Open Access

ARTICLE

Maximizing intravesical therapy options: is there an advantage to the administration of perioperative mitomycin C prior to an induction course of BCG?

Gina M. Badalato, Gregory Hruby, Mani Razmjoo, James M. McKiernan

Department of Urology, Columbia University Medical Center, New York, New York, USA
Address correspondence to Dr. Gina M. Badalato, Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion, New York, NY 10032 USA

Canadian Journal of Urology 2011, 18(5), 5890-5895.

Abstract

Introduction: This study aimed to evaluate cancer-specific outcomes among patients who received perioperative mitomycin C (MMC) prior to induction BCG compared to those who received induction BCG alone.
Materials and methods: Between January 2000 and August 2010, 260 patients were identified who underwent a course of induction BCG with or without concomitant perioperative MMC. Specifically, patients who received 40 mg MMC following transurethral resection of all visible tumors, followed by an induction course of BCG, were compared to a similar cohort receiving induction BCG alone. The primary endpoints were overall survival and recurrence-free survival (RFS).
Results: A total of 212 patients received induction BCG alone, and 48 received perioperative MMC with induction BCG. The overall cohort consisted of patients with non-muscle-invasive (NMI) bladder cancer, with no significant differences between groups in terms of demographic or pathologic characteristics. With a median follow-up of 34.5 months, there was no difference in overall survival between the two groups. However, RFS was significantly better in the combined therapy group (5-year RFS: 37.5% vs. 56.3%, p = 0.023). Despite this, the intravesical therapy regimen did not reach statistical significance as an independent predictor in multivariate analysis (HR = 0.61, p = 0.055, 95% CI: 0.36–1.01).
Conclusion: Although the combination therapy group showed a significant improvement in RFS, the intravesical therapy regimen did not independently predict this benefit. Further investigation is warranted to determine whether immediate administration of MMC prior to induction BCG improves RFS. Nevertheless, this pilot study provides important preliminary evidence for the management of NMI bladder cancer, despite the lack of contemporary large-scale randomized trials.

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