Yujiro Ozaki

Intravesical chemotherapy with 4′-epi-Adriamycin in patients with superficial bladder tumors

SummaryWe evaluated the effects of 4′-epi-Adriamycin (EPI), a derivative of Adriamycin (ADR), in intravesical instillation chemotherapy. The patients received two courses of three daily instillations of 50–80 mg EPI dissolved in 30 ml physiological saline on 3 consecutive days, with an interval of 4 days between courses. Full evaluation was possible in 33 of 35 patients with superficial bladder tumors treated with EPI. Complete response was observed in 4 cases and partial response in 14 cases, giving a response rate of 55%. Side effects such as pollakiuria and pain on micturition occurred in 9 cases. EPI appears to be an effective agent for intravesical instillation chemotherapy in patients with superficial bladder tumors.

Intravesical Adriamycin chemotherapy in bladder cancer

SummaryIn an experimental study undertaken to elucidate the mechanism whereby Adriamycin (ADM) instilled into the bladder produces its side-effects, the time course of ADM concentration in blood, urine, and tissues of various organs, and also histopathological changes in the bladder mucosa were investigated in normal adult dogs that had undergone bilateral ureterostomy and then received intravesically instilled ADM. Clinically, ADM was used in the treatment of superficial bladder tumors in an attempt to facilitate the transurethral operative procedure. A total of 261 patients were included in this trial. ADM was instilled into the bladder at the following dosages: 1,000 μg/ml (30 mg ADM per 30 ml physiological saline), 1,600 μg/ml (50 mg ADM per 30 ml physiological saline), and 2,000 μg/ml (60 mg ADM per 30 ml physiological saline). The rate of effectiveness was 32%, 66%, and 60%, respectively. The incidence of side-effects was 29%, 20%, and 45%, respectively. The systemic uptake of the drug was small and the side-effects were pain an micturition, pollakiuria, and urgency. From the aspects of efficacy and toxicity, 1,600 μg/ml was found to be the optimal dosage.

Prophylactic intravesical instillation therapy with adriamycin (ADM) and mitomycin C (MMC) in patients with superficial bladder cancer

SummaryIntravesical instillation of adriamycin (ADM) or mitomycin C (MMC) was carried out for the purpose of preventing the recurrence of superficial bladder cancers (Ta and T1) after transurethral resection or transurethral coagulation. First, eligible patients were divided into two groups (solitary and multiple) and then they were randomized into the following three groups: (1) ADM group, intravesical instillation with 50 mg ADM dissolved in 100 ml physiological saline; (2) MMC group, intravesical instillation with 30 mg MMC dissolved in 100 ml physiological saline; (3) control, transurethral resection or transurethral coagulation alone. The drugs were given six times by instillation within 2 weeks after TUR or TUC; after 2 weeks the drugs were administered for 2 consecutive days every 4 weeks for 2 years. Of the 134 patients admitted to the study, 103 were evaluable and 31 were eliminated as non-evaluable patients. The cumulative nonrecurrence rates were 73.6% for ADM, 63.4% for MMC, and 22.5% for controls after a follow-up of 24 months. The cumulative non recurrence rates of the ADM and MMC groups were significantly higher than that of the control group. The incidence of side effects was low and the grade of these side effects mild. This instillation therapy with ADM and MMC was considered useful for preventing the recurrence of superficial bladder cancers.