MP83-19 MITOMYCIN C (MMC) PLUS BACILLUS CALMETTE E GUERÌN (BCG) SEQUENTIAL THERAPY FOR RECURRENT NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC)

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2018MP83-19 MITOMYCIN C (MMC) PLUS BACILLUS CALMETTE E GUERÌN (BCG) SEQUENTIAL THERAPY FOR RECURRENT NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) Mauro Ragonese, Luca Di Gianfrancesco, Niccolò Lenci, Salvatore Marco Recupero, Giuseppe Palermo, and Marco Racioppi Mauro RagoneseMauro Ragonese More articles by this author , Luca Di GianfrancescoLuca Di Gianfrancesco More articles by this author , Niccolò LenciNiccolò Lenci More articles by this author , Salvatore Marco RecuperoSalvatore Marco Recupero More articles by this author , Giuseppe PalermoGiuseppe Palermo More articles by this author , and Marco RacioppiMarco Racioppi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2767AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES BCG therapy represents the gold standard treatment in high grade NMIBC to prevent recurrence and reduce the risk of progression. In patients who do not respond to BCG the gold standard is radical cystectomy. For patients not suitable or not willing to undergo radical surgery there are some bladder preservation strategies: a second BCG induction therapy and chemo-immunotherapy with BCG and MMC are among these options. METHODS We retrospectively evaluated data from 200 patients treated in our Department for a recurrent high grade NMIBC. All the patients were not suitable for surgery or they do not want to undergo radical surgery and were treated with different endovesical regimen. A group of 120 patients (Group 1) was treated with a schedule of combined therapy with 4 weekly instillations of MMC followed by 4 weekly instillations of BCG and a second group of 80 patients (Group 2) was treated with a second induction therapy of BCG. Patients with a complete response after induction were treated with maintenance therapy. We evaluated the complete response after the induction cycle and after a median follow up of 18 months and we compared the rate of side effects evaluated with the Common Terminology Criteria for Adverse Events (CTCAE) RESULTS Complete response after the first evaluation at three months was similar for the two groups, 67.5 % (81 patients) in group 1 and 63.7 % (51 patients) in group 2 without a statistically significant difference. At the median follow-up of 18 months a recurrent disease was present in 76 patients (38 %), 37 (46.2 %) from group 2 and 39 (37.5%) from group 1 (p < 0.01). 7 patients (6%) in group 1 and 6 patients (7.5 %) in group 2 had a progression to muscle-invasive disease. The regimen was well tolerated with low treatment toxicity, only Grade 1 and Grade 2 events were reported and the overall rate of complications was 25 % in group 1 and 11.2 % in group 2 (p < 0.01). No severe adverse events (Grade 3, 4 or 5) were reported and all the patients with a response after the induction complete the maintenance therapy. CONCLUSIONS Recurrent NMIBC is a great challenge for urologist in particular in patients not suitable for radical cystectomy. Sequential therapy and repeat BCG therapy are among these options and our preliminary findings indicate a better efficacy for the combination treatment. Further prospective randomized trials are needed to find out if this regimen could really become a valid alternative for these patients. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1123-e1124 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mauro Ragonese More articles by this author Luca Di Gianfrancesco More articles by this author Niccolò Lenci More articles by this author Salvatore Marco Recupero More articles by this author Giuseppe Palermo More articles by this author Marco Racioppi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...