Role of Neoadjuvant MMC prior to TURBT for Large NMIBC
Intravesical Instillation of MMC is advised perioperatively after TURBT as a single dose regime. Recently Marco Racioppi, Luca Gianfrancesco* et al (2019) suggested that adjuvant Intravesical MMC, 3 times a wk for two wks.
This resulted in favourable outcomes without need for TURBT and the authors make a plea that this regime could be an alternative for treatment for Low and Intermediate risk groups. How many of us in India will accept this policy will have to be seen.
But what is more fascinating is the study of M Raber et al (2020 published online Dec 17th). The endoscopic resection of large and bulky bladder cancers represents a challenge. To reduce the tumour and make it easier to resect, they used neoadjuvant short and intensive intravesical mitomycin (MMC) therapy. After neoadjuvant treatment, all tumours could be resected as the size of tumours reduced considerably (mean size reduced from 5.1 cms to <3 cms). No adverse events were recorded. Hence they opined that Intravesical cytoreductive neoadjuvant MMC as an initial treatment of large NMIBC can be considered safe, effective, and feasible.
The main issue is that this concept has not been validated with larger studies but the concept appears attractive and hopefully will be receiving attention from others in near future.
With warm Regards,