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Sequential Treatment With Bacillus Calmette-Güerin (BCG) and Mitomycin C Administered With Electromotive Drug Administration (EMDA) in Patients With High-Risk Nonmuscle Invasive Bladder Cancer After BCG Failure.
- Source :
-
Clinical genitourinary cancer [Clin Genitourin Cancer] 2023 Aug; Vol. 21 (4), pp. e286-e290. Date of Electronic Publication: 2023 Mar 17. - Publication Year :
- 2023
-
Abstract
- Background: Nowadays, there is no standard non-surgical treatment for patients with nonmuscle invasive bladder cancer (NMIBC) in whom Bacillus Calmette-Güerin (BCG) therapy has failed.<br />Objectives: To assess the clinical and oncological outcomes of sequential treatment with Bacillus Calmette-Guerin (BCG) and Mitomycin C (MMC) administered with Electromotive Drug Administration (EMDA) in patients with high-risk NMIBC who fail BCG immunotherapy.<br />Material and Methods: We retrospectively studied patients with NMIBC who failed BCG and received alternating BCG and Mitomycin C with EMDA between 2010 and 2020. Treatment schedule consisted in an induction therapy with 6 instillations (BCG, BCG, MMC + EMDA, BCG, BCG, MMC + EMDA) and a 1-year maintenance. Complete response (CR) was defined as the absence of high-grade (HG) recurrences during follow-up, and progression was defined as the occurrence of muscle invasive or metastatic disease. CR rate was estimated at 3, 6, 12, and 24 months. Progression rate and toxicity were also assessed.<br />Results: Twenty-two patients were included with a median age of 73 years. Fifty percent of tumors were single, 90% were smaller than 1.5cm, 40% were GII (HG) and 40% were Ta. CR rate was 95.5%, 81% and 70% at 3 and 6 months, 12 months and 24 months, respectively. With a median follow-up of 28.8 months, 6 patients (27%) presented HG recurrence and only 1 patient (4.5%) progressed and ended in cystectomy. This patient died due to metastatic disease. Treatment was well tolerated and 22% of the patients presented adverse effects, being dysuria the most frequent one.<br />Conclusion: Sequential treatment with BCG and Mitomycin C with EMDA achieved good responses and low toxicity in selected patients who did not respond to BCG. Only 1 patient ended in cystectomy and died due to metastatic disease, therefore, cystectomy was avoided in most cases.<br /> (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Humans
Administration, Intravesical
BCG Vaccine administration & dosage
BCG Vaccine therapeutic use
Immunotherapy
Neoplasm Invasiveness pathology
Neoplasm Recurrence, Local drug therapy
Neoplasm Recurrence, Local chemically induced
Retrospective Studies
Mitomycin administration & dosage
Mitomycin therapeutic use
Urinary Bladder Neoplasms drug therapy
Urinary Bladder Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1938-0682
- Volume :
- 21
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Clinical genitourinary cancer
- Publication Type :
- Academic Journal
- Accession number :
- 37076337
- Full Text :
- https://doi.org/10.1016/j.clgc.2023.03.002