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Bladder Cancer NCCN > Intravesical Chemotherapy > Flashcards

Intravesical Chemotherapy Flashcards

1
Q

How many instillations are given immediately post op?

A

Single installation

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2
Q

Within how many hours should you give intravesical therapy post TURBT?

A

24 hours

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3
Q

Within how many hours is the more ideal time to give intravesical chemotherapy post TURBT?

A

Within 6 hours

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4
Q

What is the rationale in giving immediate intravesical therapy post TURBT? Give two reasons.

A

To prevent implantation of cancer cells. To prevent early recurrence.

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5
Q

Does immediate intravesical therapy post TURBT decrease the risk of recurrence? By how much?

A

Yes. By 35%

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6
Q

Does immediate intravesical therapy post TURBT prolong the time of progression or time to death from bladder cancer?

A

No

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7
Q

If patients with previous recurrences had repeat TURBT, does immediate intravesical therapy post repeat TURBT still reduce recurrences?

A

Not anymore

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8
Q

In patients with EORTC recurrence score of 5 or more, will immediate intravesical therapy post TURBT decrease the risk of recurrence?

A

Not anymore

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9
Q

In patients with 8 or more tumors, does immediate postop intravesical chemotherapy reduce recurrence?

A

Not anymore

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10
Q

Does immediate postop intravesical chemotherapy reduce the risk of progression or the risk of cancer mortality?

A

No

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11
Q

What are the 2 most commonly used agents for intravesical chemotherapy?

A

Gemcitabine and Mitomycin

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12
Q

Which of the two agents is preferred for intravesical chemotherapy

A

Gemcitabine is preferred

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13
Q

Give two conditions why it is the preferred agent?

A

Better toxicity profile and better cost

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14
Q

What are the contraindications for giving immediate intravesical chemotherapy?

A

Perforation, allergy

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15
Q

Give the three most commonly used agents. (Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

Gemcitabine, mitomycin, BCG

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16
Q

Which patients should be prioritized for induction intravesical chemotherapy when there is BCG shortage?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

high risk patients (high grade T1, Tis

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17
Q

Which agents are preferable alternatives to BCG?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

Mitomycin and gemcitabine

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18
Q

Give other options for induction intravesical chemotherapy aside from the three most commonly used agents. (Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

Epirubicin Valrubicin Sequential Gemcitabine/Docetaxel Sequential Gemcitabine/mitomycin

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19
Q

Is sequential intravesical chemotherapy an option? (Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

Yes

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20
Q

What are the TWO sequential intravesical chemotherapy options available?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

Gemcitabine/Docetaxel and Gemcitabine/Mitomycin

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21
Q

What are the split dose options for BCG used in times of shortage?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

1/2 and 1/3

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22
Q

When will you initiate induction intravesical chemotherapy or BCG post TURBT?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

3-4 weeks post TURBT

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23
Q

Instillations are given on a _______ basis for ________ weeks.(Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

Given on a weekly basis for 6 weeks

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24
Q

How many consecutive cycle inductions are given at a maximum if there is no complete response? (Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

2 consecutive cycle inductions

25
Q

Give conditions to withhold induction intravesical treatment?(Induction (Adjuvant) Intravesical Chemotherapy or BCG)

A

Traumatic catheterization, bacteriuria, allergy, severe and persistent local and systemic symptoms, immunocompromised, persistent gross hematuria

26
Q

What regimen is being followed by the NCCN Member Institutions for BCG maintenance therapy?

A

SWOG

27
Q

This consists of a ________-week induction course of BCG and how many weekly instillations?

A

Six week induction course of BCG, and 3 weekly installations

28
Q

The abovementioned weekly instillations are given at what months? (7 month answers)

A

3,6,9, 12,18,24,30,36

29
Q

When there is BCG shortage, which patients are prioritized?

A

High risk patients (high grade T1 and CIS)

30
Q

When there is BCG shortage, in prioritized patients, which are the most crucial months in the maintenance period?

A

3rd month and 6th month

31
Q

For intermediate risk patients, how long should maintenance BCG therapy be given?

A

1 year

32
Q

For high risk NMIBC, how long should maintenance BCG therapy be given?

A

3 years

33
Q

Is dose reduction an option in patients receiving maintenance intravesical BCG?

A

yes

34
Q

What are the conditions for dose reductions in patients receiving maintenance intravesical BCG?

A

Substanial local symptoms during therapy

35
Q

Is there data to support decreased rate of recurrence for NMIBC in patients receiving maintenance intravesical BCG?

A

Yes

36
Q

How are topical chemotherapeutic agents delivered?

A

By instillation

37
Q

What are the approaches used in delivering the agents? (Topical or Percutaneous Administration of Chemotherapy and BCG)

A

Antegrade or retrograde (NT or ureteral stent)

38
Q

Is there a standard regimen? (Topical or Percutaneous Administration of Chemotherapy and BCG)

A

No standard regimen

39
Q

Which particular components of the prostate are involved when one is considering post-surgical intraurethral therapy for primary carcinoma of the prostate?

A

Ductal + Acinar and Prostatic Urethra

40
Q

When is the induction therapy initiated post TURP? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Prostate)

A

3-4 weeks post TURP

41
Q

What follows post induction therapy? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Prostate)

A

Maintenance BCG

42
Q

Does data indicate a reduction in the recurrence in the prostate in patients with superficial disease?

A

YES

43
Q

Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra is considered a primary treatment with what stages of the disease?

A

Ta, T1, Tis

44
Q

When is induction therapy initiated? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra)

A

3-4 weeks after TUR

45
Q

Which 3 agents are most commonly used? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra)

A

Gemcitabine, Mitomycin, BCG

46
Q

Is there a role in doing maintenance intravesical chemotherapy or BCG in this context? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra)

A

Uncertain

47
Q

Is the efficacy of this method established? (Post-Surgical Intraurethral Therapy for Primary Carcinoma of the Urethra)

A

No

48
Q

What is a recommended requirement prior to initiating intrapelvic/intravesical therapy for UTT?

A

Complete or near complete endoscopic resection or ablation

49
Q

What agent is available for intrapelvic/intravesical therapy for UTT? In what form?

A

Mitomycin gel form!

50
Q

What are the FOUR suitable indications for intrapelvic/intravesical therapy for UTT?

A

Low grade Low volume (5-15mm) Solitary Tumor Not a candidate for nephroureterectomy

51
Q

How is the available agent to be administered? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Primary Therapy)

A

via ureteral cathater or a nephrostomy tube

52
Q

What are the TWO FEATURES of patients who are candidates for intrapelvic therapy? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)

A

Non metastatic and low grade tumors

53
Q

When is induction adjuvant therapy initiated after endoscopic resection? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)

A

3-4 weeks after endoscopic resection

54
Q

What are the most commonly used agents for intrapelvic therapy? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)

A

BCG, Mitomycin, and Gemcitabine

55
Q

Is there a role for maintenance following intrapelvic therapy? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)

A

UNCERTAIN

56
Q

Is efficacy of intrapelvic therapy in upper urinary tract cancers already been established? (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)

A

NO

57
Q

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)

A

YES

58
Q

Which agents are given if there is a role for perioperative intravesical chemotherapy. (Intrapelvic and Intravesical Therapy for Upper Tract Tumors Postsurgical Therapy)

A

Mitomycin or Gemcitabine

Bladder Cancer NCCN (21 decks)

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