Intravesical Therapy: Old trials, new agents and new approaches

Intravesical Therapy Old trials, new agents and new approaches Hugh Mostafid North Hampshire Hospital, Basingstoke

What can the old trials tell us? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Survey of UK intravesical chemotherapy practice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],153 consultants outside EAU guidelines

What can the old trials tell us? ,[object Object],[object Object],[object Object],[object Object],[object Object],Induction therapy (6 courses)

What can the old trials tell us? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What can the old trials tell us? Which Drug? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Recurrence rate

Optimising intravesical chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Au 2001 MMC optimized treatment 24.6 11.8 Standard MMC 41 29.1 Optimized MMC % Recurrence free Time to recurrence

Optimising intravesical chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Optimising intravesical chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]

What can the old trials tell us? ,[object Object],[object Object],[object Object],[object Object],Progression

What can the old trials tell us? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Progression

Mode of action ,[object Object],[object Object],[object Object],[object Object]

Complications of Intravesical Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complications of Intravesical Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

New Agents - Phase I studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

New Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

New Agents ,[object Object],[object Object],[object Object],[object Object]

New Approaches ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

New Approaches ,[object Object],BCG once a week for 6 weeks (n=105) BCG infused once a week for 2 weeks, followed by 40 mg EMDA MMC for three weeks (n=107) 212 Stage pT1 patients BCG once a month for 10 months 40 mg EMDA MMC once a month for 2 months followed by BCG once a month as 1 cycle, for 3 cycles DiStasi 2006

New Approaches ,[object Object],[object Object],EMDA MMC/ BCG vs BCG: 10.6 p=0.01 10.9 p=0.045 12.6 p=0.004 16 p=0.0012 48 p=0.0012 Difference 16.2 32.4 21.9 57.9 21 BCG 5.6 21.5 9.3 41.9 69 EMDA MMC + BCG Disease-specific mortality % Overall mortality % Progression % Recurrence % Disease free interval (months)

New Approaches ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Theatre administration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Results ,[object Object],[object Object],[object Object],[object Object],[object Object],Recurrence rate (%) Median follow-up (months) 55.9 20 TURBT only 37.5 16 Theatre MMC

Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The future ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kausch 2006

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Level I evidence

Intravesical Therapy: Old trials, new agents and new approaches

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Intravesical Therapy: Old trials, new agents and new approaches