Intravesical Chemotherapy Flashcards
How many instillations are given immediately post op?
Single installation
Within how many hours should you give intravesical therapy post TURBT?
24 hours
Within how many hours is the more ideal time to give intravesical chemotherapy post TURBT?
Within 6 hours
What is the rationale in giving immediate intravesical therapy post TURBT? Give two reasons.
To prevent implantation of cancer cells. To prevent early recurrence.
Does immediate intravesical therapy post TURBT decrease the risk of recurrence? By how much?
Yes. By 35%
Does immediate intravesical therapy post TURBT prolong the time of progression or time to death from bladder cancer?
No
If patients with previous recurrences had repeat TURBT, does immediate intravesical therapy post repeat TURBT still reduce recurrences?
Not anymore
In patients with EORTC recurrence score of 5 or more, will immediate intravesical therapy post TURBT decrease the risk of recurrence?
Not anymore
In patients with 8 or more tumors, does immediate postop intravesical chemotherapy reduce recurrence?
Not anymore
Does immediate postop intravesical chemotherapy reduce the risk of progression or the risk of cancer mortality?
No
What are the 2 most commonly used agents for intravesical chemotherapy?
Gemcitabine and Mitomycin
Which of the two agents is preferred for intravesical chemotherapy
Gemcitabine is preferred
Give two conditions why it is the preferred agent?
Better toxicity profile and better cost
What are the contraindications for giving immediate intravesical chemotherapy?
Perforation, allergy
Give the three most commonly used agents. (Induction (Adjuvant) Intravesical Chemotherapy or BCG)
Gemcitabine, mitomycin, BCG
Which patients should be prioritized for induction intravesical chemotherapy when there is BCG shortage?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)
high risk patients (high grade T1, Tis
Which agents are preferable alternatives to BCG?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)
Mitomycin and gemcitabine
Give other options for induction intravesical chemotherapy aside from the three most commonly used agents. (Induction (Adjuvant) Intravesical Chemotherapy or BCG)
Epirubicin Valrubicin Sequential Gemcitabine/Docetaxel Sequential Gemcitabine/mitomycin
Is sequential intravesical chemotherapy an option? (Induction (Adjuvant) Intravesical Chemotherapy or BCG)
Yes
What are the TWO sequential intravesical chemotherapy options available?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)
Gemcitabine/Docetaxel and Gemcitabine/Mitomycin
What are the split dose options for BCG used in times of shortage?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)
1/2 and 1/3
When will you initiate induction intravesical chemotherapy or BCG post TURBT?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)
3-4 weeks post TURBT
Instillations are given on a _______ basis for ________ weeks.(Induction (Adjuvant) Intravesical Chemotherapy or BCG)
Given on a weekly basis for 6 weeks
How many consecutive cycle inductions are given at a maximum if there is no complete response? (Induction (Adjuvant) Intravesical Chemotherapy or BCG)
2 consecutive cycle inductions
Give conditions to withhold induction intravesical treatment?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)
Traumatic catheterization, bacteriuria, allergy, severe and persistent local and systemic symptoms, immunocompromised, persistent gross hematuria
What regimen is being followed by the NCCN Member Institutions for BCG maintenance therapy?
SWOG
This consists of a ________-week induction course of BCG and how many weekly instillations?
Six week induction course of BCG, and 3 weekly installations
The abovementioned weekly instillations are given at what months? (7 month answers)
3,6,9, 12,18,24,30,36
When there is BCG shortage, which patients are prioritized?
High risk patients (high grade T1 and CIS)
When there is BCG shortage, in prioritized patients, which are the most crucial months in the maintenance period?
3rd month and 6th month
For intermediate risk patients, how long should maintenance BCG therapy be given?
1 year
For high risk NMIBC, how long should maintenance BCG therapy be given?
3 years
Is dose reduction an option in patients receiving maintenance intravesical BCG?
yes
What are the conditions for dose reductions in patients receiving maintenance intravesical BCG?
Substanial local symptoms during therapy
Is there data to support decreased rate of recurrence for NMIBC in patients receiving maintenance intravesical BCG?
Yes
How are topical chemotherapeutic agents delivered?
By instillation
What are the approaches used in delivering the agents? (Topical or Percutaneous Administration of Chemotherapy and BCG)
Antegrade or retrograde (NT or ureteral stent)
Is there a standard regimen? (Topical or Percutaneous Administration of Chemotherapy and BCG)
No standard regimen
Which particular components of the prostate are involved when one is considering post-surgical intraurethral therapy for primary carcinoma of the prostate?
Ductal + Acinar and Prostatic Urethra
When is the induction therapy initiated post TURP? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Prostate)
3-4 weeks post TURP
What follows post induction therapy? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Prostate)
Maintenance BCG
Does data indicate a reduction in the recurrence in the prostate in patients with superficial disease?
YES
Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra is considered a primary treatment with what stages of the disease?
Ta, T1, Tis
When is induction therapy initiated? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra)
3-4 weeks after TUR
Which 3 agents are most commonly used? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra)
Gemcitabine, Mitomycin, BCG
Is there a role in doing maintenance intravesical chemotherapy or BCG in this context? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra)
Uncertain
Is the efficacy of this method established? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra)
No
What is a recommended requirement prior to initiating intrapelvic/intravesical therapy for UTT?
Complete or near complete endoscopic resection or ablation
What agent is available for intrapelvic/intravesical therapy for UTT? In what form?
Mitomycin gel form!
What are the FOUR suitable indications for intrapelvic/intravesical therapy for UTT?
Low grade Low volume (5-15mm) Solitary Tumor Not a candidate for nephroureterectomy
How is the available agent to be administered? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Primary Therapy)
via ureteral cathater or a nephrostomy tube
What are the TWO FEATURES of patients who are candidates for intrapelvic therapy? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)
Non metastatic and low grade tumors
When is induction adjuvant therapy initiated after endoscopic resection? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)
3-4 weeks after endoscopic resection
What are the most commonly used agents for intrapelvic therapy? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)
BCG, Mitomycin, and Gemcitabine
Is there a role for maintenance following intrapelvic therapy? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)
UNCERTAIN
Is efficacy of intrapelvic therapy in upper urinary tract cancers already been established? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)
NO
Is there a role for perioperative intravesical chemotherapy following nephroureterctomy with cuff of bladder resection? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)
YES
Which agents are given if there is a role for perioperative intravesical chemotherapy. (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)
Mitomycin or Gemcitabine
