et al. 5-year followup of a randomized prospective study comparing mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma. Swedish-Norwegian Bladder Cancer Study Group. J Urol 1999; 161(4): 1124–7.25. Witjes J.A., van der Meijden A.P., Sylvester L.C. et al. Long-term follow-up of an EORTC randomized prospective trail comparing intravesical bacillus Calmette-Guerin-RIVM and mitomycin C in superficial bladder cancer. EORTC GU Group and the Dutch South East Cooperative Urological Group. European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Collaborative Group. Urology 1998; 52(3): 403–10.Witjes J.A., van der Meijden A.P., Sylvester L.C. et al. Long-term follow-up of an EORTC randomized prospective trail comparing intravesical bacillus Calmette-Guerin-RIVM and mitomycin C in superficial bladder cancer. EORTC GU Group and the Dutch South East Cooperative Urological Group. European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Collaborative Group. Urology 1998; 52(3): 403–10.