AUA 2022: A Multicenter Study of 2-year Outcomes Following Hyperthermia Therapy with Mitomycin C in Treating BCG Unresponsive Non-Muscle Invasive Bladder Cancer: Recirculant Hyperthermic Intravesical Chemotherapy

(UroToday.com) The 2022 Annual Meeting of the American Urological Association was host to a moderated poster session for non-invasive bladder cancer. Dr. Andrew Stemberger presented the 2-year follow up results of BCG-unresponsive NMIBC patients treated with hyperthermic Mitomycin C.

Given the shortage of treatment options in the BCG-unresponsive NMIBC disease space, there has been intensified research efforts to develop treatment strategies with durable responses. Radical cystectomy remains the gold standard treatment option in this disease space, but many patients are either unfit or unwilling to undergo such a morbid procedure. In this study, the authors sought to evaluate the recurrence-free survival (RFS) and progression-free survival (PFS) of patients treated with chemo hyperthermia (CHT) with Mitomycin C using the Combat bladder recirculation system.

The authors retrospectively queried the Hyperthermic Chemotherapy registry, a prospective, multi-institutional registry of 1,028 patients with NMIBC, confirmed on transurethral resection of bladder tumor, who subsequently underwent CHT between 2012 and 2020. In this protocol, Mitomycin C is heated to 43°C using an aluminum heat exchanger that enables efficient heat transfer and accurate temperature control within ±0.5 °C.

174 patients with BCG unresponsive disease were included. Median follow up was 16.8 months (IQR: 9.1 – 26.0 months). Median age was 68.9 years (IQR: 59.8 – 76.2) and 141 (81.0%) were men.

Overall cohort:

  • RFS
    • 12 months: 78.1% (95% CI 72% – 84.7%)
    • 24 months: 57.4% (95% CI 49.7% – 66.3%)
  • PFS
    • 12 months: 95.2% (95% CI 91.8% – 98.7%)
    • 24 months: 90.1% (95% CI 84.8% and 95.8%)

CIS +/- Ta/T1:

  • RFS:
    • 12 months: 69.5% (95% CI 58.1% – 83.2%)
    • 24 months: 43.6% (95% CI 31.4% – 60.4%)

 

Ta/T1:

  • RFS:
    • 12 months: 82.2% (95% CI 75.4% – 89.6%)
    • 24 months: 64.5% (95% CI 55.4% – 75.1%)

Minor adverse events occurred in 33 (19.2%) of patients and severe events occurred in 2 (1.1%).
 

 

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The authors concluded that CHT with MMC using the Combat BRS is effective in the medium term and has a favorable adverse event profile in BCG unresponsive patients. This may represent an attractive treatment option in a space where there are limited treatment options available.
 
 

Presented by: Andrew Stemberger, Cooper Medical School, Camden, NJ

Written by: Rashid Sayyid, MD, MSc – Urology Chief Resident, Augusta University/Medical College of Georgia, @rksayyid on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.

 

 

 

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