Administering 2 doses of neoadjuvant intravesical mitomycin-C before transurethral resection of bladder tumor (TURBT) may reduce the risk of progression and recurrence in patients with non-muscle-invasive bladder cancer (NMIBC), according to preliminary results from a phase 2 trial.

Investigators randomly assigned 33 patients with suspected NMIBC to the intervention group and 38 patients to the control group. The intervention group received a maximal mitomycin C dose of 40 mg per 20 mL sterile water 1 day before and 4 hours before TURBT.

The 1-year recurrence-free survival rate was 97% and 89% for the intervention and control groups, respectively. A total of 86% of patients had no recurrence for at least 10.4 months.

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Neoadjuvant mitomycin C significantly reduced the risk of recurrence by 63%, Ho Kyung Seo, MD, MS, PhD, of the National Cancer Center in Goyang, Korea, and colleagues reported in The Journal of Urology. Cancer recurrence occurred in 3 patients in the intervention group compared with 8 patients in the control group. The investigators highlighted that TURBT was complete, with no residual tumor or recurrence at 3 months.

Disease progression occurred in 3 patients in the control group and no patients in the intervention group, the investigators reported.

Neoadjuvant mitomycin C was well tolerated. Overall, 5 of the 33 patients (15%) in the intervention group experienced drug-related adverse events, which were all grade 1-2. The most frequent events were urinary frequency and hematuria.

The investigators suggested that neoadjuvant mitomycin C might provide prophylactic effects in NMIBC without the increased risk of possible complications from extravesical leakage in a weakened or perforated bladder wall.

According to Dr Seo’s team, an optimal neoadjuvant regimen still needs to be defined.

“Our promising results also support further investigations to compare the feasibility and therapeutic efficacy between [mitomycin C] and gemcitabine in the setting of neoadjuvant intravesical setting for NMIBC.”


Lee HW, Lee HH, Park EY, et al. Clinical efficacy of neoadjuvant intravesical mitomycin-C therapy immediately before transurethral resection of bladder tumor in patients with non-muscle-invasive bladder cancer: Preliminary results of a prospective, randomized phase II study. J Urol. Published online October 12, 2022. doi:10.1097/JU.0000000000003002