Absorption of Epirubicin Instilled Intravesically Immediately after Transurethral Resection of Superficial Bladder Cancer

Abstract

As postoperative adjuvant therapy for superficial bladder cancer, intravesical instillation therapy is commonly conducted. In this case, from the view point of prevention of intraoperative dissemination, commencement of instillation therapy at an early postoperative period is preferred. However, increased drug permeability is suspected because of damage to the bladder mucosa during operation. Therefore, this study was conducted to investigate the plasma level of epirubicin (EPI) instilled immediately after transurethral operation. EPI (20 mg/40 ml or 50 mg/100 ml) was instilled immediately after a transurethral operation, and retained in the bladder for 1 h. Blood samples were obtained before instillation, as well as 30, 60, 120 and 240 min after instillation, and EPI levels were assayed. The mean EPI concentrations (ng/ml) among the 20-mg/40 ml group (n = 5) were <2.5 and <2.0 at 30 and 60 min, respectively, after which they were undetectable. The 50-mg/100 ml group (n = 5) recorded 5.0, 4.4 and <3.0 after 30, 60 and 120 min, respectively, and after 240 min it was undetectable. Intravesical instillation of EPI immediately after a transurethral operation causes a small increase in the plasma level and it is thought to cause small systemic side effects.

The absorption of pirarubicin instilled intravesically immediately after transurethral resection of superficial bladder cancer

“…Plasma concentrations of pirarubicin at any time after instillation were below the detectable limit in both groups. Previous data for epirubicin showed detectable levels of < 2.5 and < 2.0 ng/mL at 15 and 30 min after instillation of 20 ng/40 mL, and 5.0, 4.4 and < 3.0 ng/mL after the instillation of 50 mg/100 mL [9]. The recovery rates of pirarubicin in the drained fluid after retention in the bladder, measured in seven patients after instilling 30 mg/50 mL and in four after 30 mg/100 mL, are shown in Table 1.…”

“…In the present study, pirarubicin instilled into the bladder immediately after TURBT was undetectable in plasma at any time afterward in all 20 patients. A similar study using epirubicin, which is also an anthracycline anticancer drug, showed a peak concentration of 9.0 ng/mL at 30–60 min after intravesical instillation [9]. In clinical studies with epirubicin, no systemic side‐effects were reported following intravesical administration immediately after TURBT [10].…”

Drug eruption due to intravesical instillations of both epirubicin and mitomycin C

“…Concerning absorption of intravesical chemotherapy, Tsusima et al . noted intravesical instillation of epirubicin immediately after a transurethral operation caused a small increase in the plasma level of epirubicin and was thought to cause limited systemic side‐effects 11 . Although their opinions may be correct, we speculated that these phenomena in our case might be drug eruption due to absorption of the agents through the bladder wall rather than contact dermatitis because all patch tests using epirubicin and mitomycin C were negative.…”

Diagnosing the Location of Carcinoma in situ (CIS) of the Urinary Bladder Using Pirarubicin Hydrochloride

“…The cardiotoxicity of THP is less than that of ADM [11] . Compared to epirubicin hydrochloride, which is another anthracycline, THP is more likely to be absorbed by blood, although it is generally thought that THP is not readily absorbed by blood [12,13] .…”