I've had intravesical gemcitabine + mitomycin and it looks like its been very successful. Here's my sequence:
Dx with CIS 5/95
6 wk series of BCG
5 out of 6 biopsy sites positive
6 wk series of BCG + interferon
1 out of 6 biopsy site positive
four week series of gemcitabine + mitomycin (twice a week treatments)
positive FISH test
four week series of gemcitiabine + mitomycin (twice a week treatments)
0 out of 6 biopsy sites positive
negative NP22 test
currently on once a month gemcitabine + mitomycin for next 12 months
cysto next month
biopsy to be scheduled
The gemcitabine + mitomycin is very irritative, but it's supposed to be. I hope your Mom gets better.
Wendy....many thanks to you and Dr. O'Donnell! I opened Dr. O'Donnell's email message this afternoon and called the ER to give the info to my sister only to hear in the background that they were (once again) going to discharge my mom. The ER MD got on the phone and I read her Dr. O'Donnell's message and later fax'd it at their request. Based on his email, my mom was admitted tonight and medicated for the first time for this awful pain. Since then, we have clarified the medication given: they were mitomycin and gemcitabine (not adriamycin). The doctor has since advised me that this combination could have caused the same kind of severe cystitis. Tomorrow they are going to scope her to see what's going on. I cannot thank you enough for your help!....Beth
I'm familiar with Dr. O'Donnell's protocols and never heard of these chemos in combination before, so I asked Dr. O'Donnell if he had any advice for your mother, and he replied:
"First, this is NOT my protocol at all. It may be someone's misinterpretation
of several combination chemotherapy protocols that I am working on (some
involving EITHER adriamycin OR mitomycin) but I never recommended the
combination of adriamycin and mitomycin. Both are known to cause cystitis
and the combination (although very active) has been reported to cause
substantial toxicity (severe cystitis) in over half of the patients treated.
The group that has been advocating this treatment is from Japan, Dr. Fukai.
He has reported about a 70% success rate. There are no 100% successful
treatments for bladder cancer.
I have found the best solution for the chemical cystitis caused by these
types of drugs is an oral prednisone taper taken over about 2 weeks (similar
to what physicians prescribe for a bad case of poison ivy or a severe
allergy). The dose starts with 40 milligrams a day for 3-4 days then cuts in
half to 20 mg for 3-4 days then 10 mg then 5mg then 2.5mg (each over 3-4
days) then done. It is also occassionly helpful to instill a steroid
medication directly into the bladder (solumedrol) plus an anesthetic
(marcaine) once a week for several weeks. You might also try some steroid
cream (not the weak hydrocortisone but stronger creams like aristocort) on
the involved skin then apply some diaper rash cream (like desitin) on top of
it - 3 times a day for about 2 weeks.
Ultimately, the best treatment for your mom may be bladder removal. The
disease that she has (based on your report below) is very very serious and
can lead to eventual life-threatening invasive disease in 50-80% of cases
once the patient fails BCG.
Anyway, I am very sorry to hear of your mom's distress and I hope the
suggestions above will be of some benefit. Of course, please discuss them
with your mom's doctor before going through with any of them as there are
some side effects that may also occur with the steroid medications."
Michael O'Donnell, MD
Professor and Director of Urologic Oncology
University of Iowa Carver College of Medicine
I am writing about my 83 year old mom. She has been treated for superficial bladder cancer since 1997. Originally, she was treated with only BCGs and then in later years with BCGs and interferon. Last fall her urologist tried adriamycin infusion and she "did not respond" according to him. The doctor then called me in late April to say that mom had been graded a "3/3 and that now the cancer is no longer limited to her epithelium but is in her lamina propria". He recommend a treatment developed by "a doctor in Iowa". He went on to say that this new treatment was tried on 25 patients and not one had a re-occurence. After many phone calls, I have now been told that doctor may be Dr. O'Donnell. My mom had 4 infusions of mytomycin followed by adriamycin. The mytomycin was held in with a catheter (though on one visit she was sitting in a large pool of liquid) and then she was sent home to expel the adriamycin. That treatment ended this past summer and since then my mom has been in excrutiating pain 24/7. The urologist sent us to a dematologist, that doctor sent us to a GYN. Everyone agrees that the lining of my mom's vagina was burned away so we have tried Premarin and other topical anesthetics as recommended by the GYN. A month ago, she developed MRSA and was hospitalized for a week on Vancomycin. Since then, the pain is even worse and none of the topical creams or injected creams (now including nystatin) help her pain.
Finally, my question...is anyone here familiar with whether or not this protocol was developed by Dr. O'Donnell? Has anyone here had this treatment or ever heard of these complications?? If it is another doctor who developed this protocol could you please direct me to that doctor. No one here in Massachusetts, after 2 hospitalization and 5 ER visits (including the one today!) seems to have a clue why this fragile woman is in such horrific pain. I am not interested in blame, but only hope to find out why my mom is in so much pain so that we can correct whatever is wrong. Can you help??