Intravesicular interferon after transurethral resection of non-muscle invasive bladder cancer – pro

Standard adjuvant therapy for non muscle invasive cancer can reduce the risk of recurrence. Patients at high risk for cancer recurrence receive bacillus Calmette-Guérin (BCG) therapy after surgery. One study that compared mitomycin with interferon alfa-2b showed an improved outcome with mitomycin, although interferon was better tolerated. Intravesical interferon therapy  with BCGT or by itself can significantly lower the recurrence rate in superficial bladder cancer.  In vitro evidence suggested that IFN combined with BCG may have a synergistic effect on the immune response, and treatment regimens with IFN have used reduced BCG dosage in an attempt to reduce toxicity.

Evidence supporting interferon is limited. NCCN recommends mitomycin or BCG. 2013 ALberta guideline says: “Maintenance therapy BCG with alpha-2b interferon is indicated if the patient is disease free at first cystoscopy; dosage as prescribed in the pre-written orders available from Cancer Care pharmacies.” Lsmm et al says: “BCG and IFN-α combination intravesical therapy has not been investigated thoroughly; based on available data, combination therapy appears to be most effective in patients with carcinoma in situ and may be preferentially considered as an alternative to radical cystectomy for patients with intermediate-risk or high-risk NMIBC who do not tolerate the standard BCG dose or experience BCG failure after 1 year of therapy. ”

Lamm D Brausi M, O’Donnell MA, Witjes JA. Interferon alfa in the treatment paradigm for non-muscle-invasive bladder cancer.Urol Oncol. 2014 Jan;32(1):35.e21-30.

Alberta Provincial Genitourinary Tumour Team. Bladder cancer. Edmonton (Alberta): Alberta Health Services, Cancer Care; 2011 Jan. 16 p. (Clinical practice guideline; no. GU-002).  [66 references]

R. Madeb, D. Golijanin, K. Noyes, et al.. Treatment of nonmuscle invading bladder cancer: do physicians in the US practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors. Cancer 115 (2009) (2660 – 2670)

Ralph Madeb  et al, Treatment of nonmuscle invading bladder cancer: Do physicians in the United States practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors
Cancer Volume 115, Issue 12, pages 2660–2670, 15 June 2009

Boccardo F, Cannata D, Rubagotti A, et al.: Prophylaxis of superficial bladder cancer with mitomycin or interferon alfa-2b: results of a multicentric Italian study. Journal of Clinical Oncology 12(1): 7-13, 1994.

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