Intravesical therapy for superficial bladder cancer

Approximately 54,400 new cases of transitional cell carcinoma of the bladde r were reported in the United States in 1999, with an estimated 12,500 deat hs attributable to this cancer. Close to 75% of all bladder turners are con fined to the urothelium (stage Ta, or carcinoma in situ) and nearly 30% of papillary tumors invade the lamina propria (stage TI), The majority of supe rficial tumors are low grade with low rates of progression, Transurethral r esection is the standard initial treatment for transitional cell carcinoma. Intravesical therapy is an important adjunct to transurethral resection in patients with superficial bladder cancer, many of whom are at risk for dis ease recurrence and progression. Cytotoxic and immunomodulating agents and, more recently, photosensitizers have demonstrated utility against superfic ial transitional cell carcinoma. Many studies have assessed and continue to examine the efficacy of various agents at different doses and in different combinations and schedules. Recently valrubicin (Valstar) won Food and Dru g Administration (FDA) approval only for the treatment of refractory carcin oma in situ. However, bacillus Calmette-Guerin (BCG) and mitomycin (Mutamyc in) remain the most commonly used, most effective agents available for prop hylaxis against recurrence and subsequent progression of superficial bladde r cancer. This article reviews traditional and alternative intravesical age nts useful in the therapy and prophylaxis of superficial transitional cen c arcinoma of the bladder.