The efficacy of post-TURBT intravesical chemotherapy was evaluated in a meta-analysis which compared tumour recurrence following TURBT with TURBT plus intravesical chemotherapy for patients with completely resected stage Ta and T1 disease. In 11 randomised trials involving 3703 eligible patients, there were significantly fewer recurrences at 12 months in the TURBT plus chemotherapy group compared to those receiving TURBT alone (OR 0.56 ,95%; CI 0.48 to 0.65).r This corresponds to an absolute reduction in recurrence of 10-15%. Drugs evaluated were mitomycin (6 trials), doxorubicin (5 trials) thiotepa (3 trials), peplomycin (1 trial), neocarzinostat (1 trial), epirubicin (1 trial) and mitoxantrone (1 trial). There was no treatment heterogeneity detected between drugs. Treatment varied from a single instillation to a 2 year schedule, with subgroup analyses suggesting greater benefit with longer schedules. Intravesical chemotherapy has not been proven to reduce risk of progression, and the optimal number of cycles and role of maintenance schedule remains unclear.r
A number of meta-analyses indicate that intravesical BCG is superior to intravesical chemotherapy in reducing the risk of both tumour progression and recurrence, particularly with high-risk disease and when a BCG maintenance schedule is utilised, but is more toxic.rrrr
Efficacy
Disease Free Survival: (A) in all 250 patients (MMC = mitomycin):r
© Journal of Urology 1999
Toxicity
Dutch Cooperative Trial r |
Adverse event |
BCG
n=140 (%) |
Mitomycin
n=148 (%) |
Bacterial cystitis |
27 |
18 |
Drug induced cystitis |
30 |
17 |
Other local adverse reactions |
16 |
5 |
Allergic symptoms |
2 |
5 |
Fever less than 38.5°C |
5 |
0 |
Fever greater than 38.5°C |
1 |
0 |
Flu-like symptoms |
8 |
0 |
Nausea |
1 |
0 |
General malaise |
7 |
1 |
Other systemic symptoms |
3 |
1 |