Urol. praxi, 2016; 17(1): 19-22 | DOI: 10.36290/uro.2016.005

Current role of instillation chemotherapy and immunotherapy in treating non-invasive bladder cancer (Ta, T1, Tis)

MUDr.Pavel Sikora
Urologické oddělení Nemocnice Vyškov

Non–muscle-invasive bladder cancer (NMIBC) represents a group of diseases characterized by papillary tumours confined to

the mucosa (in the case of Ta tumours), invading the lamina muscularis propria (in the case of T1 tumours), and flat (mostly highgrade)

tumorous lesions of the mucosa (in the case of Tis tumours and/or CIS). Molecular biology techniques along with clinical

experience have shown a high malignant potential in T1 and CIS, requiring aggressive treatment that is currently represented

by the combination of transurethral endoresection (TURBT) and intravesical instillation chemotherapy or immunotherapy. In

accordance with the recent EAU guidelines, the present article deals in detail with the individual regimens of instillation therapy,

adverse effects, and their treatment. Also emphasized is the seriousness of the CIS diagnosis and the urgent need to eradicate the

condition, whether it be by using instillation BCG immunotherapy or performing radical cystectomy. Finally, the paper presents

the results of some recent studies dealing with current trends in treating NMIBC.

Keywords: non–muscle-invasive bladder cancer (NMIBC), carcinoma in situ (CIS), intravesical instillation chemotherapy and immunotherapy, BCG vaccine, mitomycin C (MMC), epirubicin, doxorubicin, transurethral resection of bladder tumour (TURBT),

Published: February 1, 2016  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Sikora P. Current role of instillation chemotherapy and immunotherapy in treating non-invasive bladder cancer (Ta, T1, Tis). Urol. praxi. 2016;17(1):19-22. doi: 10.36290/uro.2016.005.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Brausi M, Collette L, Kurth K, et al. EORTC Genito-Urinary Tract Cancer Collabortive Group. Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol 2002; 41(5): 523-531. http://www.ncbi.nlm.nih.gov/pubmed/12074794. Go to original source... Go to PubMed...
    2. Mariappan P, Zachou A, Grigor KM. Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol 2010 May;57(5):843-9. http://www.ncbi.nlm.nih.gov/pubmed/19524354. Go to original source... Go to PubMed...
    3. Soloway MS, Masters S. Urothelial susceptibility to tumor cell implantation: influence of cauterization. Cancer 1980; 46(5): 1158-1163. Go to original source...
    4. Brocks CP, Büttner H, Böhle A. Inhibition of tumor implantation by intravesical gemcitabine in a murine model of superficial bladder cancer. J Urol 2005; 174(3): 1115-1118. http://www.ncbi.nlm.nih.gov/pubmed/16094076145. Go to original source... Go to PubMed...
    5. Oosterlinck W, Kurth Kh, Schröder F, et al. A prospective European Organization for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage Ta, T1 papillary carcinoma of the bladder. J Urol 1993; 149(4): 749-752. http://www.ncbi.nlm.nih.gov/pubmed/8455236. Go to original source... Go to PubMed...
    6. Pode D, Alon Y, Horowitz AT, et al. The mechanism of human bladder tumor implantation in an in vitro model. J Urol 1986 Aug;136(2):482-6. http://www.ncbi.nlm.nih.gov/pubmed/3525861. Go to original source... Go to PubMed...
    7. Tolley DA, Parmar MK, Grigor KM, et al. The effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: a further report with 7 years of follow up. J Urol 1996; 155(4): 1233-1238. http://www.ncbi.nlm.nih.gov/pubmed/8632538. Go to original source... Go to PubMed...
    8. Huncharek M, McGarry R, Kupelnick B. Impact of intravesical chemotherapy on recurrence rate of recurrent superficial transitional cell carcinoma of the bladder: results of a meta-analysis. Anticancer Res 2001; 21(1B): 765-769. http://www.ncbi.nlm.nih.gov/pubmed/11299841. Go to PubMed...
    9. Böhle A, Jocham D, Bock pR. Intravesical bacillus Calmette-Guerin versus mitomycin C for superficial bladder cancer: a formal meta-analysis of comparative studies on recurrence and toxicity. J Urol 2003; 169(1): 90-95. http://www.ncbi.nlm.nih.gov/pubmed/12478111. Go to original source... Go to PubMed...
    10. Böhle A, Bock pR. Intravesical bacillus Calmette-Guerin versus mitomycin C in superficial bladder cancer: formal meta-analysis of comparative studies on tumour progression. Urology 2004; 63(4): 682-686. Discussion 686-7. http://www.ncbi.nlm.nih.gov/pubmed/15072879162. Go to original source... Go to PubMed...
    11. Sylvester RJ, van der Meijden A, Lamm DL. Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol 2002; 168(5): 1964-19670. Go to original source... Go to PubMed...
    12. Sylvester RJ, Brausi MA, Kirkels WJ, et al. EORTC Genito-Urinary Tract Cancer Group. Longterm efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guérin, and bacillus Calmette-Guérin plus isoniazid in patients with intermediate - and high-risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol 2010; 57(5): 766-773. Go to original source... Go to PubMed...
    13. Van der Meijden Ap, Sylvester RJ, Oosterlinck W, et al. EORTC Genito-Urinary Tract Cancer Group. Maintenance bacillus Calmette-Guerin for Ta, T1 bladder tumours is not associated with increased toxicity: results from a European Organisation for Research and Treatment of Cancer Genito-Urinary Group phase III Trial. Eur Urol 2003; 44(4): 429-434. http://www.ncbi.nlm.nih.gov/pubmed/14499676. Go to original source... Go to PubMed...
    14. Palou J, Rodríguez-Villamil L, Andreu-Crespo A, et al. Intravesical treatment of severe bacillus Calmette-Guerin cystitis. Int Urol Nephrol 2001;33(3): 485-489. http://www.ncbi.nlm.nih.gov/pubmed/12230277. Go to original source... Go to PubMed...
    15. Zlotta AR, van Vooren J, Huygen K, et al. What is the optimal regimen for BCG intravesical therapy? Are six weekly instillations necessary? Eur Urol 2000 Apr; 37(4): 470-477. http://www.ncbi.nlm.nih.gov/pubmed/10765079. Go to original source... Go to PubMed...
    16. Sylvester RJ, van der Meijden A, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta, T1 bladder cancer using EORTC risk tables: a combined analysis of2596 patients from seven EORTC trials. Eur Urol 2006; 49(3): 466-465. http://www.ncbi.nlm.nih.gov/pubmed/16442208123. Go to original source... Go to PubMed...
    17. Fernandez-Gomez J, Madero R, Solsona E, et al. Predicting non-muscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol 2009; 182(5): 2195-2203. http://www.ncbi.nlm.nih.gov/pubmed/19758621. Go to original source... Go to PubMed...
    18. Lamm DL. Carcinoma in situ. Urol Clin North Am 1992; 19(3): 499-508. http://www.ncbi.nlm.nih.gov/pubmed/1636234. Go to original source... Go to PubMed...
    19. Jakse G, Hall R, Bono A, et al. Intravesical BCG in patients with carcinoma in situ of the urinary bladder: long-term results of EORTC GU Group phase II protocol 30861. Eur Urol 2001; 40(2): 144-150. http://www.ncbi.nlm.nih.gov/pubmed/11528191202. Go to original source... Go to PubMed...
    20. Gofrit ON, Pode D, Pizov G, et al. The natural history of bladder carcinoma in situ after initial response to bacillus Calmette-Gúerin immunotherapy. Urol Oncol 2009; 27(3): 258-262. http://www.ncbi.nlm.nih.gov/pubmed/18440839. Go to original source... Go to PubMed...
    21. Kaasinen E, Wijkstrom H, Malmstrom U, et al. Alternating mitomycin C and BCG instillations versus BCG alone in treatment of carcinoma in situ of the urinary bladder: a Nordic study. Eur Urol 2003; 43(6): 637-645. http://www.ncbi.nlm.nih.gov/pubmed/12767365 Go to original source... Go to PubMed...
    22. Solsona E, Iborra I, Ricos JV, et al. Extravesical involvement in patients with bladder carcinoma in situ: biological and therapy implications. J Urol 1996; 155(3): 895-899. http://www.ncbi.nlm.nih.gov/pubmed/8583601. Go to original source... Go to PubMed...
    23. Sylvester R, van der Meijden A, Witjes JA, et al. High-grade Ta urothelial carcinoma and carcinoma in situ of the bladder. Urology 2005; 66(6 Suppl 1): 90-107. http://www.ncbi.nlm.nih.gov/pubmed/16399418. Go to original source... Go to PubMed...
    24. Aaronson DS, Walsh TJ, Smith JF, et al. Meta-analysis: does lidocaine gel before flexible cystoscopy provide pain relief? BJU Int 2009; 104(4): 506-509; discussion 509-10. http://www.ncbi.nlm.nih.gov/pubmed/19239453. Go to original source... Go to PubMed...
    25. Palou J, Baniel J, Klotz L, et al. Urothelial carcinoma of the prostate. Urology 2007; 69(1 Suppl): 50-61. http://www.ncbi.nlm.nih.gov/pubmed/17280908207. Go to original source... Go to PubMed...
    26. Palou Redorta J, Schatteman p, Huguet Pérez J, et al. Intravesical instillations with bacillus calmette guérin for the treatment of carcinoma in situ involving prostatic ducts. Eur Urol 2006; 49(5): 834-838;discussion 838. http://www.ncbi.nlm.nih.gov/pubmed/16426729. Go to original source... Go to PubMed...
    27. European Association of Urology (EAU) 30th Annual Congress: Abstract 944. Presented March 23, 2015.

    Return to the content


    Urology for Practice

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.