nach oben

Die Urologie

Erschienen in:

01.09.2012 | Übersichten

Das Harnblasenkarzinomrezidiv nach BCG-Instillationstherapie

Lokale Therapieoptionen?

verfasst von: Dr. J.M. Laturnus, D. Jocham, M. Sommerauer

Erschienen in: Die Urologie | Ausgabe 9/2012

Einloggen, um Zugang zu erhalten

Zusammenfassung

Patienten mit einem sog. BCG-Versagen (Bacillus Calmette-Guérin) stellen ein inhomogenes Patientenkollektiv dar. Die Patienten mit einem BCG-Relaps oder einem BCG-refraktären Tumor sind die „echten“ BCG-Versager. Abhängig vom individuellen Risikoprofil kann zwischen einer konservativen oder radikal-chirurgischen Therapieform gewählt werden. Als konservative Maßnahmen kommen eine intravesikale Chemotherapie mit Gemcitabine oder Docetaxel in Frage, des Weiteren eine intravesikale Kombinationstherapie mit BCG und Interferon- (INF-)α. Chemohyperthermie oder Mitomycin-EMDA („electromotive drug administration“) sind interessante und vielversprechende Therapieformen für die Zukunft. Die Studienergebnisse der genannten Methoden zeigen Erfolge, befinden sich aber noch im experimentellen Stadium und sollten durch weitere Studien abgesichert werden. Schlussendlich müssen alle Patienten, bei denen eine konservative Therapieform durchgeführt werden soll, darüber aufgeklärt werden, dass die Durchführung einer radikalen Zystektomie im Falle eines BCG-Versagens die besten Ergebnisse im Hinblick auf eine Verlängerung des krankheitsspezifischen Überlebens erbringt.

Babjuk M, Oosterlinck W, Sylvester R et al (2011) EAU-Guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol 59:997–1008PubMedCrossRef

Sylvester RJ, Meijden APM van der, Oosterlinck W et al (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49:466–477PubMedCrossRef

Malmström P-U, Sylvester RJ, Crawford DE et al (2009) An individual patient data meta-analysis of the long –term outcome of randomized studies comparing intravesical mitomycin C versus bacillus Calmette-Guerin for non-muscle-invasive bladder cancer. Eur Urol 56:247–256PubMedCrossRef

Böhle A, Bock PR (2004) Intravesical bacille Calmette-Guerin versus Mitomycin C in superficial bladder cancer: formal meta-analysis of comparative studies on tumor progression. Urology 63:682–686PubMedCrossRef

Sylvester RJ, Brausi MA, Kirkels WJ et al (2010) EORTC Genito-Urinary Tract Cancer Group. Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guerin, and bacillus Calmette-Guerin plus isoniazid in patients with intermediate- and high risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol 57:766–773PubMedCrossRef

Herr H, Dalbagni G, Sherri MD (2011) Bacillus Calmette-Guerin without maintenance therapy for high-risk non-muscle-invasive bladder cancer. Eur Urol 60:32–36PubMedCrossRef

Raj GV, Herr H, Serio AM et al (2007) Treatment paradigm shift may improve survival of patients with high risk superficial bladder cancer. J Urol 177:1283–1286PubMedCrossRef

Hautmann RE, Volkmer BG, Gust K (2009) Quantification of the survival benefit of early versus deferred cystectomie in high-risk non-muscle invasive bladder cancer (T1 G3). World J Urol 27:347–351PubMedCrossRef

Lambert EH, Pierorazio PM, Poon S et al (2007) The increasing use of intravesical therapies for stage T1 bladder cancer coincides with decreasing survival after cystectomy. BJU Int 100:33–36PubMedCrossRef

10.

Ameling CL, Thrasher JB, Frazier HA et al (1994) Radical cystectomie for stages Ta, Tis and T1 transitional cell carcinoma of the bladder. J Urol 151:31

11.

Schrier BP, Hollander MP, Witjes JA et al (2004) Prognosis of muscel-invasiv bladder cancer: difference between primary and progressive tumors and implications for therapy. Eur Urol 45:292–296PubMedCrossRef

12.

Sven van den Bosch, Alfred Witjes J (2011) Long-term cancer-specific survival in patients with high-risk, non-muscle-invasive bladder cancer and tumor progression: a systematic review. Eur Urol 60:493–500CrossRef

13.

Oosterlinck W, Kirkali Z, Sylvester R et al (2011) Sequential intravesical chemoimmunotherapy with mitomycin C and bacillus Calmmette-Guerin and bacillus Calmette-Guerine alone in Patients with carcinoma in situ of the urinary bladder: results of an EORTC phase 2 trial. Eur Urol 59:438–446PubMedCrossRef

14.

Lamm DK, Blumenstein BA, Crissman JD et al (2000) Maintenance BCG immunotherapy for recurrent Ta, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol 163:1124–1129PubMedCrossRef

15.

Witjes JA (2006) Management of BCG failures in superficial bladder cancer: a review. Eur Urol 49:790–797PubMedCrossRef

16.

Fernandez-Gomez J, Madero R, Solsona E et al (2011) The EORTC Tables overestimate the risk of recurrence and Progression in Patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guerin: External validation of the EORTC risk tables. Eur Urol 60:423–430PubMedCrossRef

17.

Herr HW, Dalbagni G (2003) Defining bacillus Calmette-Guerin refractory superficial bladder tumors. J Urol 169:1706–1708PubMedCrossRef

18.

Lightfoot AJ, Rosevear HM, O‘Donnell MA (2011) Recognition and treatment of BCG failure in bladder cancer. Scientific World J 11:602–613CrossRef

19.

Sylvester RJ (2011) Bacillus Calmette-Guerin treatment of non-muscle invasive bladder cancer. Int J Urol 18:113–120PubMedCrossRef

20.

Martin FM, Kamat AM (2009) Definition and management of patients with bladder cancer who fail BCG therapy. Expert Rev Anticancer Ther 9(6):815–820PubMedCrossRef

21.

Nieder AM, Brausi M, Lamm D et al (2006) Managment of stage T1 tumor of the bladder: International consensus panel. Urol 66:108–125CrossRef

22.

Yates DR, Roupret M (2011) Contemporary management of patients with high-risk non-muscle-invasive bladder cancer who fail intravesical BCG therapy. World J Urol 29:415–422PubMedCrossRef

23.

Zlotta AR, Fleshner NE, Jewett M (2009) The managment of BCG failure in non-muscle-invasive bladder cancer: an update. Can Urol Assoc J 3:199–205

24.

Solsona E, Iborra I, Almenar S et al (2000) The 3-month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer. J Urol 164:685–689PubMedCrossRef

25.

Orsola A, Trias I, Raventos CX et al (2005) Initial high-grade T1 urothelial cell carcinoma: feasibility and prognostic significance of lamina propria invasion microstaging (T1a/b/c) in BCG-treated and BCG-non-treated patients. Eur Urol 48:231–238PubMedCrossRef

26.

O‘Donnell MA, Lilli K, Leopold C (2004) Interim results from a national multicenter phase II trial of combination bacillus Calmette-Guerin plus interferon alfa-2b for superficial bladder cancer. J Urol 172:888–893CrossRef

27.

Myami JL, O‘Donnell MA (2000) Factors affecting response to BCG plus interferon α patients with urothelial CIS. J Urol 173(Suppl):248

28.

Joudin FN, Smith BJ, O‘Donnell MA (2006) Final results from a national multicenter phase II trial of combination bacillus Calmette-Guerin plus interferon Alpha-2B for reducing recurrence of superficial bladder cancer. Urol Oncol 24:344–348CrossRef

29.

Gallagher BL, Joudi FN, Maymi JL, O‘Donnell MA (2008) Impact of previous bacillus Calmette-Guerin plus interferon intravesical therapy. Urology 71:297–301PubMedCrossRef

30.

Rosevear HM, Lightfoot AJ, O‘Donnell MA et al (2011) Factors affecting response to bacillus Calmette-Guerin plus interferon for urothelial carcinoma in situ. J Urol 186:817–823PubMedCrossRef

31.

Dalbagni G, Herr HW, Bajorin D et al (2006) Phase II trial of intravesical gemcitabine in bacille Calmette-Guerin-refrakory transitional cell carzinoma of the bladder. J Clin Oncol 24:2729–2734PubMedCrossRef

32.

Bartoletti R, Cai T, Sisani M et al (2005) Intrvesical gemcitabine therapy for superfivial transitional cell carcinoma: results of a Phase II prospective multicenter study. Urology 66:726–731PubMedCrossRef

33.

Di Lorenzo G, Perdona S, Autorino R et al (2010) Gemcitabine versus bacille Calmette-Guerin after initial bacille Calmette-Guerin failure in non-muscle-invasive bladder cancer: a multicenter prospective randomized trial. Cancer 116:1893–1900CrossRef

34.

Mc Kiernan JM, Masson P, Benson MC et al (2006) Phase I trial of intravesical docetaxel in the managment of superficial bladder cancer refractory to standard intravesical therapy. J Clin Oncol 24:3075–3080CrossRef

35.

Laudano MA, Barlow LJ, Mc Kiernan JM et al (2010) Long-term clinical outcomes of a phase I trial of intravesical docetaxel in the managment of non-muscle-invasive bladder cancer refractory to standard intravesical therapy. Urology 75:134–137PubMedCrossRef

36.

Barlow LJ, McKiernan JM, Benson MC (2009) The novel use of intravesical docetaxel for the treatment of non-muscle invasive bladder cancer refractory to BCG therapy: a single institution experience. World J Urol 27:331–335PubMedCrossRef

37.

Van der Heijden AG, Verhaegh G, Witjes JA et al (2005) Effect of hyperthermia on the cytotoxicity of 4 chemotherapeutic agents currently used for the treatment of transitional cell carcinoma of the bladder: an in vitro study. J Urol 173:1375–1380CrossRef

38.

Paroni R, Salonia A, Lev A et al (2001) Effect of local hyperthermia of the bladder on mitomycin C pharmacokinetics during intravesical chemotherapy for the treatment of superficial transitional cell carcinoma. Br J Clin Pharmacol 52:273–278PubMedCrossRef

39.

Van der Heijden AG, Kiemeney LA, Gofrit ON et al (2004) Preliminary European results of local microwave chemotherapy for the treatment in intermediate or high-risk superficial transirional cell carcinoma of the bladder. Eur Urol 46:65–72CrossRef

40.

Witjes JA, Hendricksen K, Nativ O et al (2009) Intravesical hyperthermia and mitomycin C for carcinoma in situ of the urinary bladder: expirience of the European Synergo working party. World J Urol 27:319–324CrossRef

41.

Nativ O, Witjes JA, Leibovitch I et al (2009) Combined thermo-chemotherapy for recurrent bladder cancer after bacillus Calmette-Guerin. J Urol 182:1313–1317PubMedCrossRef

42.

National Cancer Institute (NCI) (2010) HYMN: a randomized controlled phase III trial comparing hyperthermia plus mitomycin to a second course of bacillus Calmette-Guerin or standard therapy in patients with recurrence of non-muscle invasive bladder cancer following induction or maintenance bacillus Calmette-Guerin therapy. NCI, Bethesda, MD, USA

43.

Brausi M, Campo B, Pizzocaro G et al (1998) Intravesical electromotive administration of drugs for treatment of superficial bladder cancer: a comparative Phase II study. Urology 51:506–509PubMedCrossRef

44.

Di Stasi SM, Riedl C (2009) Updates in intravesical electromotive drug administration of mitomycin-C for non-muscle invasive bladder cancer. World J Urol 27:325–330CrossRef

45.

Di Stasi SM, Vespasiani et al (2011) Electromotive instillation of mitomycin immediately before transurethral resection for patients with primary urothelial non-muscle invasive bladder cancer: a randomized controlled trial. Lancet Oncol 12:871–879CrossRef

46.

Di Stasi SM, Giannantoni A, Stephen RL et al (2003) Intravesical electromotive drug administration of mitomycin C versus passive transport of mitomycin C for high risk superficial bladder cancer: a prospective randomized study. J Urol 170:777CrossRef

47.

Di Stasi SM, Giannantoni A, Stephen RL et al (2006) Sequential BCG and electromotive mitomycin versus BCG alone for high-risk superficial bladder cancer: a randomized controlled trial. Lancet Oncol 7:43–51CrossRef

48.

Meijden AP van der, Sylvester RJ, Oosterlinck W et al (2003) Maintenance Bacillus Calmette-Guerin for Ta T1 bladder tumors is not associated with increased toxicity: results from a European Organisation for Research and Treatment of Cancer Genito-Urinary Group Phase III Trial. Eur Urol 44:429–434PubMedCrossRef

49.

Böhle A, Jocham D, Bock PR (2003) Intravesical bacillus Calmette-Guerin versus mitomycin C for superficial bladder cancer: a formal meta-analysis of comparative studies on recurrence and toxicity. J Urol 169:90–95PubMedCrossRef

Titel: Das Harnblasenkarzinomrezidiv nach BCG-Instillationstherapie
Lokale Therapieoptionen?
verfasst von: Dr. J.M. Laturnus
D. Jocham
M. Sommerauer
Publikationsdatum: 01.09.2012
Verlag: Springer-Verlag
Erschienen in: Die Urologie / Ausgabe 9/2012
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI: https://doi.org/10.1007/s00120-012-2875-9

Neu im Fachgebiet Urologie

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Das Harnblasenkarzinomrezidiv nach BCG-Instillationstherapie

Lokale Therapieoptionen?

Zusammenfassung

Neu im Fachgebiet Urologie

Varikozelen bei Jugendlichen: Das Für und Wider der Operation

Ureterstriktur: Innovative OP-Technik bewährt sich

Prostatakarzinom: EU initiiert neues Screeningkonzept

Blasenkarzinom – Biomarker statt Zytologie?

Update Urologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2012

Mitteilungen der DGU

Kontroverse Themen in der Urologie

Wechsel des LHRH-Analogons beim progredienten kastrationsresistenten Prostatakarzinom

Prolapschirurgie

Operative Therapie des benignen Prostatasyndroms (BPS)

Partielle Tumornephrektomie

Neu im Fachgebiet Urologie

Varikozelen bei Jugendlichen: Das Für und Wider der Operation

Ureterstriktur: Innovative OP-Technik bewährt sich

Prostatakarzinom: EU initiiert neues Screeningkonzept

Blasenkarzinom – Biomarker statt Zytologie?

Update Urologie