Thermo-Chemotherapy available in the USA?

9 months 3 weeks ago #59759 by Sarag
Hi everyone. Does anyone know if thermo-chemotherapy is available in the USA for superficial bladder cancer? I would like to speak to an oncologist who specializes in that. Or I would like more information about it. Thank you in advance.

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9 months 3 weeks ago #59760 by sara.anne
Replied by sara.anne on topic Thermo-Chemotherapy available in the USA?
Usually, chemotherapy of any kind is not indicated for superficial bladder cancer. What, exactly, is your diagnosis?

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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9 months 3 weeks ago #59761 by Sarag
Replied by Sarag on topic Thermo-Chemotherapy available in the USA?
Do you know why chemo is not recommended? Diagnosis : Superficial bladder cancer (Stage 1) - not responsive to BCG at all- One oncologist recommended immunotherapy and another one recommended thermo-chemotherapy.

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9 months 3 weeks ago #59762 by sara.anne
Replied by sara.anne on topic Thermo-Chemotherapy available in the USA?
Systemic chemotherapy is not used in non-invasive bladder cancer because the bladder is a "contained" organ, not really open to the entire rest of the body under normal circumstances. I believe that the thermo-chemtherapy you refer to is the use of local administration of a therapeutic agent such as mitomycin along with heat. I am under the impression that this is in use in the US in multiple places, but cannot tell you specific places. I believe that MD Anderson conducted clinical trials of this a few years ago. You might contact them and inquire.

As for immunotherapy, it is used in many places and has had some real success. Here is a brief summary

www.cancer.org/cancer/bladder-cancer/treating/immunotherapy-for-bladder-cancer.html

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

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9 months 3 weeks ago #59763 by Sarag
Replied by Sarag on topic Thermo-Chemotherapy available in the USA?
Very interesting. Thank you

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9 months 3 weeks ago #59764 by joea73
Replied by joea73 on topic Thermo-Chemotherapy available in the USA?
It is also called hyperthermia chemotherapy.

Several clinical trials have been done including involving US university hospitals. But I do not know which hospitals
provide such therapy in a clinical environment. I tried to call to the chief investigator, an oncology doctor at Duke University in NC who had completed one of the clinical trials which heated bladder using a radiofrequency device and instilled Mitomycin-c chemotherapy drug (Ref.1). Anyway, I have sent an email to Duke university if they can provide us the name of hospitals who are offering such therapy. When and if I will have received their response, I will post it. NIH (National Cancer Institute) states that heperthermia combined with chemotherapy and radiation therapy has been clinically tested on a small scale but no widely used in clinically. (Ref 2).

Anyway, most hyperthermia chemotherapies are used for high risk non muscle invasive bladder cancers patients whose BCG treatment did not work. It is based upon the assumption that heat combined with chemotherapy, i.e. Mitomycin-c will give better efficacy than giving chemotherapy alone.

See Ref 3 for overview and a compilation of other studies

Method of heating
- radiofrequency emitting intravesical catheters (e.g. Synergo, operating at a frequency of 915 MHz,
- externally heated chemotherapy fluid circulation in the bladder,
- intravesical magnetic nanoparticles, and external deep regional radiofrequency transmission with 70–110 MHZ

Assumptions why heating will improve efficacy
1) Tumor cells increase surface expression of several markers (e.g., MHC class I) when exposed to heat.
2) Heat causes the tumor to release HSPs, which in turn activates the host immune response.
3) Heated tumor cells release exosomes that carry tumor antigens to the immune system.
4) Heat alone directly activates the immune system.
5) Heat renders the tumor vasculature more permeable which allows for better trafficking of immune cells.

Additionally, hyperthermia is an interesting topic of research because of the sensitizing effect with chemotherapy and/ or radiotherapy. Hyperthermia has been shown to enhance drug delivery and thermosensitizes cancer cells to certain antineoplastic drugs.

Efficacy
I have noticed that most clinical trials are small scale. The clinical trial of Duke university involved 15 patients.
73% of patients completed induction and maintenance for a dropout rate of 27%. Recurrence-free survival at 24 months was 33%, but this was maintained beyond 3 years. None of the recurrences progressed to muscle invasive disease. Six of the ten patients who experienced recurrence underwent a cystectomy and all were node negative with no greater than T1 disease.

Ref 1 - Clinical trials clinicaltrials.gov/ct2/show/results/NCT00734994?term=hyperthermia+therapy&cond=bladder+cancer&draw=2&rank=1

Ref 2 - NIH www.cancer.gov/about-cancer/treatment/types/surgery/hyperthermia-fact-sheet


Ref 3 - Good overview study www.ncbi.nlm.nih.gov/pmc/articles/PMC5440174/

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