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sequential BCG + MMC

esposa
1 Recommendation

Hello whoever is "listening,"

Background:
My husband as superficial bladder cancer : he was diagnosed 2 years ago with multiple tumors and underwent 6 week BCG treatment following TUR. Within 6 months new tumors were being found and removed each 3 month checkup. The doctor recommended another round of BCG treatment. This is week 6 of 8.

Issue at hand:
I am eager to hear from anyone who has undergone (or is undergoing) a mitomycin treatment directly following BCG. I have read multiple articles indicating that this approach has better success than BCG alone.

The doctor is willing to use this method but seems quite pessimistic about it.

Any shared thoughts or experience with this would be most welcome.

thanks much!
the wife

p.s. What is the situation with Mytomycin production????

Explore topics in this discussion:

Cancer Chemotherapy Bladder cancer

27 replies

Moonerj

Hi
I had 2 recurrences after my initial dx. Non-invasive low grade tumors.
I had BCG after each Turbt.
After my 3 Turbt My Uro instilled Mitomycin C in my bladder for 1 hour.
Six weeks later I began BCG weekly treatments, clear bladder, then 12 monthly BCG treatments. All Cystos have been clear and I am now nearly 23 months cancer free. I have my next Cysto in a few weeks.
So my experience with mitomycin was 1 treatment, before BCG not after BCG treatments.
Do you know if your husband's tumors were low grade or high grade?
Hopefully others will also reply to your post with similar experiences.
All the best,
Jack

esposa

Thanks Jack for the quick reply.
His tumors are higher grade, yet superficial.

So glad t o hear your last 2 years have been without incident. My husband is extremely depressed right now and I look forward to sharing your experience with him.

browns-crossing

You may want to get a second opinion at a cancer center, usually located at teaching / university hospitals. Second opinons may give you other options or agree with your attending physican now. Most doctors are very agreeable to have a second opinion, as it helps them too. Bladder cancer has many treatments and currently there is no "standard of care". It may help you set you mind at ease.
Please ask any other quesions, and I hoped this helped.
Best,
Browns Crossing

esposa

Wow 2 responses within such a short time! I think I like this Group Discussion thing (my first ever)! :)

We will certainly go the route of a cancer center if he has another recurrence. Unfortunately, we need to decide on the sequential BCG+Chemo treatment by next week, since he will be at the end of the BCG.

-thanks again

LadyJane123

I only know of Mitomycin instilled in the bladder just after the TURB has been done, not after BCG. I have heard of Mitomycin given as an alternative to BCG.

Your husband should get a 2nd opinion as advised.

His recurrence is normal for the type of BC he has. I have had 8 cystos and no clear yet. I did have 15 BCG's in one year and that has seemed to help reduce the size of my tumours ( initially as big as a quarter, now millmeters big) and reduced the quantity I have. ( from multiples to one or two)

Good luck to you both. You can do it.

Moonerj

Do you know if your husband has had mitomycin ever instilled right after a Turbt?
Jack

LadyJane123

Hmmmm interesting. I see he wrote BCG plus and/or MitC. Something new to me. Thanks for pointing it out to me.

I hope you find the reports you are looking for. If so, would you share with us please?

Good luck and keep looking.

Cheyenne

As the front line of defense for my TCIS high grade both my Austin uro and MDA uro use BCG. Neither are in favor of MMC (in my case anyway). Sometime BCG maintenance is needed. I do not believe MMC, which is a chemotherapy directly instilled in the bladder, is as effective. Some people cannot tolerate BCG and have had MMC. Others who have had MMC have had problems with it. There is a recently reformulated Valspar available. There are other chemo agents such as Doxirubicin and many others. Everything I have learned about BCG is that if it is working (and it may need to be used more than once) the recommendation is to continue with it and with necessary TURBs. Sometimes Interferon and BCG are used together (immunotherapy). BCG is not used simultaneously with with MMC. I believe for low grade low stage tumors the approach is to have frequent cystos and removal of tumors with of course good biopsies, and continuation of BCG. If BCG is not tolerated by a person or in the tumors increase in number or become more aggressive then BCG may be deemed not to be effective and other agents used or an RC considered. In any event, very close follow up is needed. Hope this helps.

esposa

Cheyenne - thanks much for your thoughts and experience.

esposa

Yep I am a newbie. I am deleting 2 posts below where I pasted article abstracts into the post because that action was contrary to the group rules.

I have pasted a few citations for articles that may be of interest and are relevant to this discussion.

Sequential BCG and electromotive mitomycin versus BCG alone for high-risk superficial bladder cancer: a randomised controlled trial. * Di Stasi SM, * Giannantoni A, * Giurioli A, * Valenti M, * Zampa G, * Storti L, * Attisani F, * De Carolis A, * Capelli G, * Vespasiani G, * Stephen RL. Department of Surgery/Urology, Tor Vergata University, Rome, Italy. Lancet Oncol. 2006 Jan;7(1):43-51. PMID: 16389183

A combination of intravesical and BCG electromotive mitomycin for high-risk superficial bladder cancer; Ashish M Kamat* and Colin PN Dinney Correspondence *Department of Urology, Unit 1373, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA Nature Clinical Practice Urology (Nov. 2006) 3, 472-473 doi:10.1038/ncpuro0559
J Urol. 2009 Oct;182(4):1313-7. Epub 2009 Aug 14.

Combined thermo-chemotherapy for recurrent bladder cancer after bacillus Calmette-Guerin.
Nativ O, Witjes JA, Hendricksen K, Cohen M, Kedar D, Sidi A, Colombo R, Leibovitch I.
Urology Department, Bnai-Zion Medical Center, Haifa, Israel. ofer.nativ@b-zion.org.il


Expert Rev Anticancer Ther. 2009 Jun;9(6):815-20.
Definition and management of patients with bladder cancer who fail BCG therapy.
Martin FM, Kamat AM.
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.


Cancer. 2009 Jun 15;115(12):2660-70.
Treatment of nonmuscle invading bladder cancer: do physicians in the United States practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors.
Madeb R, Golijanin D, Noyes K, Fisher S, Stephenson JJ, Long SR, Knopf J, Lyman GH, Messing EM.
Department of Urology, University of Rochester School of Medicine, Rochester, New York, USA.

Cheyenne

Probably be best if you cut and past the link instead of the whole article

Cheyenne

We were all newbies on one point. I think I stayed in newbie land. (Disney land move over).

Things change quickly sometimes in research especially in the field of oncology. I would want to be sure I had the best possible urologist and oncologist. As I mentioned earlier they are not used simultaneously but could be new protocols for sequential use. I would be interested in how that works out so please keep informed. Good to know about these things.

Thanks for bringing this up. Always something new to learn.

My best wished to both of you. I hope everything goes well for you.

Cheyenne

This link may shed some light on what you mentioned about BCG and MMC used sequentially. It is from the Medical Journal Lancet. It speaks to this matter. It seems that this is may be a new protocol, both BCG and MMC are already FDA approved so it looks like a matter of a trial of this sequential use you mentioned. I don't know how much this has been studied but I'll keep digging through the medical journals.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2805%2970472 -1/fulltext

esposa

thanks Cheyenne - That article was one of the several citations I posted a few minutes ago. That article is sort of where I got started thinking about this.

You can read that they use BCG and then MMC, but apply electromotive therapy with the MMC.

There is another treatment (see citation in prior post) which uses BCG and then MMC, but uses hyperthermia treatment with the MMC.

Both of these techniques compare favorably to BCG alone. However, my frustation is that I can't find a study/trial/anecdote that compare BCG alone to a simple BCG and then MMC.

Am I making sense? :(

joybob

well if it is high grade, can't fool around. My hsuband had one little tumor superficial but high grade. 6 months later after bcg tumor back and needed the r/c. You don't want it gettin g in muscle wall, which is where my husbans lan ded in 3 months. Be careful and get a second opinion about any treatment because this is understaged most of the time. Hope this helps. Joycee

esposa

Joycee thanks for response - your email led me to another question....

To get a second opinion on the stage, do they need to do another biopsy? or do you just mail the records and pretty photos to another doctor?

so many questions, so little time...

joybob

I think they can use what they have. Howsever, MD Anderson where we went, they did another turb to see what was what. the high grade is very serious, the other ones you can keep getting and takin g them out, my father did it for 30 years. high grade is different. I am sorry we did not take out bladder before the bcg after all I read about wht he had, that is my opinion, others have great success with the treatment, b ut it is less effectiv e with high grade. I would check out the second opinion, the doctors don't really care. maybe a place c lose by but a big medical center would be better. Joycee

Cheyenne

It looks like solid research but it appears to be in the research in the investigational stages. I would want to see more research on a broader population base before I used it. I don;t see it as a proven protocol so I would be hesitant to use it myself, especially for higher grade BC. Also keep in mind that many tumors are under staged so this could be risky. Personally, while I hope they research further, I will stay with the protocols and drugs that have already been well established. Once BC gets into the muscle wall you're a person is in serious trouble even with an RC. BC is just not something to mess with. Maybe for superficial BC it might make sense in the failure of everything else as long as multiple biopsies are done to establish that it is not progressing to the point of invasive BC. Definitely need to keep it out of the muscle. If it's in Lancet it's good research. If it were me, I would get another opinion before proceeding with this, and at a major cancer research/treatment center like M.D. Anderson, Memorial Sloan Kettering, Dana farber, Cleveland Institute, and about 15 others in the U.S.

MissGoodnight

In my case, the doctors for my second opinion only had the first doctor send everything down to them. No second biopsy was done. I see you are in Utah, are you thinking of going to Huntsman for your second opinion? That is where I went for mine and I'm very glad I did.

Kandi

Cheyenne

By MMC production I assume you mean it's availability? Well, it had not been available for a while. But there were other very close cousins to it available right along. I heard from my uro that is is now available. He has had some in stock even when it it was not available. For some reason production decreased. It was not pulled by FDA. Should be available now.

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