The following is a summary of “Mitomycin C vs. Bacillus Calmette–Guerin for treatment of intermediate-risk nonmuscle invasive bladder cancer patients—A comparative analysis from a single center,” published in the July 2024 issue of Urology by Scilipoti et al.
The standard treatment for patients with intermediate-risk (IR) nonmuscle invasive bladder cancer (NMIBC) involves an induction followed by a one-year maintenance instillation of intravesical Bacillus Calmette–Guérin (BCG). However, data on the efficacy of Mitomycin C (MMC) instillation in this setting is limited. This study aimed to compare the effectiveness of MMC and BCG in treating IR-NMIBC.
Researchers retrospectively analyzed 226 patients with IR-NMIBC classified by the International Bladder Cancer Group (IBCG) and 250 IR-NMIBC treatment-naïve patients classified by the European Association of Urology (EAU). All patients received either a full induction course of BCG or 40 mg/40 ml MMC from 2012 to 2022. Optimal treatment was defined as one-year maintenance for BCG and 11 monthly maintenance instillations for MMC. Kaplan–Meier analysis was used to estimate recurrence-free survival (RFS) before and after inverse probability of treatment-weighting (IPTW) and progression-free survival (PFS). Multivariable Cox regression evaluated differences in recurrence after adjusting for clinically relevant variables before and after IPTW.
Optimal courses of BCG and MMC were administered to 21% of IR-IBCG and 23% of IR-EAU patients. Patients treated with optimal MMC and BCG at four years had similar RFS and PFS in both EAU and IBCG groups. However, patients receiving nonoptimal BCG had lower four-year RFS than those receiving optimal MMC after IPTW (82% vs. 68% in EAU and 82% vs. 65% in IBCG). Additionally, optimal MMC had more significant PFS than nonoptimal BCG at four years. Optimal MMC treatment significantly predicted lower recurrence in both EAU (adjusted and weighted HR 0.33, 95% CI, 0.11-0.98) and IBCG (adjusted and weighted HR 0.29, 95% CI, 0.08-0.97) groups compared to nonoptimal BCG.
Optimal 40 mg/40 ml MMC treatment was as effective as optimal BCG in IR-IBCG and IR-EAU NMIBC patients, reducing recurrence and progression compared to nonoptimal BCG. These findings suggest that MMC could be a viable first-line alternative to BCG for IR-EAU and IR-IBCG intravesical treatment-naïve patients, especially during BCG shortages.
Source: sciencedirect.com/science/article/abs/pii/S1078143924005386
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