1783 LONG-TERM OUTCOMES OF ELECTRO-MOTIVE DRUG ADMINISTRATION OF MITOMYCIN-C AFTER FAILED INTRAVESICAL BCG IMMUNOTHERAPY IN HIGH RISK, NON-MUSCLE INVASIVE TRANSITIONAL CELL CARCINOMA OF THE BLADDER

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial (II)1 Apr 20131783 LONG-TERM OUTCOMES OF ELECTRO-MOTIVE DRUG ADMINISTRATION OF MITOMYCIN-C AFTER FAILED INTRAVESICAL BCG IMMUNOTHERAPY IN HIGH RISK, NON-MUSCLE INVASIVE TRANSITIONAL CELL CARCINOMA OF THE BLADDER Ruairidh Crawford, Hannah Wright, Jonathan Borwell, Theresa Parker, Bruce Montgomery, and Neil Barber Ruairidh CrawfordRuairidh Crawford Frimley, United Kingdom More articles by this author , Hannah WrightHannah Wright Frimley, United Kingdom More articles by this author , Jonathan BorwellJonathan Borwell Frimley, United Kingdom More articles by this author , Theresa ParkerTheresa Parker Frimley, United Kingdom More articles by this author , Bruce MontgomeryBruce Montgomery Frimley, United Kingdom More articles by this author , and Neil BarberNeil Barber Frimley, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2873AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A recent global shortage of Bacillus Calmette-Guérin (BCG) has forced urologists to consider alternative strategies for treatment of non-muscle invasive bladder cancer (NMIBC). Electro-motive drug administration of Mitomycin-C (EMDA MMC) is one possible alternative but there is little long-term data available. We look at the efficacy and tolerability of EMDA MMC in a select patient group. METHODS Retrospective analysis of patients at a single institution who had received intravesical EMDA MMC since 2006. Indications for this treatment included recurrence or persistence of disease following initial treatment with intravesical BCG or failure to tolerate that treatment for high-risk NMIBC. All patients were considered unacceptably high risk for radical cystectomy. Clinical and operative notes and histology were analyzed to determine tolerability, rates of recurrence and disease progression. RESULTS 26 patients were identified; 20 of these completed the treatment fully. The remaining 6 either did not tolerate treatment or followed up at a different hospital. The average age at time of treatment was 79. There were 21 males and 5 females. With a mean follow-up of 44 months, 14 patients (70%) were found to have disease recurrence within the first 12 months. All were subsequently managed endoscopically. The mean time to disease recurrence was 8.4 months. Disease progression was seen in only 2 patients; one developed new high grade NMIBC and another developed metastatic disease 41 months following treatment. There were no other cases of disease progression. Only 4 patients (15.4%) discontinued their treatment due to skin reactions, intolerable storage type lower urinary tract symptoms or significant haematuria. No patients had systemic reactions to the treatment. CONCLUSIONS EMDA MMC may have an important role in treating patients who have failed BCG therapy for high risk NMIBC and who are too unfit for radical surgery. A 30% complete response rate at a year, with an apparent low risk of progression suggests impressive disease control in the long-term in this poor prognostic group. Tolerability is similar to BCG and of note, there were no systemic reactions. More formal evaluation in the form of a well powered, randomized and probably multi-centred study is needed to fully evaluate the role of EMDA MMC in the treatment of high risk NMIBC, either as an initial treatment or as salvage after BCG, and certainly suggests a potential role whilst BCG availability worldwide remains a problem. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e733 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruairidh Crawford Frimley, United Kingdom More articles by this author Hannah Wright Frimley, United Kingdom More articles by this author Jonathan Borwell Frimley, United Kingdom More articles by this author Theresa Parker Frimley, United Kingdom More articles by this author Bruce Montgomery Frimley, United Kingdom More articles by this author Neil Barber Frimley, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...