Adjuvant Intravesical Mitoxantrone versus Recombinant Interferon-α after Transurethral Resection of Superficial Bladder Cancer: A Randomized Prospective Study

Abstract

Objective: To determine the efficacy and safety of two different doses of intravesical mitoxantrone and of recombinant interferon-α (IFNα-2b), instilled after transurethral resection (TUR) of superficial transitional cell carcinoma (TCC) of the bladder. Material and Methods: 208 patients (mean age 62.05 years) with primary or recurrent superficial (TaG1, T1G1, T1G2) bladder cancer were randomly allocated into four groups, after TUR of all visible tumors. Group A (45 patients) received no further therapy; group B (56 patients) received 10 mg of mitoxantrone (6 weekly and 20 fortnightly instillations), group C (54 patients) 20 mg of mitoxantrone (3 fortnightly and 10 monthly instillations) and group D (53 patients) received 100 MU of IFNα-2b (8 weekly, 8 fortnightly and 6 monthly instillations). Results: During the follow-up (mean 21.09 months), 29 (64.44%) patients in group A had recurrence, compared with 19 (33.92%) in group B, 17 (31.48%) in group C and 15 (28.3%) patients in group D (p < 0.005). Furthermore, the differences in simple recurrence rates were statistically more significant (p < 0.05), when group A was compared with the three other groups in the terms of T1G2, recurrent and multiple neoplasms. Twenty-nine patients (10, 7, 8, and 4 in groups A–D) experienced tumor progression, and the differences between the four groups were not statistically significant (p > 0.05). The mean recurrence time was 9.03 months in group A, 13.74 in group B, 14.24 in group C and 17.4 months in group D (p < 0.001), and the recurrence rate per 100 patient-months was 4.39, 1.57, 1.48 and 1.06, respectively (p < 0.05). Toxicity (grade 1–3) was recorded in 23.21% in group B, in 31.48% in group C and in 9.43% in group D (p < 0.01). Conclusion: The two doses of mitoxantrone resulted in similar efficacy for the prevention of superficial bladder cancer recurrences, with the dose of 10 mg of mitoxantrone being related to fewer side effects. In comparison with mitoxantrone, the adjuvant intravesical immunotherapy with 100 MU of IFNα-2b showed a better combination of efficacy and safety.

Erlotinib (OSI‐774)‐induced inhibition of transitional cell carcinoma of bladder cell line growth is enhanced by interferon‐α

“…However, this effect could be considered suboptimal according to others [24], who defined the sensitivity of lung cancer cell lines as >50% in vitro growth inhibition with erlotinib at <5 µmol/L (2.1 µg/mL). The only clinical reports on the use of IFN in bladder cancer relate to the finding that IFNα can inhibit superficial bladder cancer growth and reduce recurrence after intravesical administration [25]. We were encouraged by this experience to examine its efficacy when combined with erlotinib on invasive bladder cancer cell lines, as erlotinib can block EGF downstream signals that play a negative regulatory role on IFNα.…”

New treatments for superficial bladder cancer

“…Papatsoris et al [24] recently reported a randomized study of 208 patients undergoing intravesical treatment with mitoxantrone, 10 mg; mitoxantrone, 20 mg; interferon-α; or no further therapy after resection of superficial bladder tumors. Over mean follow-up of 21 months, the mitoxantrone groups had 34% and 31.5% recurrence rates and 12.5% and 14.8% progression rates (10-mg and 20-mg groups, respectively) and the interferon-α group had 28% recurrence and 7.5% progression.…”