China
Africa
Explore chapters and articles related to this topic
Complications of Intravesical Therapy
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Michael A. O’Donnell, José L. Maymí
Because of their larger molecular weights, systemic absorption of the anthracycline drugs is very low and systemic side effects very rare (60,61). Indeed, myelosuppression occurs in <1% of patients (17). Allergic reactions, primarily skin rash, have been reported in 2% of patients treated with Adriamycin® but have also been documented with epirubicin and valrubicin (62–64). These allergic reactions are usually treated according to their symptoms, mainly by using antihistaminic drugs and supportive measures. Fever (4%) and nausea/vomiting (1–2%) have also been reported (17). As with all intravesical drugs, integrity of the bladder wall is important in limiting absorption with lower levels of absorption found during later instillations. One severe local reaction with adriamycin and three with epirubicin (and one death) from bladder perforations have been reported (65,66). Yoshimura et al. described chemical pericystitis in a patient who underwent transurethral resection of the bladder tumor, with a subsequent instillation of Adriamycin (65). The patient had fever lasting more than 2 weeks, lower abdominal pain, and mild hydronephrosis of the left kidney. A computed tomography (CT) showed an irregular thickening of his left bladder wall. Due to symptom persistence, an exploratory laparotomy was performed. The left perivesical space was found replaced by a scar and edematous tissue. Yoshimura et al. presumed that extravasation of doxorubicin was responsible. Because classic signs of peritonitis may not always be present, a CT scan (preferably CT cystogram) should be performed in all suspected perforations after TURB and perioperative drug instillation. In one documented case of valrubicin leakage, no accompanying local untoward effects were observed (64). Valrubicin has also been used for intraperitoneal chemotherapy of ovarian disease (67).
Emerging intravesical drugs for the treatment of non muscle-invasive bladder cancer
Published in Expert Opinion on Emerging Drugs, 2018
Jasper Crijnen, Theo M. De Reijke
In the chemotherapy cluster, several novel drugs, such as gemcitabin, valrubicin, apaziquone, and VAX014, could be identified. Gemcitabin shows the same response rate in terms of recurrence in the intermediate-risk NMIBC group, but is less favorable for the high-risk group. Valrubicin shows some clinical effectiveness in BCG-refractory patients. Apaziquone has the same effect in intermediate-risk patients as BCG, but has less side effects. VAX014 still has to be investigated in further studies. Although several novel chemotherapeutic drugs became available, none of these novel intravesical chemotherapies is superior in any group when compared to known therapies.