Treatment of multiple superficial tumors of bladder with intravesical bleomycin

Twenty-six patients with superficial Stage O or A transitional cell carcinoma of the urinary bladder, whose lesions were not amenable to transurethral resection, received bleomycin sulfate intravesically at weekly intervals for eight treatments. Five different drug regimens were tried, and the optimal concentration appeared to be 60 units dissolved in 30 cc. of sterile water. Serum determinations failed to reveal any significant absorption. There was a 27% complete response rate in patients with small tumor burdens. An additional 9% had partial responses which allowed the tumors to be readily managed transurethrally. However, no patients with extensive superficial tumor showed complete response to therapy. Although belomycin used intravesically is active against transitional cell carcinoma, the current cost of the drug precludes its routine use and restricts it to situations in which other agents are contraindicated.