By ecancer reporter Sharan Sharma

Bladder cancer is the second most common urologic malignancy and the fifth most common malignancy in Untied States. For non-muscle invasive bladder cancer intravesical Bacillus Calmette Guerrin (BCG) remains the most effective mode of therapy. In patients who fail to respond to BCG, removal of the bladder is the next best therapy. However in those patients who fail to respond to BCG or who are not good candidate for cystectomy or who refuse cystectomy, BCG plus interferon, mitomycin C and gemcitabine provide second line of treatment. But what is the role of combination chemotherapy in such patients?

A study published in the recent issue of Urologic Oncology: Seminars and Original Investigations, researchers from the University of California San Francisco analysed the role of gemcitabine and mitomycin C (MMC) sequential therapy in BCG refractory or intolerant patients for whom cystectomy was not an option due to medical reasons, or was offered but refused.

They identified non-muscle invasive bladder cancer patients who were BCG refractory or intolerant and had been treated with intravesical gemcitabine and MMC. Patients were treated with a combination of intravesical gemcitabine followed sequentially by intravesical Mitomycin C every week for 6 weeks (induction). Induction therapy was followed by a maintenance regimen using the same dose of gemcitabine and mitomycin C once a month for 12 months. Out of 10 patients identified 6 were recurrence free and maintained that state at the 14-month follow-up. The rest had biopsy proven recurrence. The median time to recurrence was found to be 6 months. The combination therapy was well tolerated: researchers did not find any major complications during the therapy.

The authors conclude "In patients with recurrent bladder cancer refractory to conventional intravesical therapy who refuse cystectomy or are unfit for surgery, sequential intravesical chemotherapy with gemcitabine and MMC appears to be well tolerated and yielded a complete response in a good proportion of patients" "The present results serve as impetus for larger studies with longer follow-up to determine the overall efficacy of the regiment in preventing recurrence and progression" they add.