• Treatment of non-muscle invasive bladder cancer
  • The EAU approach to non-muscle invasive bladder cancer treatment
  • A single chemotherapy dose for low- or intermediate-risk patients
  • Further chemotherapy or long-term BCG treatment for intermediate-risk patients
  • TURBT and then some
  • References
  • About Mitomycin-C Kyowa
  • Mechanism of Action
  • Solubility
  • Stability
  • Dosage, indication & side effects
  • Useful links
  1. Top >
  2. for Healthcare Professionals >
  3. A single chemotherapy dose for low- or intermediate-risk patients

Treatment of non-muscle invasive bladder cancer

EAU guidance:

Chemotherapy is effective2…

An EORTC meta-analysis by Sylvester et al., showed that a single dose of chemotherapy immediately after TURBT significantly decreased the risk of recurrence.2

Frequency of tumour recurrence

One instillation alone is insufficient treatment for patients with multiple tumours: after one instillation, 65.2% of patients with multiple tumours had recurrence vs 35.8% with single tumours.2

…as long as it's given in good time3

For chemotherapy use after TURBT, timing would appear to be everything.3

Recurrence risk doubles when chemotherapy is given more than 24 hours after surgery.3

Hazard ratio for tumour recurrence

Giving a single post-operative dose of chemotherapy is effective even in patients with frequently recurring tumours.3

Reference 2
A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage TaT1 bladder cancer: a meta-analysis of published results of randomized clinical trials

Sylvester RJ et al. J Urol 2004; 171: 2186-90.

Objectives: To determine if one immediate instillation of chemotherapy after TUR decreases recurrence risk in patients with TaT1 single and multiple bladder cancer overall and separately.

Methods: Meta-analysis of randomised clinical trials, comparing TURBT alone to TURBT plus one immediate chemotherapy instillation.

Results: Seven randomised trials with 1,476 patients were included.

Forest plot of recurrence by study

Conclusion: One immediate intravesical instillation of chemotherapy significantly decreases the risk of recurrence after TUR in patients with TaT1 single and multiple bladder cancer.

Reference 3
Factors explaining recurrence in patients undergoing chemoimmunotherapy regimens for frequently recurring superficial bladder carcinoma

Kaasinen E et al. Eur Urol 2002; 42: 167-74.

Objectives: To study the factors determining new recurrences in patients with frequently recurring superficial bladder tumours.

Results: Type of regimen was the most significant factor determining new recurrences, with preceding recurrence rate being the most important prognostic factor.

Timing of the first MMC was the third most significant predictor in the main multivariate analysis, with more than a two-fold relative risk for a new recurrence if the first MMC instillation was given later than on day zero. The percentages of patients with recurrence were 43.3%, 63.6% and 66.2% receiving the first MMC on days zero, one, and later, respectively (p=0.006; χ2-test).

Conclusion: Preceding recurrence rate most accurately reflects, in patients with frequently recurring tumours, the inherent risk for new recurrences. This risk can be considerably reduced by use of an effective chemoimmunotherapy regimen and, in addition, by inclusion of an early peri-operative chemotherapy instillation in such a regimen.

"Our analysis clearly suggests that if the first peri-operative MMC instillation is given on the day of transurethral resection instead of being administered later, the relative risk for future recurrence is reduced by half, irrespective of the rest of the regimen.”

To Page Top