title: Improving efficacy of intravesical chemotherapy.
abstract: OBJECTIVE
  This paper reviews the most relevant findings published recently on intravesical chemotherapy for superficial bladder tumours and provides recommendations based on documented research.
  
  
  METHODS
  The evidence was categorised according to the North of England Evidence Based Guideline Development Project. Levels of evidence were based on the source of the information, meta-analyses, systematic reviews, well-designed randomised or nonrandomised controlled clinical trials, and uncontrolled studies or consensus. Three levels of recommendations were assigned to the evidence obtained.
  
  
  RESULTS
  Despite intravesical chemotherapy being used prophylactically after endoscopic resection of superficial bladder tumours, the recurrence rate is still 36-44%. Researchers have focused on improving the effectiveness of intravesical chemotherapy, each adopting a different strategy. Some have aimed to identify the optimum timing for instillations and others to improve the pharmacokinetics of agents by avoiding their dilution, increasing their stability, or improving the absorption of the drug by bladder mucosa. Some researchers are looking into new, single chemotherapeutic agents or combinations for intravesical use and others into avoiding chemoresistance with resistance-reverting agents (modulating agents) or by using in vitro chemosensitivity tests to identify the most sensitive drug.
  
  
  CONCLUSIONS
  Progress has been made in optimising intravesical chemotherapy for timing of instillations and pharmacokinetic interventions. Simple and inexpensive approaches may have a widespread, practical acceptance by urologists, but it is more difficult to extend new techniques requiring more complex and sometimes expensive instrumentation to the urologic community. Further research into finding more effective cytotoxic drugs, combinations, or modulating agents should be encouraged.
authors.affiliation: University Hospital Son Dureta, Palma de Mallorca, Spain. jpburgues@pulso.com
authors.forename: Juan Pablo Burgués
authors.initials: JP
authors.lastname: Gasión
authors.forename: Juan Fernando Jiménez
authors.initials: JF
authors.lastname: Cruz
mesh_terms: D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D004357:Drug Synergism; D006801:Humans; D010535:Laparoscopy; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents