(UroToday.com) The 2024 American Urological Association (AUA) annual meeting featured a session on non-invasive bladder cancer, and a presentation by Dr. Pietro Scilipoti discussing a head-to-head oncological outcomes comparison of mitomycin C vs BCG treatment in intermediate-risk non-muscle invasive bladder cancer patients. Induction followed by one year maintenance instillation of intravesical BCG is the standard treatment for intermediate-risk non-muscle invasive bladder cancer patients. However, limited data exist on the effectiveness of mitomycin C instillation in this setting.
This study was a retrospective analysis including 226 intermediate-risk-non muscle invasive bladder cancer patients according to the International Bladder Cancer Group (IBCG) criteria (174 treated with mitomycin C, 54 treated with BCG) and 250 intermediate-risk-non muscle invasive bladder cancer patients as per European Association of Urology (EAU) criteria (169 treatment with mitomycin C, 81 treated with BCG), treated with at least one induction course of BCG or mitomycin C. EAU intermediate-risk classification include non-low and -high risk patients, including pTa high grade patients. IBCG intermediate-risk classification excludes any type of high grade tumor. Optimal treatment for mitomycin C was defined as induction + 11 maintenance instillations and for BCG was defined as 1 year of BCG. Kaplan-Meier analysis was used to estimate the 4-year recurrence-free survival and progression-free survival in both groups and curves were compared using log-rank test. Multivariable Cox-regression analysis was employed to identify predictors of recurrence among clinically relevant variables.
After a median follow-up of 45 months, 86 EAU patients and 67 IBCG patients recurred, while 15 EAU and 9 IBCG patients progressed. Adequate BCG and mitomycin C courses were administered to 31% and 29% of intermediate-risk-IBCG and intermediate-risk-EAU patients. At 4-years, patients treated with adequate mitomycin C and BCG treatment had similar recurrence-free survival (83% vs. 80%, p = 0.90 in EAU and 76% vs. 73%, p = 0.80 in IBCG) and progression-free survival rates (98% vs. 93%, p = 0.80 in EAU and 98% vs. 90%, p = 0.20 in IBCG). Patients receiving non-adequate BCG compared to those treated with adequate mitomycin C exhibited lower 4-year recurrence-free survival (83% vs 68%, p = 0.01 in both EAU and 76% vs 59%, p = 0.03 in IBCG) and lower 4-year progression-free survival rates for both EAU (98% vs 87%, p = 0.02) and IBCG (98% vs 75%, p=0.01).
Adequate mitomycin C treatment reduced the risk of recurrence in both EAU (HR 0.30, 95% CI 0.10-0.84, p = 0.02) and IBCG groups (HR 0.25, 95% CI 0.09-0.72, p = 0.01) compared to non-adequate BCG which did not.
Dr. Scilipoti concluded his presentation by discussing a head-to-head oncological outcomes comparison of mitomycin C vs BCG treatment in intermediate-risk non-muscle invasive bladder cancer patients with the following take-home messages:
- Adequate mitomycin C treatment is as effective as BCG in EAU-intermediate-risk and IBCG-intermediate-risk non muscle invasive bladder cancer patients, reducing both recurrence and progression compared to inadequate BCG treatment
- Mitomycin C is a viable alternative to BCG for intermediate-risk patients both for intermediate-risk-EAU and intermediate-risk-IBCG patients
Presented by: Pietro Scilipoti, MD, Urological Research Institute, IRCCS San Raffaele, Milan, Italy
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 American Urological Association (AUA) Annual Meeting, San Antonio, TX, Fri, May 3 – Mon, May 6, 2024.