Therapies in bladder cancer: intravesical mitomycin-C

‘Various studies have found intravesical chemotherapy with mitomycin-C to be an effective treatment in preventing the recurrence rate of superficial bladder cancer.’ The use of intravesical therapy for the treatment of superficial bladder cancer aims to reduce morbidity and mortality by eradicating existing disease, preventing tumor recurrence and attempting to halt tumor progression. Mitomycin-C is a commonly used intravesical treatment option for superficial bladder cancer and was used for the first time by Shida and colleagues in 1967 [1]. It is an antitumor antibiotic with a molecular weight of 334.3 and is soluble in water and organic solvents. Mitomycin-C is usually minimally absorbed on intravesical instillation due to its high molecular weight and hydrophobic nature. The use of an instillate at the lowest achievable osmotic strength appears to be optimal for the intravesical instillation of the drug and, hence, sterile water is preferred over saline. Its dose is typically 40 mg per instillation – this regimen has been shown to exhibit a longer time-torecurrence and less recurrence compared with the standard regimen (20 mg) in patients with Stage Ta and grade 1–2 bladder cancer [2].