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- Title
Hyperthermic Intravesical Chemotherapy (HIVEC) Using Epirubicin in an Optimized Setting in Patients with NMIBC Recurrence after Failed BCG Therapy.
- Authors
Blanc, Julien; Ruggiero, Jonathan; Lucca, Ilaria; Arnold, Nicolas; Kiss, Bernhard; Roth, Beat
- Abstract
Simple Summary: Intravesical instillation using bacillus Calmette-Guérin (BCG) is the standard therapy for patients with high-risk, non-muscle-invasive bladder cancer. If BCG therapy fails, however, radical cystectomy with urinary diversion is recommended. Still, some patients are unfit or just refuse major surgery. We showed in this study that for these patients at highest risk for recurrence and progression, device-assisted hyperthermic intravesical chemotherapy using conductive heating and epirubicin in an optimized setting might be a bladder-sparing alternative with excellent recurrence-free survival rates within the bladder and without severe side effects. Still, a major concern is the extravesical manifestation of urothelial cancer in these patients with poor prognosis due to the associated risk of metastasis. Urologists should be aware that the window of opportunity for cure by undergoing radical cystectomy is tight and should not be missed. To evaluate hyperthermic intravesical chemotherapy (HIVEC) using conductive heating and epirubicin in an optimized setting as an alternative to radical cystectomy in patients with recurrent non-muscle invasive bladder cancer (NMIBC) who have failed bacillus Calmette-Guérin (BCG) therapy. We retrospectively analyzed our prospectively recorded database of patients who underwent HIVEC between 11/2017 and 11/2022 at two Swiss University Centers. Cox regression analysis was used for univariate/multivariate analysis, and the Kaplan–Meier method for survival analysis. Of the 39 patients with NMIBC recurrence after failed BCG therapy, 25 (64%) did not recur within the bladder after a median follow-up of 28 months. The 12- and 24-month intravesical RFS were 94.8% and 80%, respectively. Extravesical recurrence developed in 14/39 (36%) of patients. Only 7/39 (18%) patients had to undergo radical cystectomy. Seven patients (18%) progressed to metastatic disease, with five of these (71%) having previously developed extravesical disease. No adverse events > grade 2 occurred during HIVEC. Device-assisted HIVEC using epirubicin in an optimized setting achieved excellent RFS rates in this recurrent NMIBC population at highest risk for recurrence after previously failed intravesical BCG therapy. Extravesical disease during or after HIVEC, however, was frequent and associated with metastatic disease and consecutively poor outcomes.
- Subjects
SWITZERLAND; NON-muscle invasive bladder cancer; CYSTECTOMY; INTRAVESICAL administration; CANCER relapse; BCG vaccines; POSTOPERATIVE pain; RETROSPECTIVE studies; DESCRIPTIVE statistics; CANCER chemotherapy; METASTASIS; TRANSITIONAL cell carcinoma; TREATMENT failure; PROGRESSION-free survival; EPIRUBICIN; DISEASE progression
- Publication
Cancers, 2024, Vol 16, Issue 7, p1398
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16071398