Chapter 23: Administration of systemic anticancer therapies
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Related theory
Instillation of cytotoxic agents, and immunotherapy, into the bladder via a urinary catheter has been used for many years in selected cases and has proved to be an effective and simple method of controlling and treating superficial bladder cancer (Washburn [264]). In measurable disease, average response rates are 60%. Approximately 30% of patients experience a complete response. Cytotoxic drugs found to be effective include (Washburn [264]):
- thiotepa
- mitomycin C
- doxorubicin
- epirubicin
- mitoxantrone
- BCG (non‐cytotoxic).
Intravesical instillation allows a high concentration of drug to bathe the endothelium, which enables localized treatment of the tumour and limits the systemic absorption so toxicity is reduced. Systemic toxicity is a problem with thiotepa, but otherwise the main problems are local inflammation, pain, burning on urination, frequency and occasional haematuria. An aseptic technique must be maintained throughout the procedure to minimize the risk of urinary tract infection (Polovich [192]).
