Advances in intravesical therapy of urinary bladder cancer.

The aim of urinary bladder cancer treatment with intravesical therapy is threefold: to eradicate existing disease, prevent recurrence and prevent tumor progression. The prognostic factors allow differentiation in different risk groups and this is useful in planning treatment. Pharmacokinetic studies have proved the efficacy of a high urine concentration of the chemotherapeutic agent. Comparing resection with and without adjuvant intravesical chemotherapy, an approximately 15% short-term decrease in tumor recurrence with chemotherapy is obtained, although no effect on progression was proven. No chemotherapeutic agent has proved more effective than the other. The importance of early administration has been highlighted by the positive results of a single, early instillation of chemotherapy, with a reported mean reduction in recurrence rate of 12-27%. Immunotherapy in the form of bacillus Calmette-Guerin has generally proven more efficious than chemotherapy. The results in comparison with mitomycin C have not been as conclusive. The best results are found with a maintenance schedule. In this review, several new approaches are explored to improve the efficacy of this therapy.