Alternating mitomycin C and Bacillus calmette-guerin instillations versus MMC or BCG monotherapy in treatment of superficial bladder cancer

ABSTRACT

To evaluate whether, in patients with superficial bladder cancer, alternating instillation therapy with mitomycin C [MMC] and bacillus Calmette-Guerin [BCG] was effective and less toxic than conventional BCG or MMC monotherapy. This study was conducted on 90 patients, their age ranged from 38-72 years [73 male and 17 female]. They were clinically evaluated and investigated by routine laboratory investigation, plain x-ray, IVU and US. Cystoscopic biopsy was done, and after confirmation of the pathology as superficial bladder cancer [Cis, Ta or T1] they were classified into three groups A,B and C each of them 30 patients in a random fashion. Transurethral resection was done for the pathological lesion. All the patients received the treatment in the first postoperative day, after the urine becomes clear. Group A received a full dose of BCG [120 mg] weekly for 6 weeks, group B received a full dose of MMC [40mg] weekly for 6 weeks and group C received weekly alternatively a reduced dose from BCG [75mg] and MMC [30 mg] for 12 weeks. All the patients were followed by cystoscopic biopsy every 3 months during a period of 18 months for recurrence or progression of the tumor and local toxicity of the drug. Comparing the results in group [C] with the other two groups [A and B] we found lower recurrence rate [6.7% versus 23.3% and 16.7% respectively] and progression rate [3.3% versus 16.7% and 13.3% respectively]. Also the regimen is well tolerated with less toxicity as compared with the two other groups [6.7% versus 23.3% and 13.3% in group C versus A and B respectively]. Alternating bacillus Calmette Guerin and mitomycin C instillations for treatment of superficial bladder cancer in low doses after transurethral resection in the early postoperative day is an effective regimen for prophylaxis against tumor recurrence and progression like monotherapy and even more effective with less toxicity and well tolerated by the patients. These results must be evaluated on a more large scale