Will long-term disease specific outcomes of bladder conservation with sequential Bacillus Calmette-Guérin (BCG) and electromotive drug administration Mitomycin-C (EMDA-MMC) for high-risk non-muscle invasive bladder cancer (HR-NMIBC) influence adoption?

Abstract

Event Abstract Back to Event Will long-term disease specific outcomes of bladder conservation with sequential Bacillus Calmette-Guérin (BCG) and electromotive drug administration Mitomycin-C (EMDA-MMC) for high-risk non-muscle invasive bladder cancer (HR-NMIBC) influence adoption? Jennifer Lane1*, Zakariya Abdille1, Christine Gan1, Kathryn Chatterton1, Suzanne Amery1, Ramesh Thurairaja1, Shamim Khan1, Sachin Malde1, Timothy O'Brien1 and Rajesh Nair1 1 Guy's and St Thomas' NHS Foundation Trust, United Kingdom Background: Superior short-term outcomes of sequential BCG with EMDA-MMC when treating HR-NMIBC have been reported. Despite this, the regimen has not been widely adopted for bladder conservation and the optimal regimen is yet to be determined. An understanding of long-term oncological outcomes would be important in understanding it’s true role and may encourage wider adoption. Methods: This is a prospective single-centre study of 464 patients, presenting with new HR-NMIBC between June 2009 and July 2017. The bladder conservation schedule followed TURBT with adjuvant 9-week induction consisting of 3 consecutive and identical cycles of; BCG in weeks 1 and 2, followed by EMDA-MMC in week 3. Maintenance was 3-weekly BCG. Cystoscopy was used to assess response at 8 weeks post induction. Primary outcome measures evaluated were recurrence free survival, progression rates and outcomes following salvage treatment. Results: 249 patients received sequential BCG/EMDA-MMC with a median follow-up of 54 months (4-108). 206/249 (83%) received treatment for high-grade (Ta/T1) disease, and 13/249 (5%) for primary carcinoma in situ. A further 30/249 (12%) received treatment for recurrent or large volume low-grade disease. Of the 196/249 (79%) patients who completed the induction course of treatment 123/196 (63%) have remained disease free during follow-up. 53/196 (27%) patients developed bladder recurrence, of which 22/53 (42%) demonstrated stage migration (T2 disease). Of note, 28/53 (53%) developed recurrence within the first three years of treatment. Of the 15/53 (28%) who subsequently underwent radical cystectomy, upstaging on final histopathology was demonstrated in 8/15 (53%) patients, 1/15 (6%) died of metastatic bladder cancer. Conclusion: If induction BCG/EMDA-MMC treatment is completed, over two-thirds of patients remain disease free during long term follow-up. This is twice the efficacy quoted for intravesical BCG alone and adds further weight to the adoption of this sequential regimen in bladder preservation for HR-NMIBC. Keywords: Bladder cancer, BCG - Bacille Calmette-Guérin vaccine, Electromotive drug administration (EMDA), Mitomycin C (Mit-C), Non-muscle invasive bladder cancer Conference: Bladder Cancer Translational Research Meeting, London, United Kingdom, 29 Mar - 29 Mar, 2019. Presentation Type: Poster Topic: Development of personalised treatment Citation: Lane J, Abdille Z, Gan C, Chatterton K, Amery S, Thurairaja R, Khan S, Malde S, O'Brien T and Nair R (2019). Will long-term disease specific outcomes of bladder conservation with sequential Bacillus Calmette-Guérin (BCG) and electromotive drug administration Mitomycin-C (EMDA-MMC) for high-risk non-muscle invasive bladder cancer (HR-NMIBC) influence adoption?. Front. Oncol. Conference Abstract: Bladder Cancer Translational Research Meeting. doi: 10.3389/conf.fonc.2019.01.00015 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 28 Feb 2019; Published Online: 27 Sep 2019. * Correspondence: Dr. Jennifer Lane, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, jennifer.lane@gstt.nhs.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Jennifer Lane Zakariya Abdille Christine Gan Kathryn Chatterton Suzanne Amery Ramesh Thurairaja Shamim Khan Sachin Malde Timothy O'Brien Rajesh Nair Google Jennifer Lane Zakariya Abdille Christine Gan Kathryn Chatterton Suzanne Amery Ramesh Thurairaja Shamim Khan Sachin Malde Timothy O'Brien Rajesh Nair Google Scholar Jennifer Lane Zakariya Abdille Christine Gan Kathryn Chatterton Suzanne Amery Ramesh Thurairaja Shamim Khan Sachin Malde Timothy O'Brien Rajesh Nair PubMed Jennifer Lane Zakariya Abdille Christine Gan Kathryn Chatterton Suzanne Amery Ramesh Thurairaja Shamim Khan Sachin Malde Timothy O'Brien Rajesh Nair Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.