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Juvet T, Mari A, Lajkosz K, Wallis CJ, Kuk C, Erlich A, Krimus L, Fleshner NE, Kulkarni GS, Zlotta AR. Sequential administration of Bacillus Calmette-Guerin (BCG) and Electromotive Drug Administration (EMDA) of mitomycin C (MMC) for the treatment of high-grade nonmuscle invasive bladder cancer after BCG failure. Urol Oncol 2020; 38:850.e9-850.e15. [PMID: 32712139 DOI: 10.1016/j.urolonc.2020.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/08/2020] [Accepted: 06/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a need for effective nonsurgical treatment options in patients with nonmuscle invasive bladder cancer (NMIBC) in whom Bacillus Calmette-Guerin (BCG) therapy has failed. OBJECTIVE We aimed to determine the efficacy of Electromotive Drug Administration (EMDA) of mitomycin C (MMC) with NMIBC after BCG failure. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of 26 NMIBC patients in whom BCG therapy failed who received BCG/EMDA-MMC between 2013 and 2017 was performed. All but 4 patients fulfilled the FDA criteria for BCG unresponsive disease. Progression and recurrence-free survival (RFS)were calculated using Kaplan-Meier curves. Progression was defined as development of muscle invasive disease, presence of metastasis on imaging or treatment. We used FDA-defined criteria as complete response (CR) for single-arm trials of BCG-unresponsive patients. RESULTS AND LIMITATIONS Twenty-six patients were included. Initial pathology was carcinoma in situ (CIS) in 53.8% (14/26), pT1 in 34.6% (9/26), and pTa HG disease in 11.6% (3/26). Twelve of 26 patients progressed (46.2%). Following BCG/EMDA-MMC treatment, progression-free survival rates were 58.3% (95% confidence interval [CI] 41.1-82.1) at 1 year and 48.9% (95% CI 48.9) at 2 years from the date of induction of BCG/EMDA-MMC, respectively. RFS was 41.9% (95% CI 25.9-67.8) at 1 year and 27.2% (95% CI 13.6-54.4) at 2 years. CR at 6, 12, and 18 months was observed in 16 (61.5%), 11 (44.0%), and 7 patients (30.4%), respectively. Side effects included dysuria (19.2%), hematuria (19.2%), and frequency (11.5%). Three patients were admitted for side effects but managed conservatively. Four patients (15.4%) died of bladder cancer over the course of the study. CONCLUSIONS EMDA-MMC BCG represents a viable option in patients with BCG unresponsive NMIBC with close to 50% progression-free survival at 2 years. However, these patients have a high risk of death from bladder cancer (15% in our cohort at 2 years) thus warranting extremely close surveillance.
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Affiliation(s)
- Tristan Juvet
- Department of Surgical Oncology, Urology. University Health Network, Toronto, ON, Canada
| | - Andrea Mari
- Department of Urology, University of Florence, Florence, Italy
| | - Katherine Lajkosz
- Department of Surgical Oncology, Urology. University Health Network, Toronto, ON, Canada; Department of Biostatistics, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Christopher Jd Wallis
- Department of Surgical Oncology, Urology. University Health Network, Toronto, ON, Canada
| | - Cynthia Kuk
- Department of Surgery, Urology, Sinai Health System, Mount Sinai Hospital, Toronto, ON, Canada
| | - Annette Erlich
- Department of Surgery, Urology, Sinai Health System, Mount Sinai Hospital, Toronto, ON, Canada
| | - Lior Krimus
- University of Toronto, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neil E Fleshner
- Department of Surgical Oncology, Urology. University Health Network, Toronto, ON, Canada
| | - Girish S Kulkarni
- Department of Surgical Oncology, Urology. University Health Network, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Department of Surgical Oncology, Urology. University Health Network, Toronto, ON, Canada; Department of Surgery, Urology, Sinai Health System, Mount Sinai Hospital, Toronto, ON, Canada.
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Abstract
Apaziquone is an interesting drug for intravesical use in patients with nonmuscle invasive bladder cancer; however, more research is needed to prove its actual benefit. Although the apaziquone trials demonstrate the potential of this new drug, the singular phase 3 trials did not reach their primary endpoint. To date, no new trials are recruiting, so the development of apaziquone seems to have stopped.
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Affiliation(s)
- Tom J H Arends
- Department of Urology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Johannes Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Geert Groote plein zuid 10, 6525 GA Nijmegen, The Netherlands.
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