Gemcitabine more effective than mitomycin for recurrent bladder transitional cell carcinoma

Gemcitabine was more effective and had a lower toxicity than mitomycin for treatment of patients with recurrent superficial bladder cancer.

“In this study, the comparison of gemcitabine and mitomycin shows that gemcitabine has a better chemopreventive activity than mitomycin,” researchers said.

From March 2003 to November 2005, they randomly assigned 54 patients to six weeks of gemcitabine and 55 patients to four weeks of mitomycin. The mean age of patients in the gemcitabine group was 64.9, and the mean age of patients in the mitomycin group was 67.9. The median follow-up duration time was 36 months.

More patients remained free of recurrence with gemcitabine (72%) than with mitomycin (61%). Among those with recurrences, six patients assigned to gemcitabine and 10 patients assigned to mitomycin also had a progressive disease by stage, according to the researchers.

Local toxicity was acceptable in both treatment groups. The mitomycin group had a higher incidence of chemical cystitis than the gemcitabine group (P=.013). Dysuria frequency was higher in the mitomycin group compared with the gemcitabine group (P=.023) as well.

“To the best of our knowledge, this is the first report specifically dealing with the use of gemcitabine for its better clinical activity and favorable toxicity profile,” the researchers said. “Therefore, gemcitabine appears a logical candidate for intravescical therapy for patients with refractory transitional cell carcinoma, in whom this cytotoxic drug may represent a valid alternative to cystectomy.”

Addeo R. J Clin Oncol. 2009;doi:10.1200/JCO.2008.20.8199.