PD19-06 HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER (HR-NMIBC) TREATED WITH SEQUENTIAL BCG / ELECTROMOTIVE DRUG ADMINISTRATION MITOMYCIN-C (EMDA-MMC): 2% DISEASE-SPECIFIC MORTALITY AT 4 YEARS' FOLLOW-UP

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2017PD19-06 HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER (HR-NMIBC) TREATED WITH SEQUENTIAL BCG / ELECTROMOTIVE DRUG ADMINISTRATION MITOMYCIN-C (EMDA-MMC): 2% DISEASE-SPECIFIC MORTALITY AT 4 YEARS' FOLLOW-UP Christine Gan, Suzanne Amery, Kathryn Chatterton, Muhammad Shamim Khan, Kay Thomas, and Tim O’ Brien Christine GanChristine Gan More articles by this author , Suzanne AmerySuzanne Amery More articles by this author , Kathryn ChattertonKathryn Chatterton More articles by this author , Muhammad Shamim KhanMuhammad Shamim Khan More articles by this author , Kay ThomasKay Thomas More articles by this author , and Tim O’ BrienTim O’ Brien More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.879AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sequential BCG/EMDA-MMC was previously reported to be superior to BCG alone, and since 2009, has been the standard induction regimen in our institution for the treatment of HR-NMIBC. We now present medium-term outcomes from this study. METHODS From June 2009 to June 2013, all patients undergoing bladder conservation for HR-NMIBC were offered sequential BCG/EMDA-MMC. BCG (Immucyst until June 2012, Oncotice since Sept 2012) was given in weeks 1 and 2, and EMDA-MMC (40mg, intravesical current 20mA for 30 mins) in week 3, and this cycle was repeated 3 times for a total of 9 weeks. Maintenance treatment was with 3 doses of BCG every 6 months, commencing 3 months after induction. Response was assessed by GA cystoscopy 8 weeks post induction, followed by 6-monthly flexible cystoscopy. RESULTS 151 patients with HR-NMIBC were treated, of whom 44 (29%) received primary cystectomy, leaving 107 patients (71%) treated with sequential BCG/EMDA-MMC. 86/107 (80%) had high grade Ta/T1 disease, of whom 34 (32%) also had carcinoma in situ (CIS). 19/107 (18%) had primary CIS. 2 (2%) had recurrent, large volume, low grade disease. Median length of follow-up was 47 months (range 4-87 months). 1 patient was lost to follow-up immediately after induction and was excluded from analysis. Overall, 37/106 (35%) patients had disease recurrence. 7/106 (7%) had disease progression, of whom 2/106 (2%) progressed to higher stage NMIBC, 3/106 (3%) progressed to muscle invasive bladder cancer (MIBC), and 2/106 (2%) developed distant metastases. 11/106 (10%) eventually underwent cystectomy for the following reasons: progression to MIBC (3/11), disease recurrence (7/11) and severe bladder storage symptoms (1/11). 17/106 patients (16%) have died, of which 2/106 (2%) died from bladder cancer. As previously reported, 30/107 patients were unable to complete the full 9-dose induction schedule, 16/30 directly due to side effects. There was no significant difference in recurrence rates between patients who received a full (36%) versus a reduced (30%) induction schedule (X2=0.39, p=0.53). CONCLUSIONS Despite the challenge of a 4-year recurrence rate of 35%, a low progression rate to muscle-invasive and metastatic disease of 5% and disease-specific mortality of 2% continue to attest to the oncological efficacy of sequential BCG/EMDA-MMC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e367 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Christine Gan More articles by this author Suzanne Amery More articles by this author Kathryn Chatterton More articles by this author Muhammad Shamim Khan More articles by this author Kay Thomas More articles by this author Tim O’ Brien More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...