Prophylactic intravesical chemotherapy with 4'-epirubicin in recurrent superficial bladder cancer

Further recurrence of superficial bladder cancer after transurethral resection is frequent in patients who have already experienced recurrence. Doxorubicin intravesical chemotherapy has been used in order to prevent recurrence in such patients, and in recent years, 4'-epirubicin, one of the derivatives of doxorubicin was developed and has been shown to have equal anti-tumor effects to doxorubicin, with less toxicity, when used systemically. In an attempt to clarify the effects of intravesical use of 4'-epirubicin in the prevention of further recurrences in patients with recurrent superficial bladder cancer, a randomized prospective trial to compare the prophylactic effect and side effects of 4'-epirubicin intravesical chemotherapy was performed. A total of 73 patients were entered in this study and randomized to receive TUR and either 30 mg 4'-epirubicin or 30 mg doxorubicin intravesically every 2 to 4 weeks for 1 year. The prophylactic effect for further recurrence and side effects were evaluated, with a 20 months median follow-up period. Further recurrence after tumor resection was observed in 13 out of 36 (36%) evaluable patients in the epirubicin group as against 18 out of 34 (53%) evaluable patients in the doxorubicin group. The non-recurrence rate at the median period of following-up was 67% in the epirubicin group versus 51% in the doxorubicin group. These differences were statistically significant. Side effects of 4'-epirubicin were only local toxic effects, including: polyuria, pain on urination, and hematuria. The incidence of these side effects was similar to those in doxorubicin group. These preliminary results suggested that intravesical 4'-epirubicin is as benificial and reliable as intravesical doxorubicin in the prevention of further recurrence of recurrent superficial bladder cancers.