Mitomycin versus BCG to reduce recurrence in intermediate to high risk superficial bladder cancer

Abstract

The present dissertation will compare the effectiveness of Mitomycin with the standard treatment BCG to evaluate which agent is superior in reducing tumour recurrences. Using the PICO framework, the research question was framed as follows; “Is mitomycin more effective than BCG in reducing tumour recurrence in patients with high risk superficial bladder cancer”. PICO elements: Patients with intermediate to high risk superficial bladder as the population, Mitomycin as a treatment intervention and BCG as the comparison intervention. The expected outcome was reduction in tumour recurrence. The eligible criteria included: English language, peer-reviewed studies published the last eleven years; both genders, all age groups and ethnic groups that had intermediate-high risk, superficial invasion, academic journals related to oncology, urology and pharmacological settings, reviews, RCTs and observational studies. Exclusion criteria were the studies that failed to meet the eligible criteria. The search yielded one systematic review, three meta-analyses, two randomised prospective studies and a retrospective study. The CASP tools were utilised to conduct a critical appraisal. Tumour recurrence was the primary outcome measured, whereas tumour progression, survival and side-effects were secondary outcomes. Results: BCG continued to be preferred over Mitomycin in reducing recurrence in highrisk tumours. However, there was no significance difference with intermediate-high risk tumours. Mitomycin was more effective when BCG maintenance was not administered. These findings imply that the outcome result is based on the tumour characteristics and the maintenance regime. Therefore findings to support EBP, are at this stage, inconclusive. Recommendations: Introduce Mitomycin for intermediate risk and BCG incompatibilities, further studies to identify ideal schedules for both agents, conducting a local study with homogenous population and treatment schedule, healthcare professionals and patient education to enhance the effectiveness of treatment.