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Minerva Urologica E Nefrologica = the... Jun 2009Transitional cell carcinoma (TCC) is the second most common urologic malignancy, and 70% of patients present with superficial, or non-muscle invasive disease (NMIBC).... (Review)
Review
Transitional cell carcinoma (TCC) is the second most common urologic malignancy, and 70% of patients present with superficial, or non-muscle invasive disease (NMIBC). Bacillus Calmette-Guerin (BCG), currently the most effective intravesical agent at preventing disease recurrence, is the only therapy shown to inhibit disease progression. Unfortunately, approximately 20% of patients discontinue BCG due to local and systemic toxicity and more than 30% show evidence of recurrence; this has led to increased interest in alternate chemotherapeutic agents. Induction intravesical chemotherapy has shown comparable efficacy to BCG in select patients and the immediate perioperative instillation of chemotherapeutic agents has become standard of care. Clinical trial evidence demonstrating the efficacy of BCG plus interferon 2B, gemcitabine and anthracyclines (doxorubicin, epirubicin, valrubicin) in patients refractory or intolerant to BCG is accumulating. Phase I trials investigating alternative agents such as apaziquone, taxanes (docetaxel, paclitaxel), and suramin are reporting promising data. Current efforts are also being directed towards optimizing the administration of existing chemotherapeutic regimens, including the use of novel modalities including hyperthermia, photodynamic therapy, magnetically targeted carriers, and liposomes. Despite recent enthusiasm for new intravesical agents, radical cystectomy remains the treatment of choice for patients with NMIBC who have failed intravesical therapy and select patients with naive T1 tumors and aggressive features. Our aim in this report is to provide a comprehensive review of contemporary intravesical therapy options for NMIBC with an emphasis on emerging agents and novel treatment modalities.
Topics: Adjuvants, Immunologic; Administration, Intravesical; Antineoplastic Combined Chemotherapy Protocols; BCG Vaccine; Carcinoma, Transitional Cell; Clinical Trials as Topic; Clinical Trials, Phase I as Topic; Disease Progression; Humans; Photochemotherapy; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 19451890
DOI: No ID Found -
Reviews in Urology 2008In the United States, bacillus Calmette-Guérin (BCG) is the treatment most used for superficial bladder cancer. Patients with carcinoma in situ (CIS) treated with...
In the United States, bacillus Calmette-Guérin (BCG) is the treatment most used for superficial bladder cancer. Patients with carcinoma in situ (CIS) treated with intravesical BCG plus interferon have a 60% to 70% chance of a complete and durable response if they were never treated with BCG or if they failed only 1 prior induction or relapsed more than a year from induction. Intravesical gemcitabine is safe, but its usefulness for BCG-refractory patients is unclear. Valrubicin, approved for intravesical treatment of BCG-refractory CIS of the bladder, has efficacy and acceptable toxicity. Cystectomy should be considered in high-risk, non-muscle-invasive cancer, particularly if intravesical therapy failed.
PubMed: 19145271
DOI: No ID Found -
Urologic Nursing Oct 2005Superficial bladder cancer can be treated surgically, but patients are at high risk for recurrence. Tumors are categorized as low, intermediate, and high-risk based on... (Review)
Review
Superficial bladder cancer can be treated surgically, but patients are at high risk for recurrence. Tumors are categorized as low, intermediate, and high-risk based on grade, stage, and pattern of recurrence. Low-risk tumors are best treated with a single instillation of chemotherapy (thiotepa, doxorubicin, or mitomycin) (Lamm, 2002). Though effective, the toxicity of bacillus Calmette-Guerin immunotherapy (BCG) restricts its use to treat higher-grade tumors. Intermediate risk tumors can be treated with chemotherapy as well, but will often require immunotherapy. High-risk tumors are best treated with intravesical BCG using a 3-week maintenance schedule. Side effects of BCG immunotherapy can be decreased by logarithmic reductions in dose. Patients who fail BCG may be rescued with BCG plus interferon alfa or radical cystectomy.
Topics: Adjuvants, Immunologic; Administration, Intravesical; Antineoplastic Agents; BCG Vaccine; Cystectomy; Doxorubicin; Drug Administration Schedule; Epirubicin; Humans; Interferon-alpha; Mitomycin; Neoplasm Recurrence, Local; Nurse's Role; Patient Selection; Risk Factors; Salvage Therapy; Survival Rate; Thiotepa; Treatment Failure; United States; Urinary Bladder Neoplasms
PubMed: 16294610
DOI: No ID Found -
Scandinavian Journal of Urology and... 2005Although intravesical chemotherapy has been used in the management of superficial bladder cancer for some decades, until recently there has been little or no progress in... (Review)
Review
Although intravesical chemotherapy has been used in the management of superficial bladder cancer for some decades, until recently there has been little or no progress in the search for new agents. However, in the past few years there have been developments of investigational drugs that may play a future role in this indication. This review highlights the mode of action, indications, dose and administration, efficacy, safety and significance of new chemotherapeutic agents such as intravesical valrubicin, gemcitabine, suramin, gamma-linolenic acid, eflornithine (DFMO), tipifarnib (R115777), fenritinide and celecoxib. Although the initial results achieved with these agents in clinical development seem encouraging, long-term data on the prevention of recurrence, disease progression and survival have yet to be obtained.
Topics: Administration, Intravesical; Antineoplastic Agents; Humans; Neoplasm Staging; Safety; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 16019763
DOI: 10.1080/00365590510007676 -
Journal of Chromatography. A May 2005Preparative counter-current chromatography (CCC) purification of valrubicin (AD-32) from crude synthetic drug has been successfully performed for the first time using...
Preparative counter-current chromatography purification of valrubicin (AD-32) from crude synthetic drug using upright coil planet centrifuge with four multilayer coils connected in series.
Preparative counter-current chromatography (CCC) purification of valrubicin (AD-32) from crude synthetic drug has been successfully performed for the first time using upright coil planet centrifuge with four multilayer coils connected in series with 1600 ml capacity. The two-phase system used was composed of light petroleum (bp 60-90 degrees C)-ethyl acetate-tetrachloromethane-methanol-water at an optimized volume ratio of 1:1:8:6:1. Target compound (1.2 g) with a purity of 99.88% was obtained from 1.5 g of crude synthetic drug with a purity 95.49% based on HPLC peak area percentage. Identification of the target compound was performed by electrospray ionization mass spectrometry, one- and two-dimensional nuclear magnetic resonance.
Topics: Centrifugation; Countercurrent Distribution; Doxorubicin; Spectrometry, Mass, Electrospray Ionization
PubMed: 15974091
DOI: 10.1016/j.chroma.2005.04.027 -
Current Opinion in Urology Sep 2003In this review new modalities in the diagnosis, staging and treatment of superficial and invasive bladder cancer are reviewed. (Review)
Review
PURPOSE OF REVIEW
In this review new modalities in the diagnosis, staging and treatment of superficial and invasive bladder cancer are reviewed.
RECENT FINDINGS
Urinary markers still cannot replace cystoscopy in diagnosing bladder cancer. However, DNA micro-array has shown promise for diagnosis. In the treatment of superficial bladder cancer, valrubicin, pirarubicin and gemcitabine are novelties. Furthermore, a combination therapy of hyperthermia and mitomycin-C as well as photodynamic therapy seem to be safe and effective new treatment modalities. For staging, computed tomography, magnetic resonance imaging and the positron emission tomography scan are limited. Nevertheless, the pT-category, pN-category and the number of lymph nodes removed affect survival significantly and are thus useful for staging and prognosis. This indicates a need for a standardized lymph node dissection in cystectomy patients.
SUMMARY
In the treatment of invasive bladder cancer, prostate-sparing cystectomy shows promising potency and continence results. In advanced disease, gemcitabine-cisplatin is a valuable alternative to methotrexate-vinblastine-doxorubicin-cisplatin with fewer side-effects. Finally, radical radiotherapy should be considered a valid treatment in patients with invasive bladder cancer.
Topics: Diagnostic Techniques, Urological; Humans; Neoplasm Staging; Urinary Bladder Neoplasms
PubMed: 12917515
DOI: 10.1097/00042307-200309000-00006 -
Farmacia Hospitalaria : Organo Oficial... 2003
Topics: Anticestodal Agents; Antineoplastic Agents; Doxorubicin; Drug Therapy; Humans; Hypoparathyroidism; Nitro Compounds; Pharmaceutical Preparations; Teriparatide; Thiazoles
PubMed: 12717569
DOI: No ID Found -
Urologic Nursing Jun 2001
Topics: Antineoplastic Agents; Carcinoma in Situ; Doxorubicin; Humans; Medical Waste Disposal; Urinary Bladder Neoplasms
PubMed: 11998650
DOI: No ID Found -
Urologic Nursing Feb 2001Treatment options for patients who fail BCG therapy are limited. While cystectomy may be curative, not all patients can withstand the medical and/or psychologic stresses... (Review)
Review
Treatment options for patients who fail BCG therapy are limited. While cystectomy may be curative, not all patients can withstand the medical and/or psychologic stresses associated with surgery or resection. Valrubicin represents a safe and effective second-line intravesical therapy.
Topics: Antineoplastic Agents; BCG Vaccine; Carcinoma in Situ; Cystectomy; Doxorubicin; Humans; Neoplasm Staging; Nursing Assessment; Urinary Bladder Neoplasms
PubMed: 11998112
DOI: No ID Found -
Expert Opinion on Pharmacotherapy Jun 2001The propensity of patients with carcinoma in situ (CIS) of the bladder to progress to invasive and metastatic disease is clearly established. Today, the standard therapy... (Review)
Review
The propensity of patients with carcinoma in situ (CIS) of the bladder to progress to invasive and metastatic disease is clearly established. Today, the standard therapy in treating patients with CIS of the bladder is intravesical bacillus Calmette-Guerin (BCG). Nevertheless, patients who fail intravesical BCG have few viable options except to undergo a radical cystectomy. Valrubicin (N-trifluoroacetyladriamycin-14-valerate) is a new semisynthetic derivative of the anthracycline antibiotic doxorubicin that has been shown to benefit patients with BCG-refractory CIS of the bladder. Intravesical instillation of valrubicin is well-tolerated, safe and can be durable. Early non-randomised studies show promise and the current utilisation of this drug is limited to patients with BCG-refractory CIS of the bladder who are not good surgical candidates. Randomised studies of intravesical valrubicin for the treatment of superficial bladder cancer are ongoing.
Topics: Administration, Intravesical; Antineoplastic Agents; Carcinoma in Situ; Carcinoma, Transitional Cell; Clinical Trials as Topic; Doxorubicin; Guidelines as Topic; Humans; Molecular Structure; Urinary Bladder Neoplasms
PubMed: 11585003
DOI: 10.1517/14656566.2.6.1009