title: Use of intravesical valrubicin in clinical practice for treatment of nonmuscle-invasive bladder cancer, including carcinoma in situ of the bladder.
abstract: OBJECTIVE
  The objective was to conduct a US multicenter, retrospective medical record study examining the effectiveness, safety, and patterns of use of valrubicin for treatment of nonmuscle-invasive bladder cancer (NMIBC) by clinicians since the 2009 reintroduction of valrubicin.
  
  
  METHODS
  Patients ≥ 18 years with NMIBC who received had one or more instillations of valrubicin (October 2009- September 2011) were eligible. The primary endpoint was event-free survival (EFS). Safety and tolerability were also assessed.
  
  
  RESULTS
  The medical records of 113 patients met the inclusion criteria; 100 patients (88.5%) completed valrubicin treatment. The median age was 75 years (range 42-95 years). The median NMIBC duration was 31 months since diagnosis: 51.3% (58/113) had carcinoma in situ (CIS) alone, and 31.9% (36/113) had unspecified NMIBC. Most patients, 94.7% (107/113), had more than three valrubicin instillations and 70.8% (80/113) completed a full course. The EFS rate (95% confidence interval) was 51.6% (40.9-61.3%), 30.4% (20.4-41.1%), and 16.4% (7.9-27.5%) at 3, 6, and 12 months, respectively. Median time to an event was 3.5 (2.5-4.0) months after the first valrubicin instillation. Local adverse reactions (LARs) were experienced by 49.6% (56/113) of patients; most LARs were mild (93.6%). The most frequent LARs were hematuria, pollakiuria, micturition urgency, bladder spasm, and dysuria. In total, 4.4% (5/113) of patients discontinued valrubicin because of adverse events or LARs.
  
  
  CONCLUSIONS
  Data from the present retrospective study are consistent with previous prospective clinical trials that demonstrated valrubicin effectiveness and tolerability for select patients with CIS, before considering cystectomy. Additional prospective studies are warranted to evaluate valrubicin safety and efficacy in the broader patient population with NMIBC.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, MCN A-1302, Nashville, TN 37027, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Formerly of Endo Pharmaceuticals Inc., Malvern, PA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Lihou
authors.affiliation: Endo Pharmaceuticals Inc., Malvern, PA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Li
authors.affiliation: Formerly of Endo Pharmaceuticals Inc., Malvern, PA, USA.
authors.forename: Samira Q
authors.initials: SQ
authors.lastname: Harper
authors.affiliation: Formerly of Endo Pharmaceuticals Inc., Malvern, PA, USA.
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Lang
authors.affiliation: Chesapeake Urology Research Associates, Towson, MD, USA.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Tutrone
keywords: bladder cancer; chemotherapy; cystectomy; disease progression; recurrence