Efficacy of HIVEC in patients with high-risk non-muscle invasive bladder cancer who are contraindicated to BCG and in patients who fail BCG therapy

Hyperthermic intravesical chemotherapy with mitomycin‐C for the treatment of high‐risk non‐muscle‐invasive bladder cancer patients

“…Overall, the 12-month RFS, PFS and OS rates were promising, with slightly higher rates than other high-risk HIVEC studies. 17,18 Higher RFS, PFS and OS have been reported in one randomised trial of BCG versus HIVEC, 16 which excluded patients with CIS, enrolled fewer patients with recurrent tumours or prior treatment, and had a lower median age; and the second, a large prospective observational cohort in Spain, 30 For example, transport challenges to and from the department, finding the treatment too time consuming, other life commitments, opting for a watch and wait approach.…”

“…Oncological outcomes (RFS, PFS and OS) were promising in this high-risk, pretreated cohort, and were similar to other high-risk NMIBC HIVEC studies. 17,18 HR-NMIBC represents almost one-third of the BC workload managed at our institution, 22 many of whom are unfit, or unwilling, to receive RC. Their management options are limited to adjuvant intravesical BCG, 8 which has high failure rates due to toxicity and recurrence 7,23,24 ; this is further compounded by poor BCG availability due to international supply shortages.…”

“…Hyperthemic MMC can be delivered using two models: radiofrequency-induced thermo-chemotherapy (RITE) using microwave radiation through a catheter device, and recombinant systems that use recirculation systems to externally heat and instil chemotherapeutic agents, such as, HIVEC. 25 With recent evidence emerging to support the use of hyperthermic MMC, in both its forms, as a potential adjuvant treatment in highrisk patients, [16][17][18][19][20][21]26,27 we established a specialist HIVEC clinic in our department. The primary focus was to explore the tolerability and acceptability of HIVEC treatment for patients with HR-NMIBC.…”

Device-assisted intravesical chemotherapy treatment for nonmuscle invasive bladder cancer: 2022 update

“…After removal of duplicates, reviews, and conference abstracts, 65 full-text original articles were assessed. Nine studies that investigated HIVEC (oncological outcomes were reported for 1137 patients and AEs for 970 patients) were included for final evaluation after fulfilling the inclusion criteria [13 ▪▪ ,14 ▪▪ ,15 ▪▪ ,16 ▪▪ ,17 ▪▪ ,18 ▪▪ ,19 ▪ ,20 ▪▪ ,21 ▪▪ ]. Another three studies were additionally analyzed: two of them reported outcomes after radiofrequency-induced HIVEC [22 ▪▪ ,23 ▪▪ ], and one after EMDA [24 ▪▪ ].…”

“…Three studies included only BCG naïve patients and reported a RFS at 2 years from 70.7% [18 ▪▪ ] to 82.4% [17 ▪▪ ], PFS was reported only in the study of Plata et al with 92% at 2 yrs and 89.8% at 5 yrs. Two studies [15 ▪▪ ,16 ▪▪ ] included both BCG naive and BCG refractory patients, treated with induction cycle of 6 to 8 weeks with 40 mg hyperthermia MMC, reported a RFS at 1 yr. of 60.5% to 70% [16 ▪▪ ] and a PFS of 94% [15 ▪▪ ]. One retrospective study that included only BCG refractory high-risk NMIBC patients, reported a 5-year DFS of 43% and PFS of 59.8% [20 ▪▪ ].…”