Improving efficacy of intravesical chemotherapy.
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.
Gasión
Juan Pablo Burgués
JP
University Hospital Son Dureta, Palma de Mallorca, Spain. jpburgues@pulso.com
Cruz
Juan Fernando Jiménez
JF
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
D000970:Antineoplastic Agents