Prevention of Recurrence of Superficial Bladder Cancers: Intravesical Instillation of Bacillus Calmette-guerin versus Bacillus Calmette-guerin plus Epirubicin

Purpose The short-term effects of intravesical chemoimmunotherapy with epirubicin and Bacillus Calmette- ‍Guerin (BCG) administered repeatedlly for prophylaxis of recurrence of superficial bladder cancer (pTa, pT1) were ‍investigated in 22 patients with a median of 70 years between March, 1995 and February, 1999, and were compared ‍with those of BCG monotherapy in 50 patients between March, 1995 and February, 1999. ‍Patients and Methods The patients underwent intravesical instillation of Tokyo-strain BCG with or without ‍epirubicin after transurethral resection (TUR) of bladder cancer. For the combined treatment, at 1❛2 weeks after ‍TUR, epirubicin (40 mg) and BCG (80 mg) were instilled into the bladder by turn once a week for 12 weeks. For the ‍BCG alone group, 80 mg instillation were performed with the same schedule. Thereafter, the patients were followed ‍by cystoscopy and urinary cytology every 3 months for up to 3 years after intravesical therapy. ‍Results and Conclusions The simple recurrence rate was 22.7% (5/21) in patients with chemoimmunotherapy ‍and 32.0% (16/50) in BCG-treated patients. Adverse reactions, including increased frequency of urination, urgency ‍and miction pain, were observed in 18 patients (85.7%) undergoing chemoimmunotherapy and 58.0% undergoing ‍BCG monotherapy. One patient receiving chemoimmunotherapy was withdrawn from treatment because of severe ‍bladder-irritation symptoms due to instillation. Intravesical chemoimmunotherapy using epirubicin and BCG was ‍inferior in comparison with BCG monotherapy for prophylaxis of recurrence of superficial bladder cancer.