SUO 2017: Post-Transurethral Resection Intravesical Mitomycin C Debate
The AUA, SUO, NCCN and EAU guidelines support intravesical therapy post TUR for specific patient populations. Specifically, the AUA and SUO suggest that patients with suspected or known low risk (low grade solitary Ta <3cm or PUNLMP) or intermediate risk (recurrence within 1 year low grade Ta, solitary low grade Ta >3cm, multifocal low grade Ta, high grade Ta <3cm, or low grade T1) bladder cancers should be considered for intravesical therapy post TUR. In 2016, the EAU also supported intravesical therapy post TUR if the EORTC recurrence score was <5.
A meta-analysis of 11 randomized controlled trials from 1985-2011 (n=2278), of which 4 trials utilized Mitomycin C, showed a 35% relative risk reduction and a 14% absolute reduction at 5-year recurrence rates (44% with vs 49% without). Additionally, looking specifically at Mitomycin C, there was an 18.6% absolute risk reduction in time to first recurrence. Not surprisingly, there was no benefit in progression or survival outcomes.
Dr. Taylor also referenced two studies that examined the current use of immediate intravesical postoperative chemotherapy. Mitomycin C was the chemotherapeutic utilized in 83% of cases.
The incidence of non-muscle invasive bladder cancer recurrence rates speak to the need to develop strategies to reduce recurrences. Stratification by risk categories and goals for those in pre-determined groups will identify patients who would be more likely to benefit from treatment. The goal of which is judicious use of immediate intravesical postoperative instillation and to avoid treatment in non-ideal cases. Currently Mitomycin C is the most widely available and widely used in the United States.
Presented by: Jennifer M. Taylor, MD, MPH, Baylor College of Medicine, Houston, TX
Written by: David B. Cahn, DO, MBS, Fox Chase Cancer Center, Philadelphia, PA, Twitter: @dbcahn at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC