Presented by: Nitish Aggarwal
AIIMS NEW DELHI

Introduction

Bladder cancer (BC) is one of the most common urological malignancy. The current international guidelines recommend a single instillation of intravesical Mitomycin C in the immediate postoperative period following TURBT . The recent NCCN guidelines recommends gemcitabine as preferred agent for immediate intravesical therapy . Till date no randomized trial is available comparing the intravesical gemcitabine with intravesical MMC

Materials

It was 2 arm randomized controlled trial. Patients were followed for efficacy(recurrence) and tolerance (side effects).

Results

,

During the 2 years of accrual (one year of enrolment and one year of follow up) total 0f 215 patients were screened, out of which 54 patients met eligibility criteria

Out of the 26 patients in gemcitabine group and 27 in  Mitomycin group at 1 year , 3 patients in the gemcitabine arm(11.53%) and 3 patients in the Mitomycin arm(11.11%) experienced a recurrence . Out of these 6 recurrences ,  one patient in mitomycin C arm showed progression in T stage on Re TURBT. No progression was seen in respect to grade of tumour.

Injection gemcitabine was found to be Slightly less costly than Injection mitomycin C. ($24.47 vs $26.559)

There was no grade 3 or above adverse events. Dysuria /voiding pain was the most common adverse event(more in mitomycin arm ) followed by haematuria and culture positive UTI

Conclusion

It can be said that gemcitabine is as effective as Mitomycin C in decreasing recurrence rate and progression especially in low grade/low risk tumour over short follow up period. Intravesical gemcitabine is better tolerated than mitomycin. Cost and availability of these drugs is not an important issue in Indian setup. Larger multi-institutional prospective randomized studies with longer follow up are required before we label any one agent superior to other

Funding

None

Lead Authors

brushabhanu nayak,
aiims new delhi