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Mitomycin-C, 1 Treatment versus 6?

2 weeks 4 days ago - 2 weeks 4 days ago #56292 by Knifedealer
Hello and welcome Braun1984. I had my first TURBT 10 days ago. It included an intravesical instillation of MMC, which was far from a walk in the park. I should know more this week when I meet with my urologist to discuss the pathology report and treatment recommendations. Fingers crossed.

While the information found at the link(s) below may not directly answer your question, you may find them helpful.

https://www.ncbi.nlm.nih.gov/pubmed/22014799

In the above, the authors indicate that "appropriate management of recurrence depends on the patient level of risk as well as previous treatment." Your questions are valid and I believe the person(s) able to answer them best, specific to your situation, would be those who are privy to this information (i.e., your doctor and/or treatment team) and then, ultimately, you. While others may share if they believe the treatment was worth it for them, at the end of the day, based on all of the information I am able to glean, I am the one who will decide if it is "worth putting my body through" any treatment options recommended to me. I don't think we differ in this regard.

I found the article linked below to be informative. In it, the authors state: "one of the instillation schedules used in an adjuvant [applied after initial treatment, especially to suppress secondary tumor formation] setting is weekly mitomycin C 40 mg for 6 weeks, and in the case of negative cystoscopy, monthly instillations for 1 year."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263923/

How did you respond to the MMC dose during surgery? Have you fully recovered from the procedure? I ask because I having significant dyuria (burning, pain) and fear it may be a result of the MMC. The thought additional MMC frightens me.

Regardless of what path you choose, I wish you the best.

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2 weeks 4 days ago #56291 by sara.anne
First, I want to ask exactly what your diagnosis was? Was it low grade? High grade? CIS (carcinoma in situ?)
That is what determines what the treatment post-TURB should be.

The purpose of one treatment of mitomycin and six instillations of mitomycin or something else are different. The
one dose of mitomycin after the TURB is just in case there are very small amounts of cancer left or against the possibility that the TURB might have distributed a few cells. IF the diagnosis is high grade or CIS, once the bladder has healed, intravesical therapy (six doses) is used. However, the drug of choice for this is BCG, not mitomycin.
IF a patient cannot tolerate BCG, mitomycin is sometimes used as a second choice but it is not as effective as BCG.
A few years ago there was a shortage of BCG and for several months it was not available and so mitomycin was used instead.

The current standard of care for high grade non-invasive bladder cancer is 6 treatments of BCG, one per week for six weeks. If the bladder remains clear most urologists recommend at least two years of maintenance treatments with BCG. This has been shown to reduce recurrences by as much at 70%.

I agree with Alan....I would want to know WHY your urologist is not using BCG. And perhaps I would want to get a second opinion.

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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2 weeks 4 days ago #56289 by Braun1984
Thank you Alan for the response. BCG was never discussed at all with me by my Urologist. He simply told me that the six rounds Mitomycin-C would reduce the chances of recurrence by 50%.

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2 weeks 4 days ago - 2 weeks 4 days ago #56287 by Alan
Welcome Braun1984. Most of us have taken BCG and the vast amount of evidence that at least 6 instillations plus some kind of maintenance or use after 6 is beneficial on that regimen. I am presuming the same will apply on mitomycin except I have read very little on this. It usually has been used where there are other questions such as reactions etc on BCG. The only question I would have for your URO why this instead of BCG?

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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2 weeks 4 days ago #56286 by Braun1984
Hello. I’m 34 & recently had TURBT surgery (9/1). My doctor told me that I’d get a single Mitomycin-C dose while under for surgery but after the surgery was done, he told me that I’d be receiving 6 more.

My question is just how much do these additional 6 doses impact the recurrence rate & is it worth putting my body through this process?

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