Intensive Intravesical Mitomycin C Therapy in Non-Muscle-Invasive Bladder Cancer: A Dose Intensity Approach

Mitomycin C (MMC) as an intravesical chemotherapeutic agent is a well-known option for treatment of nonmuscle invasive bladder cancer (NMIBC) recurrence; it is probably the most commonly used agent given its low rate of side effects and its efficacy.Both the American Urologic Association (AUA) and European Association of Urology (EAU) consider MMC as a standard treatment for immediate single-dose postoperative treatment and for adjuvant therapy in low and intermediate-risk NMIBC.Despite the popularity of this agent in the treatment of NMIBCs, many questions regarding the optimal approach to MMC therapy remain unanswered and the schedule widely used is empirical.Nevertheless, even when the current optimal approaches to MMC administration are used, a large proportion of NMIBCs recur.This apparent treatment resistance might be overcome by an optimization of standard MMC therapy or with a combination of MMC with other agents that have different mechanisms of action.Strategies to enhance passive delivery of MMC have been well studied and multiple measures are recommended for implementation of use in routine clinical practice.A modified scheme of instillation seems to be an easy and inexpensive alternative to increase efficacy of intravesical MMC and to also use this agent with an ablative intent.Enhancing tumor response with a sequential therapy is another option that has been investigated, mostly for chemo-immunotherapy wherein the different mechanisms of action of Bacillus of Calmette and Guerìn (BCG) and MMC are combined to achieve a higher response.

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“…In our experience, the intensive treatment showed good results both in the ablative treatment and the adjuvant one (16).…”

Section: Optimizing Schedule Of Administrationmentioning

confidence: 75%

Mitomycin C: New Strategies to Improve Efficacy of a Well-Known Therapy

et al. 2016

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“…In considerazione di queste caratteristiche, è stata valutata la variazione dell'intensità di dose raggiunta durante il trattamento andando a modificare la cadenza delle instillazioni. Con tale obiettivo, Racioppi et al (27) hanno valutato gli effetti di un approccio intensivo nella cadenza delle instillazioni endovescicali di MMC; in particolare, 40 pazienti con diagnosi di neoplasia vescicale non muscolo invasiva a rischio intermedio sono stati trattati dopo la resezione endoscopica con 40 mg di MMC tre volte a settimana per due settimane. Gli eventi avversi locali osservati sono stati trascurabili e non si è osservato alcun effetto avverso a livello sistemico.…”

Section: Riassuntounclassified

Innovative Tratments of Non Muscle Invasive Bladder Cancer

et al. 2013

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Bladder cancer represents the second most common neoplasm of the urinary tract and the fourth in general among all the neoplastic pathologies for the male gender; in females, it is the eighth most frequent among all cancers. At the initial diagnosis, 70% of bladder tumors are non-muscle invasive. Treatment of this stage is multimodal, both surgical and pharmacological; the aim is not only to remove the tumor completely but also to prevent tumor recurrence and to inhibit its progression. The treatment for non-muscle invasive bladder cancer is a current topic in the scientific community and it is represented by the endoscopic resection of the tumor, which is generally followed by the adjuvant intravesical treatment with chemotherapy or immunotherapy agents, according to the different risk groups. Benefits and limits of intravesical therapies have been known for long; the aim of this study is to present new drugs or new treatment patterns which could emerge as a valid therapeutic alternative to conventional treatments, given the fact that, regardless of the type of treatment, 2/3 of the patients with a diagnosis of non-muscle invasive bladder cancer have a disease recurrence, and the 10-20% of these show a progression to a muscle-invasive tumor. Furthermore, the failure of intravesical therapy implies another therapeutic option, such as radical cystectomy for non-muscle invasive bladder cancer. According to this fact, new strategies include the activation of host immune system and the optimization of cytotoxic effects of chemotherapeutic drugs. Although most of these studies are still in a pre-clinical phase, the experimental outcomes and the initial results in humans are encouraging.

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