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Adjuvant Hyperthermic Intravesical Chemotherapy in Intermediate- and High-Risk Non-muscle Invasive Bladder Cancer

dc.contributor.authorMagalhães, Joana C
dc.contributor.authorSousa, Maria João
dc.contributor.authorBasto, Raquel
dc.contributor.authorFraga, Teresa
dc.contributor.authorGomes, Inês
dc.contributor.authorFernandes, Catarina
dc.contributor.authorMariano, Mónica
dc.contributor.authorPaulo, Judy
dc.contributor.authorMadeira, Pedro
dc.contributor.authorSousa, Gabriela
dc.date.accessioned2024-06-18T10:21:39Z
dc.date.available2024-06-18T10:21:39Z
dc.date.issued2023-09
dc.description.abstractIntroduction: Non-muscle invasive bladder cancer (NMIBC) is a frequently diagnosed neoplasm, which is typically managed with transurethral resection of bladder tumor (TURBT) eventually followed by intravesical therapies. Bacillus Calmette-Guérin (BCG) is used as first-line adjuvant treatment in high- (HR) and intermediate-risk (IR) NMIBC, although, in the latter, mitomycin C (MMC) may also be used. Multiple limitations to the use of BCG encouraged the search for therapeutic alternatives. In this context, hyperthermic intravesical chemotherapy with MMC (HIVEC-MMC) emerged as a promising therapy in the adjuvant setting for NMIBC. The aim of our study was to evaluate the tolerability, compliance, and survival outcomes of HIVEC-MMC in patients with IR- and HR-NMIBC. Material and methods: This was a single-center retrospective analysis of IR- and HR- NMIBC patients who received HIVEC-MMC after TURBT between August 2018 and August 2022. Levels of risk stratification were defined using the European Association of Urology (EAU) criteria. The protocol consisted of four weekly HIVEC-MMC instillations (induction) followed by six monthly instillations (maintenance). The primary outcomes were to evaluate the tolerability and compliance with the HIVEC-MMC protocol and secondary outcomes were disease-free survival (DFS) and overall survival (OS). For the purpose of statistical analysis, methods of descriptive statistics, survival analysis (Kaplan-Meier estimation), and multivariate analysis (Cox regression, and binary logistic regression) were used. Results: Fifty-seven patients were enrolled with a median age of 67.9 (34.4-83.5) years old. In this cohort, 40 patients (70.2%) had primary tumors. At the time of referral for HIVEC-MMC, the majority of the patients had IR-NMIBC (n= 33, 57.9%). A total of 41 patients (71.9%) completed the HIVEC-MMC protocol. Disease recurrence and adverse events (AEs) were the most common reasons to stop the protocol. After a median follow-up of 31 months (95% CI, 5.0-54.0), 32 patients (61.4%) were disease-free, 22 (38.6%) experienced recurrent disease and six patients (10.5%) died, although only one death was directly attributable to bladder cancer. The median DFS was 42 months (95% CI, 28.0-56.0). Completion of the HIVEC-MMC maintenance phase protocol stood as a predictive factor for DFS (44 months, 95% CI 29.1-58.9 vs. 14 months, 95% CI 0.0-29.6, p < 0.001; HR 4.48, 95% CI 1.65-12.15). The median OS was not reached; the 24- and 48-month OS were 92.6% and 82.7%, respectively. EAU risk group, ECOG-PS, and completion of HIVEC protocol were found to be significant predictive factors of OS but lost their significance on multivariate analysis. However, if we exclude those who experienced recurrence during the maintenance phase protocol, treatment completion had a significant positive impact on OS (HR: 42.8, 95% CI 1.75-1045.072, p= 0.021). Conclusions: Our study suggests that HIVEC is a secure and well-tolerated treatment with promising efficacy data, making this therapeutic approach a feasible option in IR- and HR-NMIBC patients, mainly in those who cannot tolerate or have contraindications to BCG therapy, but also as an alternative during BCG shortages.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationMagalhães JC, Sousa M, Basto R, et al. Adjuvant Hyperthermic Intravesical Chemotherapy in Intermediate- and High-Risk Non-muscle Invasive Bladder Cancer. Cureus. 2023;15(9):e45672. doi:10.7759/cureus.45672pt_PT
dc.identifier.doi10.7759/cureus.45672pt_PT
dc.identifier.issn2168-8184
dc.identifier.urihttp://hdl.handle.net/10400.16/2956
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherCureus, Inc.pt_PT
dc.relation.publisherversionhttps://www.cureus.com/articles/188165-adjuvant-hyperthermic-intravesical-chemotherapy-in-intermediate--and-high-risk-non-muscle-invasive-bladder-cancer#!/pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectadjuvant intravesical chemotherapypt_PT
dc.subjectbacillus calmette-guérinpt_PT
dc.subjecthyperthermic intravesical chemotherapypt_PT
dc.subjectmitomycin cpt_PT
dc.subjectnon-muscle invasive bladder cancerpt_PT
dc.titleAdjuvant Hyperthermic Intravesical Chemotherapy in Intermediate- and High-Risk Non-muscle Invasive Bladder Cancerpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceUnited States of Americapt_PT
oaire.citation.issue9pt_PT
oaire.citation.startPagee45672pt_PT
oaire.citation.titleCureuspt_PT
oaire.citation.volume15pt_PT
person.familyNameSousa
person.givenNameMaria João
person.identifier.orcid0000-0003-1125-2871
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication8f36b51c-7ffc-4a9d-aa12-d9a7ecced3ca
relation.isAuthorOfPublication.latestForDiscovery8f36b51c-7ffc-4a9d-aa12-d9a7ecced3ca

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