Intravesical therapy for urothelial carcinoma of the urinary bladder: a critical review

The management of non-muscle-invasive urothelial carcinoma of the bladder (UCB) is a challenge for physicians and patients alike. This is largely due to the heterogeneous natural history of this disease, in which tumors range from indolent to rapidly progressive and eventually fatal. Moreover, the high rate of recurrence and progression cause significant morbidity, expense, and detriment to quality of life. The advent of effective and safe intravesical therapies has improved the management of non-muscle-invasive UCB. Nevertheless, despite over 30 years of research and clinical experience, the mechanism, risks, benefits, and optimal regimens and treatment algorithms remain unclear. Although immunotherapy with bacillus Calmette-Guerin (BCG) has been the mainstay of intravesical treatment and represents a significant advance in the interaction of immunology and oncology, its clinical effectiveness is accompanied by a wide range of adverse events. Here, we review the literature on intravesical immunotherapy and chemotherapy with the aim of evaluating the clinical utility of the different treatments and providing recommendations. Many studies over the years have compared efficacy and toxicities of different agents and regimens, and certain conclusions are now well supported by high-level evidence. Future perspectives and promising advances in drug development are discussed and areas of improvement are identified in order to promote better cancer control and decrease the rate and severity of side-effects.

Comparison of bladder cancer survival among Japanese, Chinese, Filipino, Hawaiian and Caucasian populations in the United States.

BACKGROUND: Racial differences for bladder cancer survival have been reported for Caucasians and African-Americans. However, the survival experience of bladder cancer patients in Asian and Pacific Islander ethnic groups in the United States have not been fully explored. The purpose of this study was to compare the bladder cancer survival rates of Japanese, Chinese, Filipinos, Hawaiians and Caucasians in the U.S. population. MATERIALS AND METHODS: The data was from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute between 1973 and 1998. Cox proportional hazard models and Kaplan-Meier's estimates were used to study differences in survival between the ethnic groups, adjusting for factors including age at diagnosis, gender, year of diagnosis, histological grade, stage, surgery type, and radiation therapy. RESULTS: The overall bladder cancer survival was 66% for Japanese patients, 64% for Chinese patients, 61% for Caucasians, 59% for Filipino patients and 52% for Hawaiian patients. Differences in bladder cancer survival rates between Japanese and Chinese populations in the United States were not observed. In the Asian population, higher relative risks and lower 5-year survival were observed with increasing age at diagnosis (p for trend<0.0001), grade (p for trend<0.0001), and stage (p for trend<0.0001). Asian women had lower survival and a higher risk of death due to bladder cancer than Asian men. CONCLUSIONS: Japanese and Chinese bladder cancer patients had higher overall survival rates than Caucasians, while Filipino and Hawaiian patients had lower survival than Caucasians.