A Systematic Review and Meta-analysis of Chemoablation for Non–muscle-invasive Bladder Cancer

• Published in: European urology focus 2023-05, Vol.9 (3), p.463-479
• Main Authors: Yanagisawa, Takafumi, Quhal, Fahad, Kawada, Tatsushi, Mostafaei, Hadi, Motlagh, Reza Sari, Laukhtina, Ekaterina, Rajwa, Pawel, Deimling, Markus von, Bianchi, Alberto, Pallauf, Maximilian, Majdoub, Muhammad, Pradere, Benjamin, Moschini, Marco, Karakiewicz, Pierre I., Teoh, Jeremy Yuen-Chun, Miki, Jun, Kimura, Takahiro, Shariat, Shahrokh F.
• Format: Article
• Language: English
• Subjects: Bacillus Calmette-Guérin; Chemoablation; Epirubicin; Gemcitabine; Intravesical therapy; Mitomycin; Non–muscle-invasive bladder cancer
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2022.12.003

Chemoablation appears to be a promising treatment option for well-selected non–muscle-invasive bladder cancer (NMIBC) patients and can potentially help avoid an unnecessary transurethral resection of a bladder tumor, specifically in some elderly patients with intermediate-risk NMIBC. 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. 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. 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. 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