SUO 2017: Post-TUR Mitomycin C Debate: Should it be Standard of Care?

Washington, DC ( Dr. Skinner presented the argument against routine use of immediate postoperative Mitomycin C (MMC) for low grade (LG) UCC tumors. A meta-analysis looking at the body of literature promoting the use of MMC, she argued, demonstrates that the quality of these studies was generally poor. Looking deeper into the trials, it is clear that postoperative MMC does not benefit patients with a EORTC recurrence risk score >=5, which accounted for 48% of people in the EORTC trials. This is the rationale for postoperative MMC use in just LG cases.

MMC doesn’t avoid the need for induction therapy for patients with intermediate or high risk disease. It does not improve the outcome for patients who are bound to receive BCG anyways. MMC also tends to block healing after TURBT. This makes follow-up more challenging, since surveillance cystoscopy may demonstrate calcified or atypical lesions that, although likely benign, would prompt most Urologists to re-biopsy to make sure recurrence isn’t present.

Lastly, complications from MMC are rare but extremely severe. Many are likely due to unrecognized perforations during TURBT. Symptoms include severe frequency, urgency, pain, incontinence, and dramatically decreased bladder capacity. Many of these patients ultimately need to have their bladders removed. Dr. Skinner very effectively posited the question: Is this really worth it for LG tumors?

Dr. Skinner no longer uses postoperative MMC. She argues that it really only helps people who have the least aggressive disease, and the toxicity risks far outweigh the benefits. It is hard to argue with this point, especially now that agents such as gemcitabine are now demonstrating such dramatic effectiveness with nearly no toxicity.

Presented by: Eila Skinner, MD. Chair, Department of Urology, Professor - Med Center Line, Urology Stanford University

Written by: Shreyas Joshi, MD, @ssjoshimd Fox Chase Cancer Center, Philadelphia, PA at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC