[Therapy of superficial bladder carcinoma]

Area of Science:

• Urology
• Oncology
• Cancer Research

Context:

• Superficial bladder cancer treatment often involves transurethral resection (TUR).
• Adjuvant topical therapies, including chemotherapy and immunotherapy, are used to prevent cancer recurrence and progression.
• Current evidence on the efficacy of these topical treatments is mixed.

Purpose:

• To evaluate the effectiveness of topical chemotherapy and bacillus Calmette-Guérin (BCG) immunotherapy after TUR for superficial bladder cancer.
• To provide guidance on selecting appropriate topical treatment strategies based on tumor characteristics.
• To highlight the need for ongoing research into optimal treatment schedules and their associated side effects.

Summary:

• Prospective studies indicate limited success for topical chemotherapy in reducing tumor recurrence.
• Topical immunotherapy with BCG shows potential but has not demonstrated superiority over existing treatments in multicenter trials.
• Neither chemotherapy nor immunotherapy currently influences progression or survival rates for superficial bladder cancer.
• Specific patient groups, such as those with carcinoma in situ, may benefit from topical therapy, with BCG potentially being more effective.
• Patients with pTaG1 tumors should be excluded from topical therapy, and pT1G3 tumors may not benefit from this adjuvant treatment due to high progression rates.
• No definitive first-line drug has been established, and early versus delayed intravesical chemotherapy shows no advantage.
• Long-term chemoprophylaxis is comparable to short-term prophylaxis, and BCG immunotherapy can be limited to six months.

Impact:

• Current topical therapies have limited impact on preventing recurrence, progression, or improving survival in superficial bladder cancer.
• The findings underscore the importance of patient selection for topical treatments.
• Continued enrollment in prospective studies is crucial for refining treatment protocols and understanding therapeutic activity and side effects.