Recurrent NMIBC: short-term, intensive chemoresection safe, yields good response

  • Lindgren MS & et al.
  • Eur Urol
  • 28 Jul 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Short-term, intensive chemoresection with mitomycin C yields a tumor response of 57% in patients with recurrent stage Ta bladder cancer.
  • The treatment is associated with fewer clinically significant adverse effects vs standard transurethral resection of the bladder tumor (TURBT).

Why this matters

  • Short-term, intensive chemoresection may be a nonsurgical option for older, multimorbid patients.

Study design

  • The DaBlaCa-13 study of 120 patients with recurrent stage Ta non-muscle invasive bladder cancer (NMIBC) who were randomly assigned to: 
    • Intervention: intravesical mitomycin C thrice a week for 2 weeks.
    • Control: TURBT and adjuvant instillations.
  • Primary outcome: tumor response in the intervention group at 4 weeks.
  • Funding: Danish Cancer Society; others.

Key results

  • 57% of patients in the intervention group had completed tumor response (95% CI, 43%-70%).
  • No difference in tumor response was observed between low- and high-grade tumors (P=.7).
  • A high number of recurrent tumors at baseline was associated with a higher risk for incomplete response (OR, 1.65; P=.02).
  • No grade 4 toxicities were reported.
  • 3 grade 3 adverse events were observed in the control group.
  • Patients in the intervention group reported significantly lower incidence of dysuria (difference, 20%; P=.03), pollakiuria (difference, 25%; P=.007), and palmar skin rash (difference, 18%; P=.002).

Limitations

  • Open label.