Intravesical Mitomycin in LG-IR-NMIBC Stands Up to Other Options

Sam S. Chang, MD, MBA, professor in the Department of Urology, Patricia and Rodes Hart professor of urologic surgery, chief in the Division of Urologic Oncology, and chief surgical officer at Vanderbilt Ingram Cancer Center, discusses intravesical mitomycin (Zusduri; formerly UGN-102) in low-grade intermediate-risk nonmuscle-invasive bladder cancer (LG-IR-NMIBC) compared with other treatment options.

Mitomycin, a novel chemotherapy ablation treatment for LG-IR-NMIBC, can be used to avoid the need for transurethral resection of bladder tumor in certain cases. According to Chang, this could alter the perception of mitomycin among physicians compared with how it is seen when used in addition to resection.

This treatment is particularly effective for low- and intermediate-risk tumors. Chang contrasted it to Bacillus Calmette-Guérin [BCG] vaccine, which is more commonly used for high-risk disease. Chang notes that although direct comparative studies have not been performed between these 2 nonsurgical treatments, intravesical mitomycin has shown better long-term success rates in low-risk papillary tumors than those that have typically been seen with BCG.

TRANSCRIPTION

0:09 | We're talking about a different treatment modality, a different algorithm. I think that'll be important to impress upon those individuals that treat patients with bladder cancer. It's a chemo-ablative treatment, so you are actually obviating the need of doing a resection. Instead of the resection, you try a treatment.

0:35 | Another important educational point is, because we don't have that resection, we may have had a negative perception of mitomycin after a resection—the perioperative use—but the calcifications, the eschars, and the areas of poor healing [have] not been noticed, at least in the trial setting, because these patients haven't had resections. So as a result, if you're looking at differences between current chemotherapy and this reverse thermal gel formulation, you see the key differences there. It's chemo-ablative, [and] you don't require resection.

1:17 | Compared to BCG, importantly, is the fact that this is really focused on low-grade and intermediate-risk tumors. BCG tends to be in those patients who have higher-risk disease. As a result, if you look at long-term efficacy of papillary low-risk disease, this actually—probably—you can't say directly because there have been no studies, but the success rate actually exceeds BCG for this type of patient population.