• 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. Further chemotherapy or long-term BCG treatment for intermediate-risk patients

Treatment of non-muscle invasive bladder cancer

EAU guidance

Effective repeat-dose treatment4…

Repeated doses of Mitomycin-C are effective for patients with tumours at intermediate recurrence-risk.4

Recurrence-free survival

Despite extra treatments, patients receiving repeated Mitomycin-C doses did not have significantly more adverse events than those in the two shorter-term treatment groups.4

…with long-term well-tolerated results5

A meta-analysis of individual patient data shows similar survival and time-to-progression rates for Mitomycin-C vs. BCG.5

Duration of survival Time to progression

There was no difference in survival time or progression between treatment groups.5

Recurrence rates were superior to Mitomycin-C in the BCG group, but only if maintenance treatment was given.5

Favourable side effects your patients could tolerate5

Additional Mitomycin-C instillations are an effective and well-tolerated option for your intermediate-risk patients.4,5

Reference 4
Long-term intravesical adjuvant chemotherapy further reduces recurrence rate compared with short-term intravesical chemotherapy and short-term therapy with Bacillus Calmette-Guérin (BCG) in patients with non-muscle-invasive bladder carcinoma

Friedrich MG et al. Eur Urol 2007; 52:1123-30.

Objectives: To compare short- and long-term Mitomycin-C chemoprophylaxis with short-term immunoprophylaxis after TURBT for TaT1 bladder cancer.

Methods: Phase four, randomised, parallel group trial with three treatment arms:
BCG RIVM 2 x 108 CFU weekly for six weeks
Mitomycin-C 20 mg weekly for six weeks
Mitomycin-C 20 mg weekly for six weeks, monthly for three years

Results: 495 patients randomised to the three treatment arms.

In the long-term Mitomycin-C arm, the median number of instillations was 21 (approximately 15 months’ maintenance). Side effects were not significantly different between the three treatment arms.

Multivariate Cox regression analysis for recurrence-free interval

Conclusion: Long-term Mitomycin-C use significantly reduced the risk of tumour recurrence without enhanced toxicity compared with both short-term BCG and Mitomycin-C in patients with intermediate- and high-risk TaT1 bladder cancer.

Reference 5
An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical Mitomycin-C versus Bacillus Calmette-Guerin for non-muscle-invasive bladder cancer

Malmstrőm P-U et al. Eur Urol 2009; 56: 247-56.

Objectives: To perform an individual patient data (IPD)-based meta-analysis to compare the long-term efficacy of intravesical Mitomycin-C to BCG in patients with TaT1 bladder cancer.

Methods: A meta-analysis of randomised clinical trials.

Results: 2,820 patients in nine trials were included in the analysis.

Time to first recurrence Time to death bladder cancer

Overall there was no significant difference in the risk of recurrence between BCG and Mitomycin-C (p=0.09). Time to death did not differ significantly between either treatment group. However, BCG maintenance conferred a 32%reduction in recurrence risk compared with Mitomycin-C, irrespective of previous chemotherapy.

Conclusion: Maintenance BCG was needed to be more effective than Mitomycin-C for prophylaxis of recurrence. Risk of toxicity must be weighed against recurrence and progression. BCG should be standard in high-risk populations, while less toxic Mitomycin-C treatment could be considered in intermediate-risk populations, with failures switched to BCG.

To Page Top