A Systematic Review and Meta-analysis of Chemoablation for Non-muscle-invasive Bladder Cancer
Beteiligte Einrichtungen
Abstract
Context
The ablative effect of intravesical therapy is known for decades. However, the clinical feasibility and efficacy of chemoablation for non–muscle-invasive bladder cancer (NMIBC) have not become accepted.
Objective
To assess the treatment outcomes of chemoablation for NMIBC and to compare its safety with that of the standard treatment, transurethral resection of bladder tumors (TURBT) followed by intravesical therapy.
Evidence acquisition
Multiple databases were queried in July 2022 for studies investigating the complete response (CR) rates and adverse events in NMIBC patients treated with chemoablation using mitomycin C (MMC), gemcitabine, epirubicin, or bacillus Calmette-Guérin.
Evidence synthesis
Overall, 23 studies comprising 1199 patients were eligible for this meta-analysis. Among these studies, 20 assessed the efficacy of chemoablation and three compared the treatment outcomes of MMC chemoablation versus standard treatment. Among patients treated with weekly administration of any agent, the pooled CR rates at initial assessment were 50.9% (95% confidence interval [CI]: 45.9–55.9) for the marker lesion and 47.5% (95% CI: 36.5–58.7) for well-selected NMIBC (ie, small tumors and/or a small number of tumors). Novel regimens for chemoablation such as MMC-gel (70.6%, 95% CI: 60.1–79.3) and an intensive MMC regimen (64.7%, 95% CI: 56.2–72.3) provided better CR rates in well-selected NMIBC patients. Comparable CR rates were noted irrespective of tumor multiplicity, whereas tumor size <5 mm was associated with a higher CR rate than tumor size ≥5 mm (odds ratio: 0.36, 95% CI: 0.17–0.79). The novel intensive MMC regimen resulted in lower rates of dysuria and urinary frequency than standard treatment.
Conclusions
Despite the lack of long-term outcomes, chemoablation appears to be a promising treatment option for well-selected NMIBC patients and can potentially help avoid unnecessary TURBT, specifically in some elderly patients with intermediate-risk NMIBC. Further well-designed studies with larger cohorts are necessary to address the differential tolerability and long-term anticancer efficacy of this resurging approach.
The ablative effect of intravesical therapy is known for decades. However, the clinical feasibility and efficacy of chemoablation for non–muscle-invasive bladder cancer (NMIBC) have not become accepted.
Objective
To assess the treatment outcomes of chemoablation for NMIBC and to compare its safety with that of the standard treatment, transurethral resection of bladder tumors (TURBT) followed by intravesical therapy.
Evidence acquisition
Multiple databases were queried in July 2022 for studies investigating the complete response (CR) rates and adverse events in NMIBC patients treated with chemoablation using mitomycin C (MMC), gemcitabine, epirubicin, or bacillus Calmette-Guérin.
Evidence synthesis
Overall, 23 studies comprising 1199 patients were eligible for this meta-analysis. Among these studies, 20 assessed the efficacy of chemoablation and three compared the treatment outcomes of MMC chemoablation versus standard treatment. Among patients treated with weekly administration of any agent, the pooled CR rates at initial assessment were 50.9% (95% confidence interval [CI]: 45.9–55.9) for the marker lesion and 47.5% (95% CI: 36.5–58.7) for well-selected NMIBC (ie, small tumors and/or a small number of tumors). Novel regimens for chemoablation such as MMC-gel (70.6%, 95% CI: 60.1–79.3) and an intensive MMC regimen (64.7%, 95% CI: 56.2–72.3) provided better CR rates in well-selected NMIBC patients. Comparable CR rates were noted irrespective of tumor multiplicity, whereas tumor size <5 mm was associated with a higher CR rate than tumor size ≥5 mm (odds ratio: 0.36, 95% CI: 0.17–0.79). The novel intensive MMC regimen resulted in lower rates of dysuria and urinary frequency than standard treatment.
Conclusions
Despite the lack of long-term outcomes, chemoablation appears to be a promising treatment option for well-selected NMIBC patients and can potentially help avoid unnecessary TURBT, specifically in some elderly patients with intermediate-risk NMIBC. Further well-designed studies with larger cohorts are necessary to address the differential tolerability and long-term anticancer efficacy of this resurging approach.
Bibliografische Daten
| Originalsprache | Englisch |
|---|---|
| ISSN | 2405-4569 |
| DOIs | |
| Status | Veröffentlicht - 05.2023 |
