Adjuvant Hyperthermic Intravesical Chemotherapy in Intermediate- and High-Risk Non-muscle Invasive Bladder Cancer.

Area of Science:

• Urology
• Oncology
• Cancer Treatment

Background:

• Non-muscle invasive bladder cancer (NMIBC) is commonly treated with transurethral resection of bladder tumor (TURBT) followed by intravesical therapies like Bacillus Calmette-Guérin (BCG) or mitomycin C (MMC).
• Limitations associated with BCG have driven the search for alternative adjuvant treatments.
• Hyperthermic intravesical chemotherapy with MMC (HIVEC-MMC) has emerged as a potential alternative for NMIBC management.

Purpose of the Study:

• To evaluate the tolerability and compliance of HIVEC-MMC in patients with intermediate-risk (IR) and high-risk (HR) NMIBC.
• To assess the disease-free survival (DFS) and overall survival (OS) outcomes associated with HIVEC-MMC treatment.
• To identify predictive factors for treatment success in NMIBC patients receiving HIVEC-MMC.

Main Methods:

• A single-center retrospective analysis included 57 patients with IR- and HR-NMIBC who received HIVEC-MMC post-TURBT.
• The treatment protocol involved induction (4 weekly instillations) and maintenance (6 monthly instillations) of HIVEC-MMC.
• Statistical analyses included descriptive statistics, Kaplan-Meier survival estimation, and Cox/logistic regression for outcome assessment.

Main Results:

• Of 57 patients, 41 (71.9%) completed the HIVEC-MMC protocol; recurrence and adverse events were primary reasons for discontinuation.
• After a median follow-up of 31 months, 61.4% of patients were disease-free, with a median DFS of 42 months.
• Completion of the maintenance phase was a significant predictor of DFS (p < 0.001) and positively impacted OS when recurrence was excluded (p=0.021).

Conclusions:

• HIVEC-MMC demonstrates a secure and well-tolerated profile with promising efficacy in IR- and HR-NMIBC.
• This approach offers a feasible therapeutic option for NMIBC patients who cannot tolerate BCG or have contraindications.
• HIVEC-MMC serves as a valuable alternative, particularly during shortages of BCG.