PD66-03 SEQUENTIAL ADMINISTRATION OF BCG AND ELECTROMOTIVE DRUG ADMINISTRATION (EMDA) OF MITOMYCIN C (MMC) IN NON-MUSCLE INVASIVE BLADDER CANCER HAVING PREVIOUSLY RECEIVED INTRAVESICAL THERAPY

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive III1 Apr 2018PD66-03 SEQUENTIAL ADMINISTRATION OF BCG AND ELECTROMOTIVE DRUG ADMINISTRATION (EMDA) OF MITOMYCIN C (MMC) IN NON-MUSCLE INVASIVE BLADDER CANCER HAVING PREVIOUSLY RECEIVED INTRAVESICAL THERAPY Tristan Juvet, Christopher Wallis, Lior Krimus, Annette Erlich, Girish Kulkarni, and Alexandre Zlotta Tristan JuvetTristan Juvet More articles by this author , Christopher WallisChristopher Wallis More articles by this author , Lior KrimusLior Krimus More articles by this author , Annette ErlichAnnette Erlich More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , and Alexandre ZlottaAlexandre Zlotta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2999AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A number of randomized controlled trials have studied the use of Electromotive Drug Administration (EMDA) of mitomycin C (MMC) in the setting of non-muscle invasive bladder cancer (NMIBC). These studies have focused on treatments prior to and following initial bladder tumor resection (TURBT). They have demonstrated potential benefit in terms of recurrence rates, disease free interval and decreased mortality when compared to standard Bacille Calmette-Guerin (BCG) monotherapy. Evidence remains lacking on the use of EMDA-MMC in patients who have become unresponsive to BCG therapy. Our objective was to determine the efficacy of EMDA-MMC in patients having failed treatment with BCG. METHODS After obtaining institutional review board approval, patients presenting to our multi-disciplinary bladder cancer clinic were reviewed to identify those who had received an initial BCG treatment, progressed, and received BCG/EMDA-MMC between 2013 and April 2016. Patients received BCG/EMDA-MMC as per our research protocol. Progression and overall survival time were calculated using Kaplan-Meier curves. Progression was defined as development of muscle invasive disease, presence of metastasis on imaging or treatment (surgery, chemotherapy, radiation). RESULTS A total of 30 patients having undergone BCG/EMDA-MMC over the study course were reviewed. Median age was 63 years. All patients had undergone at least one BCG induction. Initial pathology was carcinoma in situ (CIS) in 43.3% (13/30), pT1 in 26.7 % (8/30) and pTa disease in 30% (9/30). 55.6% (5/9) of pTa patients were found to have low grade disease (WHO 2003). 43.33% (13/30) of all patients progressed, requiring additional treatment. 84.6% of these patients (11/13) had high grade disease. Following BCG/EMDA-MMC treatment, progression-free survival rates were 79.5% (95% CI 0.63.4-95.5%) at 1 year and 61.7% (95% CI 0.41.8-81.5%) at 2 years from the date of induction of BCG/EMDA-MMC. Median survival was not reached at 4 years follow-up. CONCLUSIONS Our study focuses on one of the limited options available to patients having failed to respond to BCG treatment. Although this remains a novel treatment, our early data show evidence of progression free survival in over 60% of patients at the two year mark. Patients with high grade disease were most likely to progress. Treatment with BCG/EMDA-MMC in this setting may delay more aggressive treatments, although further studies are needed in this subset of patients to determine the exact benefits. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1230-e1231 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Tristan Juvet More articles by this author Christopher Wallis More articles by this author Lior Krimus More articles by this author Annette Erlich More articles by this author Girish Kulkarni More articles by this author Alexandre Zlotta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...