Intravesical Mitomycin C Salvage Chemotherapy After Bacillus Calmette-Guerin Failure

Brett D Lebed*¹, Richard E Greenberg^2
1Temple University Hospital, Philadelphia, PA;²Fox Chase Cancer Center, Philadelphia, PA

Introduction: Intravesical immunotherapy and chemotherapy agents decrease the high recurrence rate of superficial bladder tumors after transurethral resection. However, additional courses of BCG after initial therapy failures are accompanied by a significant risk of disease progression. This study evaluates the effect of an intravesical Mitomycin-C (MMC) protocol in patients refractory to prior intravesical BCG treatment for superficial transitional cell carcinoma, in an effort to prevent or delay recurrence, progression, and radical cystectomy.
Methods: Patients who demonstrated biopsy proven superficial tumor recurrence after prior BCG treatment received six weekly intravesical instillations of MMC 40mg (1mg/mL), followed by monthly instillations of MMC 40mg for ten to twelve months. Interval cystoscopy, biopsy, and urine cytologic evaluations were performed to evaluate recurrence and progression until last recorded follow up date.
Results: Nineteen consecutive patients were treated after initial BCG failure. 53% (10/19) of patients had complete response to MMC, 5% (1/19) had partial response, and 42% (8/19) had evidence of recurrence. Average disease free interval after start of MMC treatment was 16 months overall, 22 months for complete responders. Stage progression occurred in 16% (3/19) of patients. No patients developed muscle invasive disease. 26% (5/19) of patients completed the entire protocol, reasons for withdrawal included significant side effects or tumor recurrence.
Conclusions: Progression rates for our MMC protocol are superior to BCG as second course therapy for initial BCG failure. Salvage Mitomycin C salvage chemotherapy can be considered as an alternative to cystectomy for high-risk recurrent superficial transitional cell cancer disease after BCG failure.

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