Epirubicin - A review of its intravesical use in superficial bladder canter

The anthracycline epirubicin has been investigated for intravesical use in patients with superficial bladder cancer, In multicentre. randomised trials , prophylaxis with intravesical epirubicin 30 to 80mg after transurethral r esection (TUR) was more effective than no prophylaxis in the prevention of disease recurrence. Intravesical prophylaxis with epirubicin was as effecti ve as that with equivalent dosages of doxorubicin after TUR, Data are confl icting concerning the relative efficacy of intravesical epirubicin and baci llus Calmette-Guerin (BCG) in patients at intermediate risk of recurrence a fter TUR, but epirubicin was less effective than BCG in those at high risk. The efficacy and to tolerability of prophylaxis with epirubicin relative t o that with mitomycin is not yet established. The efficacy of epirubicin as prophylaxis after TUR in combination with BCG or interferon-alpha-2b, or a s treatment in patients with superficial bladder cancer has been evaluated in small, noncomparative trials, but requires clarification. Adverse events associated with intravesical epirubicin were generally mild and transient. The most common adverse events were localised to the bladder (cystitis, haematuria and urinary tract infection). Systemic adverse event s (cardiac, haematological or related to hypersensitivity) were not reporte d in many trials of intravesical epirubicin, and when reported generally oc curred in less than or equal to 5% of patients who received the drug. Intra vesical epirubicin was generally tolerated as well as intravesical doxorubi cin and was associated with a lower incidence of mild chemical cystitis in 1 clinical trial. The incidence of adverse events associated with intravesi cal epirubicin was markedly lower than that associated with intravesical BC G. Conclusions: Intravesical epirubicin has shown efficacy in preventing disea se recurrence after TUR of superficial bladder cancer. In comparison with e quivalent dosages of doxorubicin. the efficacy of epirubicin for this indic ation is generally similar. and the tolerability profile may be more favour able. Epirubicin is less effective than CG as intravesical prophylaxis in p atients at high risk of recurrence after TUR; the relative efficacy of epir ubicin and BCG after TUR in patients at intermediate risk is not yet clear. Intravesical epirubicin is generally tolerated better than BCG. Intravesic al epirubicin may be used as prophylaxis after TUR in patients who are at l ow or intermediate risk of recurrence of superficial bladder cancer.