Bladder carcinoma, treatment

Uracil is used more effectively, in nucleic acid synthesis within a rat hepatoma than in normal liver. This observation appears to have stimulated the synthesis of 5-fluorouracil (1027) as an antimetabolite mainly because the introduction of a fluorine atom involves a minimal increase in size. In the event, 5-fluorouracil did prove to have antineoplastic activity and it is now a valuable drug for treatment of tumors of the breast, colon or rectum, and to a lesser extent, gastric, hepatic, pancreatic, uterine, ovarian and bladder carcinomas. As with other drugs which interfere with DNA synthesis, the therapeutic index is quite low and great care is required during treatment (69MI21301). 

Kaempfer, R. et al., Prediction of response to treatment in superficial bladder carcinoma through pattern of interleukin-2 gene expression, J Clin. Oncol., 14, 1778, 1996. 

Rotman M, Macchia R, Silverstein M. Treatment of advanced bladder carcinoma with irradiation and concomitant 5-FU infusion. Cancer 1987 59 710-714. 

Sauer R, Schrott KM, Dunst J, Thiel H-J, Hermanek P, Bomhof C. Preliminary results of treatment of invasive bladder carcinoma with radiotherapy and cisplatin. Int J Radiation Oncology Biol Phys 1988 15 871-875. 

Immunocyanin is an effective medicine for the treatment of urinary bladder carcinoma. It is derived from a sea snail protein. The instillation of immunocyanin into the bladder results in a marked immuno-stimulation of macrophages and hence a specific immune response against mmour cells that are still in the bladder after cancer therapy. 

Thiotepa has antitumor activity against ovarian and breast cancers and lymphomas. However, it has been largely supplanted by cyclophosphamide and other nitrogen mustards for treatment of these diseases. It is used by direct instillation into the bladder for multifocal local bladder carcinoma. 

Unlabeled Uses Treatment of active chronic hepatitis, bladder carcinoma, chronic myelocytic leukemia, laryngeal papillomatosis, malignant melanoma, multiple myeloma, mycosis fungoides, non-Hodgkin s lymphoma... 

Therapeutic applications Cisplatin has found wide application in the treatment of solid tumors such as metastatic testicular carcinoma in combination with vinblastine (see p. 390) and bleomycin (see p. 386), ovarian carcinoma in combination with cyclophosphamide (see p. 388), or alone for bladder carcinoma. Carboplatin is employed when patients cannot be vigorously hydrated as is required for cisplatin treatment, or if they suffer from kidney dysfunction or are prone to neuro- or ototoxicity. 

Cell-binding studies on human erythrocytes, several human, urinary-bladder, carcinoma cell-lines, and an osteogenic-sarcoma cellline have been conducted.189 After treatment with neuraminidase, 80% of human lymphocytes will bind the H. pomatia lectin.5728 Neuraminidase-treated lymphocytes can also be fractionated on Helix pomatia hemagglutinin coupled to Sepharose beads.572b... 

Bono AV, Lovisolo JA, Saredi G. Conservative treatment of primary T1G3 bladder carcinoma results from a phase II trial. Br J Urol 1997 80(Suppl 2) 117. 

Intravesical instillation of BCG has been nsed to treat superficial bladder carcinoma and interstitial cystitis. Many reports have confirmed the efficacy of BCG in the treatment of transitional cell bladder cancers and have delineated its adverse effects (SEDA-12, 273) (SEDA-13, 278) (SEDA-15, 344) (SEDA-16, 375) (SEDA-17, 366) (SEDA-18, 328) (SEDA-20, 287) (SEDA-21, 328) (SEDA-22, 336). The exact mechanism of its antitumor activity is unknown, but live BCG provokes an inflammatory response that includes activation of macrophages, a delayed hypersensitivity reaction, and stimulation of T and B lymphocytes and natural killer cells. 

A 71-year-old man with bladder carcinoma in situ received six instillations of BCG at weekly intervals followed 3 months later by three booster instillations at weekly intervals. Four months later an inflammatory aortic aneurysm, which had ruptured into a pseudoaneurysm, was diagnosed and excised. Mycobacterium bovis was found. After treatment with isoniazid and rifampicin he recovered. There was no sign of tumor in the bladder at cystocopy 8 months after the last BCG instillation. 

Oral bropirimine (3 g/day thrice weekly for 1 year) has been compared with weekly intravesical Bacillus Calmette-Guerin (2 cycles of 6 weeks) in 55 patients with newly diagnosed bladder carcinoma (3). Whereas the response to treatment was not significantly different between the two groups, adverse effects resulted in more withdrawals with BCG than bropirimine (14 versus 4%). Bropirimine produced more frequent systemic reactions (in particular diarrhea, fever, flu-like syndrome, headache, nausea/vomiting) but less frequent and less severe local comphcations. 

O Keane JC. Carcinoma of the urinary bladder after treatment with cyclophosphamide. N Engl J Med 1988 319(13) 871. 

Metal-based drugs have probably had most impact in the area of cancer therapy, with cisplatin still used to treat approximately 70% of all cancer patients. Cisplatin is particularly useful for treatment of testicular, ovarian, oropharyngeal, bronchogenic, cervical, and bladder carcinomas, lymphoma, osteosarcoma, melanoma, and neuroblastoma. Metallocene-type compounds were the first organometallic compounds to be evaluated in cancer therapy, and until recently, Ti(77 -C5H5)2Cl2 was undergoing clinical trials (see above). Despite this setback to the field,... 

C. Prinsze, L.C. Penning, T.M. Dubbelman, J. Van Steveninck (1992). Interaction of photodynamic treatment and either hyperthermia or ionizing radiation and of ionizing radiation and hyperthermia with respect to cell killing of L929 fibroblasts, Chinese hamster ovary cells, and T24 human bladder carcinoma cells. Cancer Res., 52(1), 117-120. 

Mokarim A et al. (1997) Combined intraarterial chemotherapy and radiotherapy in the treatment of bladder carcinoma. Cancer 80 1776-1785... 

Jurincic-Winkler, C.D., Von der Kammer, H., Beuth, J., Scheit, K.H., and Klippel, K.F. (1996) Antibody response to keyhole limpet hemocyanin (KLH) treatment in patients with superfidal bladder carcinoma. Anti-Cancer Res., 16,2105-2110. 

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