Long-term follow-up of patients with superficial transitional cell carcinoma of the urinary bladder treated by intravesical mitomycin C.

Prophylactic intravesical chemotherapy (IVC) reduces recurrence rates of superficial transitional cell carcinoma (TCC) of the urinary bladder. The patient cohort existed of 86 individuals (stage TaN0M0 or T1N0M0) superficial carcinoma of various grades of malignancy. Following initial transuretheral resection or diagnostic cystoscopy, mitomycin C (MMC), 20 mg dissolved in 50 ml saline, was instilled intravesically by catheter over 1 hr at 2-week intervals, initially and then four more times followed by diagnostic cystoscopy (one course = 12 weeks). Two similar courses were administered thereafter for a total period of 36 weeks. For patients in remission, installations continued in monthly fractionations for 9 more months (cystoscopy every 3 months) and then at 2-month intervals for 12 more months (cystoscopy every 6 months). When cystoscopy revealed recurrence, IVC was repeated from the beginning. No symptoms of MMC-related toxicity were observed. Cystoscopic follow-up evaluations showed a complete response rate of 84% at 3 years and 81% at 5 years after initial therapy. Twenty-seven patients who had not responded to previous treatment with other drugs responded to MMC.

Randomized study comparing chemotherapy with and without estrogen priming in advanced breast-cancer.

A randomized trial was performed to determine if combination chemotherapy (CT) with estrogen (E) priming (E+ study arm) was superior to CT alone (E- study arm) in patients with advanced breast cancer. CT for both arms included adriamycin + vincristine (AV) starting on day 7 alternating with cytoxan + methotrexate + fluorouracil (CMF) starting on day 28, the entire cycle repeated every 6 weeks. Estrogen priming consisting of 2 mg estradiol + 1 mg estriol (E+ arm) was given orally twice daily beginning on day 1 and continuously through CT until disease progression or unacceptable toxicity. Performance status (KPS) for all patients (n=19, E+ arm; n=22, E- arm) ranged between 70-100%. Mean age (53 y, E+ arm; 56 y, E- arm), menopausal and estrogen receptor status and treatment duration (approximately 38 weeks) were similar for both groups. Estrogen priming did not alter or enhance CT toxicity. Objective responses (CR,PR) were noted in 79% on the E+ arm (CR=11%, PR=68%) and in 73% on the E- arm (CR=9%, PR=64%). Thus, estrogen priming in this cohort of patients with advanced breast cancer did not appear to add to the toxicity or palliative benefit of CT.

Efficacy of intravesical mitomycin C in the treatment of superficial transitional cell carcinoma of the urinary bladder.

We treated 47 patients with recurrent transitional cell carcinoma of the bladder with intravesical chemotherapy. Twenty milligrams of mitomycin C per treatment was introduced 7 days after transurethral resection (TUR) or diagnostic cystoscopy, and was repeated at 2-week intervals for five times followed again by cystoscopy. Two more similar courses were administered for a total of 36 weeks. Clinical data revealed no toxicity-related symptoms. Cystoscopic follow-up showed a gradual decline in the presence of tumor to a complete response rate of 87.1% at 36 weeks. Thirteen patients who were previously treatment failures with other drugs responded to mitomycin C.