INTRODUCTION: Preliminary studies show that device assisted intravesical therapies appear more effective than passive diffusion intravesical therapy for the treatment of non-muscle invasive bladder cancer (NMIBC) in specific settings, and phase III studies are now being conducted. Consequently, we have undertaken a non-systematic review with the objective of describing the scientific basis and mechanisms of action of electromotive drug administration (EMDA) and chemohyperthermia (CHT). METHODS: PubMed, ClinicalTrials.gov and the Cochrane Library were searched to source evidence for this non-systematic review. Randomised controlled trials, systematic reviews and meta-analyses were evaluated. Publications regarding the scientific basis and mechanisms of action of EMDA and CHT were identified, as well as clinical studies to date. RESULTS: EMDA takes advantage of three phenomena: iontophoresis, electro-osmosis and electroporation. It has been found to reduce recurrence rates in NMIBC patients and has been proposed as an addition or alternative to bacillus Calmette-Guérin (BCG) therapy in the treatment of high risk NMIBC. CHT improves the efficacy of mitomycin C by three mechanisms: tumour cell cytotoxicity, altered tumour blood flow and localised immune responses. Fewer studies have been conducted with CHT than with EMDA but they have demonstrated utility for increasing disease-free survival, especially in patients who have previously failed BCG therapy. CONCLUSIONS: It is anticipated that EMDA and CHT will play important roles in the management of NMIBC in the future. Techniques of delivery should be standardised, and there is a need for more randomised controlled trials to evaluate the benefits of the treatments alongside quality of life and cost-effectiveness.
INTRODUCTION: Preliminary studies show that device assisted intravesical therapies appear more effective than passive diffusion intravesical therapy for the treatment of non-muscle invasive bladder cancer (NMIBC) in specific settings, and phase III studies are now being conducted. Consequently, we have undertaken a non-systematic review with the objective of describing the scientific basis and mechanisms of action of electromotive drug administration (EMDA) and chemohyperthermia (CHT). METHODS: PubMed, ClinicalTrials.gov and the Cochrane Library were searched to source evidence for this non-systematic review. Randomised controlled trials, systematic reviews and meta-analyses were evaluated. Publications regarding the scientific basis and mechanisms of action of EMDA and CHT were identified, as well as clinical studies to date. RESULTS:EMDA takes advantage of three phenomena: iontophoresis, electro-osmosis and electroporation. It has been found to reduce recurrence rates in NMIBC patients and has been proposed as an addition or alternative to bacillus Calmette-Guérin (BCG) therapy in the treatment of high risk NMIBC. CHT improves the efficacy of mitomycin C by three mechanisms: tumour cell cytotoxicity, altered tumour blood flow and localised immune responses. Fewer studies have been conducted with CHT than with EMDA but they have demonstrated utility for increasing disease-free survival, especially in patients who have previously failed BCG therapy. CONCLUSIONS: It is anticipated that EMDA and CHT will play important roles in the management of NMIBC in the future. Techniques of delivery should be standardised, and there is a need for more randomised controlled trials to evaluate the benefits of the treatments alongside quality of life and cost-effectiveness.
Authors: Cristina Roca; Luca Primo; Donatella Valdembri; Anna Cividalli; Paul Declerck; Peter Carmeliet; Pietro Gabriele; Federico Bussolino Journal: Cancer Res Date: 2003-04-01 Impact factor: 12.701
Authors: S M Di Stasi; A Giannantoni; R Massoud; S Dolci; P Navarra; G Vespasiani; R L Stephen Journal: Cancer Res Date: 1999-10-01 Impact factor: 12.701
Authors: Savino M Di Stasi; Antonella Giannantoni; Robert L Stephen; Giovanni Capelli; Pierluigi Navarra; Renato Massoud; Giuseppe Vespasiani Journal: J Urol Date: 2003-09 Impact factor: 7.450
Authors: Antoine G van der Heijden; Cornelius F J Jansen; Gerald Verhaegh; Michael A O'donnell; Jack A Schalken; J Alfred Witjes Journal: Eur Urol Date: 2004-11 Impact factor: 20.096
Authors: A G van der Heijden; L A Kiemeney; O N Gofrit; O Nativ; A Sidi; Z Leib; R Colombo; R Naspro; M Pavone; J Baniel; F Hasner; J A Witjes Journal: Eur Urol Date: 2004-07 Impact factor: 20.096
Authors: Stefanie Schmidt; Frank Kunath; Bernadette Coles; Desiree Louise Draeger; Laura-Maria Krabbe; Rick Dersch; Samuel Kilian; Katrin Jensen; Philipp Dahm; Joerg J Meerpohl Journal: Cochrane Database Syst Rev Date: 2020-01-08