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Pignot G, Baboudjian M, Lebacle C, Chamouni A, Lechevallier E, Irani J, Tillou X, Waeckel T, Monges A, Doisy L, Walz J, Gravis G, Mourey E, Duperron C, Masson-Lecomte A. Efficacy of hyperthermic intravesical chemotherapy (HIVEC) in patients with non-muscle invasive bladder cancer after BCG failure. World J Urol 2023; 41:3195-3203. [PMID: 36811732 DOI: 10.1007/s00345-023-04332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE To evaluate hyperthermic intravesical chemotherapy (HIVEC) efficacy regarding 1-year disease-free survival (RFS) rate and bladder preservation rate in patients with non-muscle invasive bladder cancer (NMIBC) who fail bacillus Calmette-Guérin (BCG) therapy. METHODS This is a multicenter retrospective series from a national database (7 expert centers). Between January 2016 and October 2021, patients treated with HIVEC for NMIBC who failed BCG have been included in our study. These patients had a theoretical indication for cystectomy but were ineligible for surgery or refused it. RESULTS A total of 116 patients treated with HIVEC and with a follow-up > 6 months were included in this study and retrospectively analyzed. The median follow-up was 20.6 months. The 12 month-RFS (recurrence-free survival) rate was 62.9%. The bladder preservation rate was 87.1%. Fifteen patients (12.9%) progressed to muscle infiltration, three of them having a metastatic disease at the time of progression. Predictive factors of progression were T1 stage, high grade and very high-risk tumors according to the EORTC classification. CONCLUSION Chemohyperthermia using HIVEC achieved an RFS rate of 62.9% at 1 year and enabled a bladder preservation rate of 87.1%. However, the risk of progression to muscle-invasive disease is not negligible, particularly for patients with very high-risk tumors. In these patients who fail BCG, cystectomy should remain the standard of care and HIVEC may be discussed cautiously for patients who are not eligible for surgery and well informed of the risk of progression.
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Affiliation(s)
- Géraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, 232 Boulevard de Ste Marguerite, 13009, Marseille, France.
| | - Michael Baboudjian
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception Academic Hospital, Marseille, France
| | - Cédric Lebacle
- Department of Urology, Kremlin-Bicêtre Academic Hospital, Bicêtre, France
| | - Alexandre Chamouni
- Department of Urology, Université de Paris, APHP, Saint Louis Hospital, Paris, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception Academic Hospital, Marseille, France
| | - Jacques Irani
- Department of Urology, Kremlin-Bicêtre Academic Hospital, Bicêtre, France
| | - Xavier Tillou
- Department of Urology, Centre Hospitalier Universitaire Caen, Caen, France
| | - Thibaut Waeckel
- Department of Urology, Centre Hospitalier Universitaire Caen, Caen, France
| | - Arnaud Monges
- Department of Urology, Polyclinique du Parc Rambot, Hôpital Privé de Provence, Aix-en-Provence, France
| | - Laure Doisy
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, 232 Boulevard de Ste Marguerite, 13009, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, 232 Boulevard de Ste Marguerite, 13009, Marseille, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Eric Mourey
- Department of Urology, University Hospital François Mitterrand, Dijon, France
| | - Céline Duperron
- Department of Urology, University Hospital François Mitterrand, Dijon, France
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Cimier A, Thach S, Lacroix B, Mariat C. [Evaluation of the efficacy and safety of HIVEC intravesical thermochemotherapy with intermediate-risk and high-risk non-muscle-invasive bladder cancer]. Prog Urol 2023; 33:254-264. [PMID: 36906430 DOI: 10.1016/j.purol.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/25/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Non-muscle-infiltrating cancers (NMIBC) represent 75% of bladder tumors. The objective of our study is to report a single-center experience of the efficacy and tolerability of HIVEC on intermediate- and high-risk NMIBC in adjuvant therapy. MATERIAL AND METHOD Between December 2016 and October 2020, patients with intermediate-risk or high-risk NMIBC were included. They were all treated with HIVEC as an adjuvant therapy to bladder resection. Efficacy was assessed by endoscopic follow-up and tolerance by a standardized questionnaire. RESULTS A total of 50 patients were included. The median age was 70years (34-88). The median follow-up time was 31 months (4-48). Forty-nine patients had cystoscopy as part of the follow-up. Nine recurred. One patient progressed to Cis. The 24-month recurrence-free survival was 86.6%. There were no severe adverse events (grade 3 or 4). The ratio of delivered instillations to planned instillations was 93%. CONCLUSION HIVEC with the COMBAT system is well tolerated in adjuvant treatment. However, it is not better than standard treatments, especially for intermediate-risk NMIBC. While waiting for recommendations, it cannot be proposed as an alternative to standard treatment. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- A Cimier
- Service d'urologie, CHU de Saint-Étienne, hôpital Nord, 42055 Saint-Étienne, France.
| | - S Thach
- Service d'urologie, clinique Mutualiste, 3, rue Le Verrier, 42000 Saint-Étienne, France
| | - B Lacroix
- Service d'urologie, clinique Mutualiste, 3, rue Le Verrier, 42000 Saint-Étienne, France
| | - C Mariat
- Service d'urologie, CHU de Saint-Étienne, hôpital Nord, 42055 Saint-Étienne, France
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Doisy L, Cimier A, Adypagavane A, Walz J, Marquette T, Maubon T, Rybikowski S, Fakhfakh S, Loverde K, Mottet N, Irani J, Lechevallier E, Rossi D, Gravis G, Pignot G. Efficacy of HIVEC in patients with high-risk non-muscle invasive bladder cancer who are contraindicated to BCG and in patients who fail BCG therapy. Int J Hyperthermia 2021; 38:1633-1638. [PMID: 34775896 DOI: 10.1080/02656736.2021.2002435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate Hyperthermic-Intra-Vesical Chemotherapy (HIVEC) efficacy regarding 1-year disease-free survival (RFS) rate and bladder preservation rate in patients with High-risk Non-Muscle Invasive Bladder Cancer (NMIBC) who fail BCG therapy or are contraindicated to BCG. METHODS Between June 2016 and October 2019, patients treated with HIVEC for mostly high-risk NMIBC who failed BCG or BCG-naive if BCG contraindicated have been included in our study. These patients had a theoretical indication for cystectomy but were ineligible for surgery or refused it. RESULTS Fifty-three patients, median age 72 [39-93] years, were included in this study (n = 29 BCG-failure and n = 24 BCG-naive). The median follow-up was 18 months. The bladder preservation rate was 92.4%. The 12 months-RFS rate was 60.5%. The RFS rates for BCG-naive and BCG-failure groups were respectively 70% and 52.2% at 12 months. Three patients progressed to muscle infiltration, all in the BCG-failure group and all in the very high-risk EORTC group. Two of them developed metastatic disease and died from bladder cancer. CONCLUSION Chemohyperthermia using HIVEC achieved a RFS rate of 60% at 1 year and enabled a bladder preservation rate of 92%. Given the low risk of progression in the BCG-naive group, HIVEC could be a good alternative. Conversely, for patients with very high-risk tumors that fail BCG, cystectomy should remain the standard of care and HIVEC may be discussed cautiously for patients who are not eligible for surgery and well informed of the risk of progression to muscle-invasive disease.
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Affiliation(s)
- Laure Doisy
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Arnaud Cimier
- Department of Urology, Jean Monnet University, Nord Academic Hospital, Saint-Etienne, France
| | | | - Jochen Walz
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Thibault Marquette
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Thomas Maubon
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Stanislas Rybikowski
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Sami Fakhfakh
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Kevin Loverde
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Nicolas Mottet
- Department of Urology, Jean Monnet University, Nord Academic Hospital, Saint-Etienne, France
| | - Jacques Irani
- Department of Urology, Kremlin-Bicêtre Academic Hospital, Bicêtre, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception Academic Hospital, Marseille, France
| | - Dominique Rossi
- Department of Urology, Aix-Marseille University, APHM, Nord Academic Hospital, Marseille, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Géraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli Calmettes Cancer Center, Marseille, France
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Marquette T, Walz J, Rybikowski S, Maubon T, Branger N, Fakhfakh S, Verde KL, Dermeche S, Gravis G, Pignot G. [Safety of Hyperthermic IntraVEsical Chemotherapy (HIVEC) for BCG Unresponsive Non-Muscle Invasive Bladder Cancer Patients]. Prog Urol 2019; 30:35-40. [PMID: 31787540 DOI: 10.1016/j.purol.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 09/28/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION There is increasing evidence that Hyperthermic Intravesical Chemotherapy is an effective treatment for non-muscle invasive bladder cancer (NMIBC). HIVEC (COMBAT BRS system) is an innovative hyperthermia delivering device. The aim of our study is to evaluate tolerance and safety of HIVEC in patients with BCG-refractory NMIBC. MATERIALS AND METHODS In this study, we included 22 patients between January 2017 and April 2018. The treatment consisted in a weekly instillation of Hyperthermic Mitomycin for a total of 6 weeks, with a follow-up every 3 months. In order to evaluate the tolerance, patients filled a questionnaire before each instillation. We analyzed collected data to evaluate safety and efficiency of the treatment after one year. RESULTS Among 22 patients included, no patient suffered from severe side effects. The minor side effects reported were : urinary urgency (40,1 %), urinary pain (40,1%), macroscopic hematuria (4,5%). The IPSS score didn't significantly varied before and after instillations (mean IPSS: 10.8 versus 10.1, p=0.77). The mean follow-up was 11.2 months. The recurrence rate was 27,3% with an average time to recurrence of 7.36 months. Two patients (9.1%) presented a progression to muscle-invasive disease. Four patients (18,2%) had a radical cystectomy. CONCLUSION Hyperthermic Mitomycin using the HIVEC® device is a rather safe and well tolerated treatment. Efficiency remains partial as 27.3% of patients experienced recurrence during the first year. These data should be confirmed by prospective multicentric studies.
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Affiliation(s)
- T Marquette
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite 13009 Marseille, France
| | - J Walz
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite 13009 Marseille, France
| | - S Rybikowski
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite 13009 Marseille, France
| | - T Maubon
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite 13009 Marseille, France
| | - N Branger
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite 13009 Marseille, France
| | - S Fakhfakh
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite 13009 Marseille, France
| | - K L Verde
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite 13009 Marseille, France
| | - S Dermeche
- Service d'Oncologie Médicale, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite, 13009 Marseille, France
| | - G Gravis
- Service d'Oncologie Médicale, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite, 13009 Marseille, France
| | - G Pignot
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite 13009 Marseille, France.
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