Hyperthermic-Intravesical-Chemotherapy (HIVEC) with Mitomycin for recurrent Urothelial Cell Carcinoma (UCC) in patients pre-treated for non-muscle invasive bladder cancer (NMIBC): a single institution study.
BAUS ePoster online library. Conroy S. 06/22/21; 319002; p10-13
Disclosure(s): The Urology Foundation Research Scholar 2020-21
Ms. Samantha Conroy
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Abstract
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Introduction: There are limited evidence-based treatments for patients with recurrent NMIBC after intravesical BCG; particularly in those unsuitable or unwilling to accept primary cystectomy. Here, we report the safety and efficacy of HIVEC with mitomycin, using COMBAT BRS, for patients with pre-treated, recurrent NMIBC.
Patients and Methods: High-risk (6+3+3) and intermediate-risk (6+3) HIVEC protocols are displayed in Figure 1. Re-induction is offered to patients with recurrence who are unwilling or unable to undergo cystectomy. Demographics, histopathology, instillation dates, safety and tolerability data were collected prospectively through a dedicated clinic (9/8/17-14/10/19). Retrospective case note review was completed to evaluate clinical outcomes (1/9/20-8/12/20).
Results: 42 pre-treated patients received HIVEC. Table 1 describes patient and tumour characteristics. Median(IQR) follow-up was 19months(13-27). 35(83%) patients had received prior BCG, 12(29%) ambient MMC, and 4(9.5%) epirubicin. 28(80%) patients who received prior BCG, were BCG failures. 12(29%) completed the recommended protocol. Only 10(24%) experienced treatment-limiting side-effects.
19(45%) patients developed recurrence (median time to recurrence: 9months); 10(24%) progressed despite HIVEC treatment (median time to progression: 9 months), and 5(12%) required radical treatment. 12-month recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) rates in this cohort were 73.5%, 79.2% and 94.6%, respectively. Disease specific mortality was 7% and overall mortality was 17% across a median 19-month follow-up period.
Conclusions: Intravesical HIVEC with mitomycin is safe and well-tolerated. 12-month RFS, PFS, and OS rates, in this predominantly high-risk cohort are promising, and HIVEC salvage therapy may be useful in patients unfit or unwilling to undergo radical treatment.
Patients and Methods: High-risk (6+3+3) and intermediate-risk (6+3) HIVEC protocols are displayed in Figure 1. Re-induction is offered to patients with recurrence who are unwilling or unable to undergo cystectomy. Demographics, histopathology, instillation dates, safety and tolerability data were collected prospectively through a dedicated clinic (9/8/17-14/10/19). Retrospective case note review was completed to evaluate clinical outcomes (1/9/20-8/12/20).
Results: 42 pre-treated patients received HIVEC. Table 1 describes patient and tumour characteristics. Median(IQR) follow-up was 19months(13-27). 35(83%) patients had received prior BCG, 12(29%) ambient MMC, and 4(9.5%) epirubicin. 28(80%) patients who received prior BCG, were BCG failures. 12(29%) completed the recommended protocol. Only 10(24%) experienced treatment-limiting side-effects.
19(45%) patients developed recurrence (median time to recurrence: 9months); 10(24%) progressed despite HIVEC treatment (median time to progression: 9 months), and 5(12%) required radical treatment. 12-month recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) rates in this cohort were 73.5%, 79.2% and 94.6%, respectively. Disease specific mortality was 7% and overall mortality was 17% across a median 19-month follow-up period.
Conclusions: Intravesical HIVEC with mitomycin is safe and well-tolerated. 12-month RFS, PFS, and OS rates, in this predominantly high-risk cohort are promising, and HIVEC salvage therapy may be useful in patients unfit or unwilling to undergo radical treatment.
Introduction: There are limited evidence-based treatments for patients with recurrent NMIBC after intravesical BCG; particularly in those unsuitable or unwilling to accept primary cystectomy. Here, we report the safety and efficacy of HIVEC with mitomycin, using COMBAT BRS, for patients with pre-treated, recurrent NMIBC.
Patients and Methods: High-risk (6+3+3) and intermediate-risk (6+3) HIVEC protocols are displayed in Figure 1. Re-induction is offered to patients with recurrence who are unwilling or unable to undergo cystectomy. Demographics, histopathology, instillation dates, safety and tolerability data were collected prospectively through a dedicated clinic (9/8/17-14/10/19). Retrospective case note review was completed to evaluate clinical outcomes (1/9/20-8/12/20).
Results: 42 pre-treated patients received HIVEC. Table 1 describes patient and tumour characteristics. Median(IQR) follow-up was 19months(13-27). 35(83%) patients had received prior BCG, 12(29%) ambient MMC, and 4(9.5%) epirubicin. 28(80%) patients who received prior BCG, were BCG failures. 12(29%) completed the recommended protocol. Only 10(24%) experienced treatment-limiting side-effects.
19(45%) patients developed recurrence (median time to recurrence: 9months); 10(24%) progressed despite HIVEC treatment (median time to progression: 9 months), and 5(12%) required radical treatment. 12-month recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) rates in this cohort were 73.5%, 79.2% and 94.6%, respectively. Disease specific mortality was 7% and overall mortality was 17% across a median 19-month follow-up period.
Conclusions: Intravesical HIVEC with mitomycin is safe and well-tolerated. 12-month RFS, PFS, and OS rates, in this predominantly high-risk cohort are promising, and HIVEC salvage therapy may be useful in patients unfit or unwilling to undergo radical treatment.
Patients and Methods: High-risk (6+3+3) and intermediate-risk (6+3) HIVEC protocols are displayed in Figure 1. Re-induction is offered to patients with recurrence who are unwilling or unable to undergo cystectomy. Demographics, histopathology, instillation dates, safety and tolerability data were collected prospectively through a dedicated clinic (9/8/17-14/10/19). Retrospective case note review was completed to evaluate clinical outcomes (1/9/20-8/12/20).
Results: 42 pre-treated patients received HIVEC. Table 1 describes patient and tumour characteristics. Median(IQR) follow-up was 19months(13-27). 35(83%) patients had received prior BCG, 12(29%) ambient MMC, and 4(9.5%) epirubicin. 28(80%) patients who received prior BCG, were BCG failures. 12(29%) completed the recommended protocol. Only 10(24%) experienced treatment-limiting side-effects.
19(45%) patients developed recurrence (median time to recurrence: 9months); 10(24%) progressed despite HIVEC treatment (median time to progression: 9 months), and 5(12%) required radical treatment. 12-month recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) rates in this cohort were 73.5%, 79.2% and 94.6%, respectively. Disease specific mortality was 7% and overall mortality was 17% across a median 19-month follow-up period.
Conclusions: Intravesical HIVEC with mitomycin is safe and well-tolerated. 12-month RFS, PFS, and OS rates, in this predominantly high-risk cohort are promising, and HIVEC salvage therapy may be useful in patients unfit or unwilling to undergo radical treatment.
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