Verri Cristian, Liberati Emanuele, Celestino Francesco, De Carlo Francesco, Torelli Fiammetta, Di Stasi Savino M
Unità Operative Semplice de Urologia Oncologia, Policlinico Casilino, Roma, Italy.
Urologia. 2013 Apr-Jun;80(2):105-11. doi: 10.5301/RU.2013.11290. Epub 2013 Jul 1.
In the management of non-muscle invasive bladder cancer (NMIBC), high-level evidence supports the widespread practice of intravesical therapy with mitomycin-C (MMC). Randomized trials showed a significant reduction in short-term recurrence compared with transurethral resection of bladder tumor (TURBT) alone, but little effect on long-term and no impact at all in preventing progression. Electromotive drug administration (EMDA®) offers a means of controlling and enhancing the tissue transport of certain drugs, in order to increase their efficacy. In both laboratory and clinical studies, intravesical electromotive drug administration (EMDA) increases MMC bladder uptake, resulting in an improved clinical efficacy in NMIBC without systemic side effects. New frameworks for treatment of NMIBC - e.g., sequential intravesical BCG and EMDA/MMC, as well as intravesical EMDA/MMC immediately before TURBT - have provided promising preliminary results with higher remission rates and longer remission times, and they are a priority to minimise the costs of disease management. These findings suggest EMDA-enhanced MMC efficacy against urothelial cancer could be a major therapeutic breakthrough in the treatment of NMIBC.
在非肌肉浸润性膀胱癌（NMIBC）的管理中，高级别证据支持丝裂霉素C（MMC）膀胱内灌注治疗的广泛应用。随机试验表明，与单纯经尿道膀胱肿瘤切除术（TURBT）相比，短期复发率显著降低，但对长期复发影响不大，且对预防疾病进展毫无作用。电动药物给药（EMDA®）提供了一种控制和增强某些药物组织转运的方法，以提高其疗效。在实验室和临床研究中，膀胱内电动药物给药（EMDA）均能增加MMC在膀胱内的摄取，从而在不产生全身副作用的情况下提高NMIBC的临床疗效。NMIBC的新治疗方案，如序贯膀胱内卡介苗和EMDA/MMC，以及在TURBT前立即进行膀胱内EMDA/MMC，已取得了较高缓解率和较长缓解时间的有前景的初步结果，并且它们是将疾病管理成本降至最低的优先选择。这些发现表明，EMDA增强的MMC对尿路上皮癌的疗效可能是NMIBC治疗中的一项重大治疗突破。
